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During the enrollment period, which ends Dec. 7, people will have the opportunity to choose between traditional Medicare and privately run Medicare Advantage plans in their area, as well as prescription drug plans. Medicare Advantage plans provided by insurers frequently offer prescription drug coverage , as well as extra benefits like dental or vision coverage not provided by traditional Medicare. The federal government also said Thursday that millions of Social Security recipients will get a 3.2% increase in their benefits next year. The average Medicare beneficiary could choose from 43 Medicare Advantage plans for this year, or more than double the choices available in 2018, according to KFF. After this year’s open enrollment window ends in December, people will be able to switch to another Medicare Advantage plan or opt for traditional Medicare during another enrollment period from Jan. 1 to March 31.

Persons: Tricia Neuman, KFF, Neuman Organizations: Medicare, Medicare’s, Social Security, Services, Social

☆ Medicare will pay for Alzheimer's drug Leqembi. What patients and doctors should know
▼ + stars: | 2023-07-08 | by ( Spencer Kimball | ) www.cnbc.com time to read: +2 min

The Alzheimer's drug Leqembi is seen in this undated handout image obtained by Reuters on January 20, 2023. Medicare has agreed to pay for the Alzheimer's treatment Leqembi, a major turning point for patients who are diagnosed with the early stages of the disease. Medicare coverage is crucial for most patients to have any hope of being able to afford Leqembi. Eisai has priced Leqembi at $26,500 per year before insurance coverage, which is extraordinarily expensive for Medicare patients, who have a median income of about $30,000. Patients with traditional Medicare will pay 20% of the bill for Leqembi, according to the federal Centers for Medicare and Medicaid Services.

Persons: Leqembi, Biogen, Tricia Neuman, Neuman Organizations: Reuters, Medicare, Food and Drug Administration, Services Locations: Cambridge , Massachusetts

☆ Explainer: How could a US debt ceiling default hit regular Americans?
▼ + stars: | 2023-05-23 | by ( Jason Lange | ) www.reuters.com time to read: +4 min

Americans could quickly notice painful blows to their retirement accounts as stock markets swooned, and within days the lack of federal payments could weigh heavily on doctors' offices, retirees and workplaces throughout the country. At that point, Washington would be under severe pressure to keep making payments on U.S. bonds, which underpin the global financial system. Within days, the financial mayhem would be a principal force putting the economy on the path to recession, Zandi said. More Medicare bills would come due in subsequent days, and because Medicare funds about a fifth of U.S. healthcare, some doctors might not have money to pay staff and other bills. Payments could also stop going out to government contractors, including $1 billion due to defense contractors on June 5.

☆ Medicare is prohibited from paying for weight-loss drugs. These are the 3 potential ways to change that.
▼ + stars: | 2023-05-22 | by ( ) www.businessinsider.com time to read: +6 min

There are three routes lawmakers and regulators could use to add coverage for weight-loss drugs. Older Americans hoping to get their hands on powerful weight-loss drugs such as Ozempic and Wegovy may find it impossible to access them. Should Medicare cover weight loss medication, it could also unlock access for people who have private coverage. "A decision by Medicare to cover weight-loss drugs would put pressure on employers and other private insurers to cover weight-loss drugs too," said Tricia Neuman, a senior vice president at KFF who co-authored a recent brief on the subject. There are three potential strategies that could be used to expand Medicare coverage to weight-loss drugs.

Chart showing the percentage cut the committee would make to each area of government spending to balance the budget over 10 years. 8 8 8 Deficit 6 6 6 4 4 4 Spending Spending Spending Revenue Revenue Revenue 2 2 2 2023 2033 2023 2033 2023 2033 Current projections Deficits are projected to grow to $2.7 trillion by 2033. 8 8 8 Deficit 6 6 6 4 4 4 Spending Spending Spending Revenue Revenue Revenue 2 2 2 2023 2033 2023 2033 2023 2033 Eliminate by increasing taxes Current projections Eliminate by cutting spending Deficits are projected to grow to $2.7 trillion by 2033. plan to balance budget 50% Projections 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Current trajectory 200% of G.D.P. plan to balance budget 50% Projections 1930 1960 1990 2020 2050 Sources: Committee for a Responsible Federal Budget; Congressional Budget Office; Republican Study Committee Note: Both plans were released in 2022 and are based on outdated baseline projections; their debt reduction may differ modestly.

