All articles tagged with #medicare
Nearly every House Republican backed a proposed constitutional amendment that would bar federal deficit spending with a wartime exception, a move experts say would trigger deep cuts to Medicare, Social Security, nutrition programs and more. The final vote was 211-207, short of the two-thirds needed for ratification, with only one Democrat, Rep. Henry Cuellar, voting yes.
CBS News documents a dramatic clustering of 89 licensed hospice firms in a single Van Nuys building (Merabi Plaza), a pattern auditors say raises red flags for fraud; 72 of the 89 show multiple warning signs such as multiple firms in one building, low patient counts, or excessive billing, and regulators have logged roughly 400 violations at 75 companies from 2021–2025; the building’s owner disputes the count, noting some tenants moved out, prompting concerns about ghost hospices while federal officials pledge ongoing Medicare scrutiny.
A caregiver’s attempt to manage a mother's care by using a post office box and changing her address highlights how Medicare notices and eligibility can be disrupted by simple mail changes, risking gaps in coverage and underscoring the need for careful coordination with Medicare during relocations or changes in contact details.
Through a personal toothache, the columnist shows that Medicare barely covers senior dental care and Medi-Cal reimbursements are limited, leaving many 65+ with high out-of-pocket costs, long delays, or no care at all; some travel to Mexico or Costa Rica for cheaper implants and crowns, while policy debates threaten to slash Medi-Cal funding, worsening access and driving preventable emergencies.
The administration unveiled a multi-pronged plan to curb healthcare fraud, including deferring $259.5 million in Minnesota Medicaid payments pending review, a nationwide DMEPOS enrollment moratorium, and a CRUSH initiative inviting public input, all backed by real-time AI tools to detect and stop improper payments before they occur, aiming to reduce fraud, save taxpayer dollars, and improve affordability for patients.
A California couple’s health care bills surge after Congress let enhanced ACA subsidies lapse, with monthly premiums rising sevenfold and threatening retirement savings. Jean Franklin’s ALS diagnosis enabled Medicare enrollment that saves about $1,600 a month, but the combined costs—including premiums for her plan and her husband’s coverage—remain a heavy burden as millions near retirement face a similar “premium cliff,” contributing to coverage losses and financial strain nationwide.
In a large UK trial of 142,000 adults over three years, Grail's Galleri multi-cancer blood test did not reduce late-stage cancers (stages 3–4), though researchers noted a secondary signal of fewer Stage 4 cancers; the test remains FDA-unapproved, is sold with limited insurer coverage, and Medicare coverage remains under legislative review.
A BuzzFeed feature curating elder perspectives from a Reddit thread about aging in America, highlighting underreported issues such as workplace ageism, Medicare and medical planning hassles, retirement insecurity, health and mobility challenges (vision, hearing, balance), and the emotional toll of isolation and stigma—calling for greater awareness and support for older adults.
Eli Lilly CEO Dave Ricks says Medicare coverage of obesity treatments later this year could be a major catalyst for the launch of orforglipron, with a full rollout planned in Q2 and price reductions expected in the second half under Trump-era deals; the move could expand access to 20–30 million beneficiaries and follows strong early demand for competitor Wegovy, a GLP-1 obesity pill.
A looming partial government shutdown could affect roughly half of federal workers—about 500k unpaid and 480k furloughed—while SNAP remains funded; Social Security and Medicare payments would continue but benefit verification and card issuance could pause, and travel may face delays as TSA operates without pay. Funding gaps would hit major agencies like Defense, Education, HHS, and Homeland Security, while others (Agriculture, Justice, Energy, Interior, Veterans Affairs) stay funded. Lawmakers are negotiating Homeland Security reforms to avert the shutdown, with a midnight Friday deadline.
Medicare announced the next round of price negotiations under the Inflation Reduction Act, targeting Botox plus 14 other expensive drugs (including Trulicity) used for cancer, diabetes, Crohn’s disease, ulcerative colitis, and rheumatoid arthritis. The negotiated prices, affecting about $27 billion in Medicare Part B and Part D spending, will take effect in 2028. Drugmakers can opt out, but historically none have; Part B covers clinic-administered drugs and Part D covers prescriptions.
The Trump administration proposed Medicare insurer payment rates that were lower than analysts expected, triggering a sharp selloff in stocks of UnitedHealth Group, Humana, and CVS Health as investors priced in tighter reimbursements.
The CMS proposed only a 0.09% average 2027 increase for Medicare Advantage rates, far below analysts’ expectations, sending shares of UnitedHealth, Humana, CVS Health and peers down sharply (as much as about 20% for UNH) on concerns about margins and future revenue. The notice also highlighted a plan to exclude diagnosis information from certain risk-score calculations, which could further affect payments. Analysts noted the flat-rate stance would blunt the sector’s margin turnaround despite past rate hikes, contributing to a broad market pullback in health-insurer stocks.
The White House announced that 15 prescription drugs will be included in Medicare's price-negotiation program, a major move aimed at lowering U.S. prescription costs, disclosed during a rural health care event with the President and key health officials in attendance.
CMS announced the third cycle of its Medicare Drug Price Negotiation program, selecting 15 high-cost drugs—including Part B therapies for the first time—plus one renegotiation (Tradjenta); negotiations will occur in 2026 with negotiated prices taking effect January 1, 2028. The agency also released a list of 50 top negotiation-eligible drugs. The 15 drugs were used by about 1.8 million beneficiaries in 2024–2025, accounting for roughly $27 billion in Part B/D spending (about 6% of total); CMS notes potential savings—about $8.5 billion—if those prices had been in effect in 2024, and providers have until February 28, 2026 to participate.