Medicare is Under Threat This Election

Joe Baker and Judith SteinMedicare Watch0 Comments

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We told you so. Shortly after the passage of last year’s massive tax cut, our organizations stated that it would “result in a gaping revenue shortfall of $1.5 trillion or more, putting Medicaid, Medicare, and Social Security directly in the cross-hairs of policy-makers seeking to pay for the tax cuts.” After driving up the deficit, it was clear that some policymakers would use the huge shortfall they created to justify cuts to programs like Medicare. Read More...

Trump Administration Drug-Pricing Proposal Includes Big Changes to Medicare Part B

Julie CarterMedicare Watch0 Comments

Last week, the Department of Health & Human Services (HHS), the department of the federal government that oversees the Medicare program, previewed some changes it will be proposing for Medicare Part B prescription drug coverage. The administration claims these changes will lower the cost of Part B medications. Most prescription drugs are covered under Medicare Part D, but a select number of drugs–usually ones that are administered by providers–are covered under Part B. These drugs tend to be very expensive and are generally used to treat serious conditions such as cancer, End-Stage Renal Disease, autoimmune disorders, or in the event of an organ transplant. Read More...

New York Times Article Highlights Complexities of Part B Enrollment and the BENES Act’s Legislative Solutions

Lindsey CopelandMedicare Watch0 Comments

While most people newly eligible for Medicare are automatically enrolled in the program because they are receiving Social Security benefits at age 65, a growing number are not—and can face significant challenges in knowing how and when to do so. A recent article in The New York Times, “Why You Shouldn’t Wait to Sign Up for Medicare Part B,” highlights these complexities through the experience of Mr. Zeppenfeldt-Cestero, whose mistake in delaying Part B triggered punitive financial penalties and harmful coverage gaps. The article also focuses the BENES Act (S.1909/H.R. 2575), in particular that it would help prevent enrollment mistakes by modernizing and simplifying the Part B enrollment process, and by sending notices to people who are approaching age 65 that clearly explain Part B enrollment. Read More...

Pre-Existing Conditions: Here’s What You Need to Know

Julie CarterMedicare Watch0 Comments

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Pre-existing conditions have been prominent in the news lately and much of the discussion includes some misunderstandings about what it actually means to protect coverage of pre-existing conditions and why it matters. While Medicare and Medicaid cover pre-existing conditions and that coverage is not under threat, there are changes in laws and regulations, and even a pending court case, that do put coverage at-risk for millions of people in the United States who are covered by employer or individual insurance. Polling consistently finds that Americans want protections for pre-existing conditions, with 75% of the public saying it’s “very important” such protections remain law. But there is a lot of confusion about what this means. Read More...

How Prior Authorization Can Impede Access to Care in Medicare Advantage

Lindsey CopelandMedicare Watch0 Comments

Credit: Pixsooz/Thinkstockphotos.com

While Medicare Advantage (MA) plans are required to cover the same health services as Original Medicare, they are not required to offer the same level of provider access and can impose coverage restrictions—like prior authorization—that require enrollees to take additional steps before accessing prescribed care. If a service is covered “with prior authorization,” enrollees must get approval from the plan prior to receiving the service. If approval is not granted or sought, the plan generally will not cover it. Read More...