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Medicare

All articles tagged with #medicare

White House Proposes Hospital-Doctor Imaging Payment Parity
healthcare8 days ago

White House Proposes Hospital-Doctor Imaging Payment Parity

The White House proposed a rule to cut hospital payments for routine imaging services (X-rays, ultrasounds, MRIs) to level with what doctor’s offices are paid, aiming to save about $9.5 billion for the Medicare trust fund over a decade (the CBO estimates about $7.6 billion in savings). The rule would apply to most scans except contrast-enhanced procedures, would take effect January 1, and is open to public comment before finalization. Proponents say site-neutral payments curb healthcare spending, while hospitals argue they cover more complex patients and higher overhead. This continues prior site-neutral efforts, including recent moves on off-campus drug administration.

Trump drug-price rule targets 340B markups, forecasting $1.1B in Medicare savings
politics8 days ago

Trump drug-price rule targets 340B markups, forecasting $1.1B in Medicare savings

AP live updates report the Trump administration proposing a rule to bar hospitals from charging markups on discounted drugs for Medicare patients under the 340B program, potentially saving $1.1 billion next year; the feed also covers former CIA Director John Brennan's lawsuit to preserve records, Trump's maiden flight on a retrofitted Air Force One, his visit to the Theodore Roosevelt Presidential Library, and plans for Trump's Accounts that would give newborns $1,000.

Medicare's $50 GLP-1 Plan Targets Seniors, But With Limitations
health-policy9 days ago

Medicare's $50 GLP-1 Plan Targets Seniors, But With Limitations

Medicare launches an 18-month GLP-1 Bridge program outside Part D to offer eligible beneficiaries $50-a-month copays for certain weight‑loss drugs (Foundayo tablets, Wegovy, Zepbound) ending Dec 31, 2027. Eligibility is based on BMI and specific health conditions, and prescriptions can be issued even if the doctor doesn’t take Medicare, but some diabetics and individuals with sleep apnea or fatty liver may still face higher costs under Part D. Medicare covers about $245 of the drug cost minus the $50 copay, potentially leaving a total outlay of up to roughly $900 over 18 months for a participant, with no low-income subsidy. Total taxpayer cost is projected at $1.3 billion to $10 billion depending on uptake. The program could boost access but may strain clinics and lacks long-term funding certainty.

Medicare rolls out temporary obesity-drug coverage via Bridge program with $50 copay
health11 days ago

Medicare rolls out temporary obesity-drug coverage via Bridge program with $50 copay

Medicare will temporarily cover obesity GLP-1 medications under the Bridge program starting July 1, with a flat $50 monthly copay for eligible Part D beneficiaries and no deductible contribution toward costs. Drugs like Wegovy and Zepbound are included, and eligibility is based on BMI thresholds and related health conditions; the coverage runs through an 18-month demonstration ending in 2027 unless extended, with prior-authorization handled by providers and Humana. While the move could unlock millions of potential patients for Novo Nordisk and Lilly, concerns include surge in demand, administrative burden, and the uncertain long-term viability beyond the demonstration, as well as ongoing policy debates such as Balance and the Treat and Reduce Obesity Act.

Medicare kicks off temporary, discounted obesity-drug coverage for eligible seniors
health11 days ago

Medicare kicks off temporary, discounted obesity-drug coverage for eligible seniors

Medicare will launch the temporary GLP-1 Bridge program on July 1, offering eligible Part D enrollees access to weight-loss drugs (Wegovy, Zepbound, Foundayo) for about $50 a month, subject to BMI and health criteria. The 18-month pilot tests new coverage ahead of a potential Balance model in 2028; costs to Medicare are uncertain and depend on enrollment. While many seniors could benefit, eligibility gaps remain, and questions linger about post-Bridge access and insurer participation. Drugs can be obtained via pharmacies or LillyDirect, and manufacturers say supply is sufficient. The program aims to treat obesity like other diseases and reduce related health risks, though long-term savings are debated.

Medicare to require hospitals to log end-of-life preferences in electronic records by 2028
health-policy12 days ago

Medicare to require hospitals to log end-of-life preferences in electronic records by 2028

Medicare proposes hospitals begin recording adults’ end-of-life care preferences (including DNR orders and designated decision-makers) in electronic health records by 2028, with these preferences part of quality metrics that could affect reimbursements from 2030. The goal is to normalize advance care planning and reduce unwanted, costly interventions, though providers warn about added burden and studies show mixed effects on care and outcomes.