A provision in the Inflation Reduction Act that allows Medicare to negotiate prices on the costliest prescription drugs each year will likely save the U.S. billions of dollars — as long as the drug industry doesn't interfere, according to a study published Friday in JAMA Health Forum. They identified 40 drugs that would have been selected by Medicare for drug pricing negotiation under the Inflation Reduction Act's provision. The researchers simulated negotiated prices by using a so-called ceiling price, which is at least 25% off the average price drug manufacturers charge to nongovernment entities, like private health insurance providers. The researchers found that the Medicare drug negotiation provision would have saved the U.S. $26.5 billion, or 5% of all drug spending, during those three years. It plans to release a list of the first 10 drugs it will target for drug pricing negotiation by September.

☆ House GOP study group is proposing changes to Medicare. Here's what you need to know
▼ + stars: | 2023-01-26 | by ( Sarah O'Brien | ) www.cnbc.com time to read: +3 min

There also is Part D (prescription drug coverage) and Part C (Medicare Advantage Plans), both of which are offered by private insurers. The stakes in a debate like this are high, given the importance of Medicare. Tricia Neuman executive director for the Kaiser Family Foundation's program on Medicare policyRight now, Neuman said, the savings proposals are being described at a fairly high level. "The policy debate starts to get real when the specifics are laid out," she said. "The stakes in a debate like this are high, given the importance of Medicare [for] seniors and younger people with disabilities."

☆ Most Alzheimer’s patients would pay up to $26,500 per year for new treatment Leqembi
▼ + stars: | 2023-01-09 | by ( Spencer Kimball | ) www.cnbc.com time to read: +5 min

Few seniors with early Alzheimer's disease will have access to the new treatment Leqembi due to its high cost and very limited coverage by Medicare. "Even with Medicare coverage, beneficiaries would still be responsible for 20% coinsurance, and that's not a trivial amount." An investigation by lawmakers in the House concluded that the FDA approval process for Aduhelm was "rife with irregularities." "It's not going to be widely available even to people who are potentially eligible based on whether or not they have mild cognitive impairment related to Alzheimer's disease," Neuman said. CMS plans to provide broader coverage for Leqembi if the treatment receives full FDA approval under the traditional process, according to an agency statement.

☆ Popular Medicare Advantage plans have 'clear cases of overpayments and improper billing of US taxpayers,' advocates and analysts say
▼ + stars: | 2022-12-05 | by ( Jason Lalljee | ) www.businessinsider.com time to read: +6 min

The original Medicare program is offered directly through the federal government. "There hasn't been enough of an indictment of Medicare Advantage plans," Mary Johnson, a Social Security and Medicare policy analyst at the Senior Citizens League, told Insider. The Congressional Budget Office estimates that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will grow to 61% by 2032. The politics of Medicare AdvantagePoliticians, primarily Republicans, have done their part to promote Medicare Advantage over the original Medicare plans since President George W. Bush overhauled the program in 2003. Johnson said Medicare Advantage was so popular among conservatives because it shifted financial responsibility from the government to patients.

☆ The Inflation Reduction Act aims to lower drug costs — but here’s how Big Pharma could get around it
▼ + stars: | 2022-09-20 | by ( Https | Media-Cldnry.S-Nbcnews.Com Image Upload Newscms Berkeley-Lovelace-Jr.Jpg | Berkeley Lovelace Jr. | ) www.nbcnews.com time to read: +7 min

The Inflation Reduction Act is set to lower drug prices for millions of people in the United States — but experts fear pharmaceutical companies could exploit loopholes in the bill, ultimately keeping prescription costs high for many. The tactics may ultimately threaten the law’s ability to lower drug costs for consumers. Higher prices for new drugsOther experts are concerned about how companies might abuse the inflation rebate rule in the health law. The provision, which takes effect next year, imposes a rebate on drug manufacturers that raise the prices of their medications faster than inflation. By releasing new drugs at higher prices, drug companies will be able to make up for any lost revenue that they would normally receive from steadily raising prices each year, she said.

Patient advocates were disappointed with Sunday’s vote — Republican senators blocked the $35 insulin cap for private insurers — and expressed hope that federal and state measures could be included in legislation down the road. Clayton McCook of Edmond, Oklahoma, is among those who support capping the cost of insulin for people with private health insurance. A federal insulin cap for private insurance would have made “a huge difference to our family,” he said. “This year, with an evenly divided Senate, the insulin cap for people with private insurance didn’t secure enough votes,” Neuman said. McCook also advocated for changes besides a cap on insulin costs, saying Congress pass legislation that would lower the list price.

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