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Thousands of people who had a Medicare drug plan with zero-dollar premiums last year got small premium increases this year — and didn’t know it. They were dropped from their coverage for failing to pay amounts as little as $8, and most can’t get it again until 2027.
Breakups between insurers and health systems, on top of plan cuts, left more than 3.7 million Medicare Advantage enrollees facing a tough choice last year: find new insurance or new doctors. But hospital systems say their Advantage plans can avert such upheaval, giving patients peace of mind.
Health systems drop out of Medicare Advantage plans all the time. Yet government documents obtained by KFF Health News show that federal regulators rarely warn plans that their networks of health providers are so skimpy they violate legal requirements.
Breakups between health providers and Advantage plans are increasingly common. The Centers for Medicare & Medicaid Services has allowed whole groups of patients to leave their plans.
Every year, Medicare officials encourage beneficiaries to shop around for their drug coverage. Few take the time. This year, it might be more important than ever.
President Joe Biden is campaigning for reelection on his efforts to cut costs for Medicare patients at the pharmacy counter. But independent pharmacists say one strategy makes it unaffordable for them to keep some brand-name medicines in stock.
Disputes between hospitals and Medicare Advantage plans are leading to entire hospital systems suddenly leaving insurance networks. Patients are left stuck in the middle, choosing between their doctors and their insurance plan. There’s a way out.
As open enrollment ends, many people are tuning out. They could wind up with a surprise next year: higher costs and less access to health care providers.
The Biden administration wants to crack down on deceptive or misleading Medicare Advantage and drug plan sales tactics. It’s counting on beneficiaries to help catch offenders.
Software sifts through millions of medical records to match patients with similar diagnoses and characteristics and then predicts what kind of care an individual will need and for how long. New federal rules will ensure human experts are part of the process.
Before the covid-19 public health emergency ended, Medicare advocates around the country noticed a rise in complaints from beneficiaries who received at-home covid tests they never requested. Bad actors may have used seniors’ Medicare information to improperly bill the federal government — and could do it again, say federal investigators.
In August, Congress approved a $35 cap on what seniors will pay for insulin, but that change came too late to add to the online tool that helps Medicare beneficiaries compare dozens of drug and medical plans. Federal officials say beneficiaries who use insulin will have the opportunity to switch plans after open enrollment ends Dec. 7.
Medicare can pay for some dental care if it is medically necessary to safely treat another covered medical condition, and federal officials have asked for suggestions on whether that list of conditions should be expanded.
Private Medicare Advantage health plans are increasingly ending coverage for skilled nursing or rehab services before medical providers think patients are healthy enough to go home, doctors and patient advocates say.
The Biden administration is considering whether Medicaid, which pays the bills for 62% of nursing home residents, should require that most of that funding be used to provide care, rather than for maintenance, capital improvements, or profits.
Even the savviest Medicare drug plan shoppers can get a shock when they fill prescriptions: That great deal on medications is no bargain after prices go up.
Private and public employers are increasingly using the government’s Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. As a result, the federal government is paying the “overwhelming majority” of medical costs, according to an industry analyst.
If federal officials accept a court’s decision, some patients will get a chance to seek refunds for their nursing home and other expenses.
Medicare officials say complaints are rising from seniors lured into private plans with misleading information or enrolled without their consent. In response, officials have threatened to penalize the private companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers.
Following the devastating impact of covid-19 on nursing homes, state lawmakers want to be sure that government and private payments primarily go to improve care and staffing.
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