Medicare to cover GLP-1 weight-loss meds in 18-month pilot with $50 copay
health12 days ago

Medicare to cover GLP-1 weight-loss meds in 18-month pilot with $50 copay

Beginning Wednesday, Medicare will temporarily cover GLP-1 weight-loss drugs for seniors and certain disabled beneficiaries through an 18-month pilot, with a $50 monthly copay; coverage requires prior authorization and the program’s costs to taxpayers have not been disclosed. Covered drugs include Eli Lilly’s Zepbound and Novo Nordisk’s Wegovy (including the Wegovy pill Foundayo). The move aims to curb obesity-related health risks but raises questions about long-term affordability and access.

Selling Your Home in Retirement Could Inflate Medicare Bills Two Years On
personal-finance12 days ago

Selling Your Home in Retirement Could Inflate Medicare Bills Two Years On

A retirement home sale can trigger CMS’s two-year MAGI lookback, potentially pushing 2026 Medicare Part B (and Part D) premiums higher for couples near IRMAA thresholds. Even after the $500,000 couple exclusion, the capital gain and MAGI calculation can elevate Medicare costs two years later, with 2026 brackets showing Part B at $649.20 per person per month plus a Part D surcharge for higher incomes. The timing of the sale and careful tax planning (including the lookback year) are crucial to avoid a surprise bill in retirement.

A Big Pension Can Lock You Into Medicare’s Top IRMAA Bracket for Life
personal-finance13 days ago

A Big Pension Can Lock You Into Medicare’s Top IRMAA Bracket for Life

A 66-year-old retiree with a $410,000 pension can push MAGI into Medicare’s top IRMAA tier for 2026, permanently raising his Part B and Part D surcharges to about $578 per month ($6,936 per year). Because IRMAA uses a two-year lookback, pension income and future RMDs can keep him in that bracket for years, with survivor rules potentially shifting thresholds. Strategies to mitigate include partial Roth conversions before age 73, using Qualified Charitable Distributions to reduce MAGI, and filing SSA-44 after qualifying life events when income dips (though a pension alone doesn’t qualify). The key is to separate permanent from controllable income and plan ahead to avoid permanently higher IRMAA costs.

Medicare Opens Obesity-Drug Access for Seniors, Yet Awareness Is Lagging
health13 days ago

Medicare Opens Obesity-Drug Access for Seniors, Yet Awareness Is Lagging

Medicare’s Bridge demonstration program will start covering obesity medications for eligible beneficiaries with a $50 monthly copay, starting July 1, expanding access to GLP-1 drugs like Wegovy and Zepbound; however, awareness among seniors is low, enrollment isn’t automatic and requires a prescription plus prior authorization, and public outreach is being scaled up after launch as CMS and drugmakers prepare for possible demand through 2027.

Louisville medical professionals among defendants in federal health care fraud crackdown
crime16 days ago

Louisville medical professionals among defendants in federal health care fraud crackdown

Four Louisville-area defendants, including a physician and a nurse, are among those charged in a nationwide, multi-case federal health care fraud crackdown—the 2026 National Health Care Fraud Takedown that charged 455 people with over $6.5 billion in false claims. In Louisville, Angela Renfro and Briana Gosnell (KLF Company LLC and Freedom Center LLC) allegedly submitted more than $11 million in Medicaid claims for peer-support and psychoeducation services using providers’ NPI numbers without authorization. Dr. Christian Berkhahn is charged with conspiracy to obtain controlled substances and health care fraud for prescriptions written under others' names; nurse Meredith Douglass is accused of stealing medications and falsifying records to obtain fentanyl and other Schedule II drugs. A fourth defendant, Einar Serrano Reyes, allegedly used a Louisville location to bill Medicare for over $450,000 for services never provided. Prosecutors say the schemes diverted funds from programs for vulnerable patients; defendants are presumed innocent unless proven guilty.

Louisville residents among defendants in nationwide healthcare fraud takedown
crime16 days ago

Louisville residents among defendants in nationwide healthcare fraud takedown

As part of the DOJ's 2026 National Health Care Fraud Takedown, four Kentucky cases accuse Louisville residents and local companies of defrauding Medicaid, misusing provider identifiers, and submitting fraudulent claims totaling more than $11 million for peer-support services; a Louisville physician allegedly fraudulently procured controlled substances using others’ names; a nurse is charged with stealing medications and falsifying records; and a Florida man is accused of billing Medicare for services never provided. The nationwide crackdown charged 455 defendants with more than $6.5 billion in false claims.