All articles tagged with #medicare
Medicare’s 18-month GLP-1 Bridge offers weight-loss drugs for about $50 a month, but anyone with an FDA-approved medical indication for GLP-1s (like sleep apnea or diabetes) is redirected to costly Part D plans, leaving potentially 5.9 million beneficiaries excluded and highlighting a gap between cost relief and real medical need.
Costco is partnering with SCAN Group to offer private Medicare plans in a limited number of states, including jointly branded Medicare Advantage plans in two states and a Medicare Supplement plan in a third, subject to regulatory approval. The plans may include pharmacy, vision, hearing and OTC benefits and would be marketed at Costco locations via SCAN’s sales team and brokers. SCAN operates in AZ, CA, NV, NM, TX and WA with about 460,000 enrollees. The move aims to simplify benefits and leverage Costco’s senior-friendly reputation, but Medicare Advantage plans can face scrutiny over prior authorization. Open enrollment runs Oct. 15–Dec. 7.”,
Costco will offer Medicare Advantage in two states and a Medigap plan in one state through a SCAN Group partnership; the exact rollout states haven’t been disclosed, but SCAN already serves Arizona, California, Nevada, New Mexico, Texas and Washington, where Costco operates many stores. This expands Costco’s services beyond groceries and aligns with moves by rivals like Walmart to broaden warehouse-club healthcare offerings, targeting its substantial population of baby boomer shoppers.
Medicare pays about $520 for a standard cataract operation, and reimbursements have fallen over the past decade, even as more doctors offer laser-assisted cataract surgery that can add roughly $1,000–$3,000 in patient out-of-pocket costs per eye plus $1,000–$4,000 for premium lenses. Studies show laser does not improve outcomes for standard cataracts, though private insurers generally follow Medicare rules. About 12% of the roughly 5 million annual cataract surgeries are laser-assisted—and the share is rising as doctors face lower reimbursements and higher equipment costs—while patients are urged to choose after being educated on all options; critics call it a revenue booster, supporters say it offers precision and choice.
Costco plans a multiyear Medicare plan and other senior‑focused insurance products through a partnership with SCAN Health Plan, pending regulatory approval, with a potential rollout of Medicare Advantage in two states and a Medicare supplement in a third.
Humana says it will terminate plans covering about 600,000 Medicare Advantage members in 2027 (roughly 8% of its MA base), with disenrollment letters going out in September 2026. The exit triggers a 63-day guaranteed-issue Medigap window (Plan G commonly) to buy coverage without health underwriting, plus ongoing enrollment options during AEP and a special enrollment period. Members should confirm their disenrollment date, secure Medigap quotes within the window, and compare Original Medicare plus a Medigap plan vs staying with another MA plan, as costs can vary widely.
New inflation data points to a 3.6% COLA for 2027, potentially adding about $75 to the average retiree’s monthly check; final COLA will be announced mid-October after September CPI data. AARP expects about 3.5%. Medicare Part B premiums could rise 3.5% to $209.50/month in 2027. Despite cooling CPI, seniors still face high costs in healthcare, housing, and utilities, and most rely on Social Security for a large share of income (about three-quarters for half of seniors, 44% for all).
The U.S. July budget gap rose to $432.3 billion, the largest for a July since March 2021, as a surge in Medicare costs and ongoing debt financing pushed the year-to-date shortfall toward about $1.8 trillion, surpassing the pace of 2025. Medicare July outlays were $174 billion (totaling $955 billion for the year), with Social Security at $141 billion and net interest at $104 billion in July. Timing effects — including a $99 billion nonbusiness-day acceleration — and $33 billion in tariff refunds also boosted outlays. Through ten months, debt financing remains a major expense; the government has paid $1.17 trillion on a $39.9 trillion debt, about $931 billion in net interest year-to-date, with $32.1 trillion held by the public.
The Justice Department is expanding its Northeast Health Care Fraud Strike Force to Philadelphia, charging 19 defendants in more than $4 million in Medicare and Medicaid fraud tied to home-health services. The cases involve false clock-ins, services billed while defendants were incarcerated or away, overlapping hours, and a Medicaid recipient who worked as a carpenter while claiming extensive home-health needs. The expansion strengthens federal enforcement in the Eastern District of Pennsylvania through partnerships with HHS OIG, FBI, and DEA, following broader nationwide actions targeting billions in losses in 2025–2026.
Sixty years after Medicare and Medicaid began in 1966, this post traces their roots from Truman’s Economic Bill of Rights to LBJ’s signing of the amendments, showing how the programs expanded health coverage and anchored a social safety net, then contrasts that history with today’s GOP push to reshape or cut Medicaid and change Medicare drug subsidies under the 2025 One Big Beautiful Bill Act, highlighting the ongoing struggle between collective health security and political calls for reduced government involvement.
The Trump administration has ended a Medicare drug subsidy program, a move that could lift out-of-pocket costs for certain beneficiaries and shift some expenses within Medicare. The impact will vary by individual drug needs and coverage, with broader implications for overall healthcare spending and policy.
Starting July 1, 2026, Medicare will offer Wegovy and other GLP-1 weight‑loss drugs for a $50 monthly copay through a temporary GLP‑1 Bridge outside Part D that runs through December 31, 2027. Eligibility is tightly restricted by BMI and comorbidities and requires Part D enrollment; those with type 2 diabetes, sleep apnea, or certain liver diseases are excluded and must pursue Part D coverage instead. The $50 copay is outside Part D and does not count toward deductibles or the $2,100 out‑of‑pocket limit. Beneficiaries should verify their plan, gather medical documentation, and work with a clinician to determine if they meet the three eligible tiers.
Medicare's GLP-1 Bridge Program runs July 1, 2026 through December 31, 2027, giving Part D beneficiaries access to GLP-1 weight‑loss medications (Wegovy, Ozempic, Zepbound, Foundayo) prescribed for weight loss with a flat $50 copay. Eligibility uses BMI thresholds (no underlying condition: BMI 35+; with condition: BMI 27+). The program is managed centrally outside standard Part D; providers submit prior authorization, and coverage is nationwide. The drugs covered include Wegovy and Foundayo, plus Zepbound KwikPen. The $50 copay doesn't count toward deductibles or the out‑of‑pocket limit. GLP‑1 drugs can yield 14–20% weight loss per year, but stopping typically leads to regain and side effects like nausea; the drugs are often intended to be used long‑term.
Fidelity estimates a 65-year-old retiree in 2026 will need about $185,500 for health and medical costs—up 7.5% from last year—driven by higher costs and more chronic conditions. The projection assumes traditional Medicare (Parts A/B plus Part D) with about 48% of costs from cost-sharing, 45% from premiums, and 7% from out-of-pocket drug costs; long-term care costs are not included but can push totals higher, and many pre-retirees underestimate Medicare coverage, underscoring the value of early saving and HSAs.
If Congress does nothing, Social Security trust funds are projected to run dry by end of 2032, triggering a roughly 22% annual benefit cut in 2033 that could mean about $16,900 less per year for newly retired couples. Medicare Part A is also expected to face about an 11% cut around 2033, while Parts B and D premiums rise, increasing out-of-pocket costs. Lawmakers have proposed various options (raising payroll taxes, lifting the benefit cap, extending the retirement age, and creating a bipartisan advisory board), but no consensus has emerged to shore up funding.