Biden Administration Confirms 2025 Medicare Advantage Payments To Drop
Stat notes that the government wasn't convinced by insurer and lobbyist efforts arguing that Medicare Advantage payouts wouldn't cover the costs for people using health care. Also, experts warn Medicare coverage for Wegovy could hike monthly payments for many.
Stat:
Medicare Advantage 2025 Payments Will Dip, Biden Administration Says
Over the past few weeks, Medicare Advantage insurers demanded that the Biden administration give them higher payment rates for next year. The government’s data on how much people were using health care didn’t match their own data, insurers and lobbyists griped — and therefore they wouldn’t be paid enough to cover those costs. But the federal government was not persuaded by the industry’s data or lobbying push. The Biden administration and its Medicare agency decided to stick with their proposals from January on Monday, dealing a blow to an insurance industry that has come to rely on Medicare Advantage for a steady stream of profits. (Herman, 4/1)
Axios:
Medicare Advantage Plans To See 2025 Base Pay Fall
The Biden administration on Monday followed through on its proposal to cut next year's base payments to Medicare Advantage plans an average of 0.16%, despite pressure from insurers and their allies in Congress. Why it matters: While the plans will wind up seeing a net increase once payments are risk-adjusted to account for the health of their customers, the news sent shares of UnitedHealth, CVS Health, Humana and Centene falling amid predictions of continued financial pressure. (Goldman, 4/2)
NBC News:
Medicare's Weight-Loss Drug Wegovy Coverage Poses Potential Premium Hike For Millions Of Enrollees
Medicare’s recent move to cover the weight-loss drug Wegovy for some recipients with heart disease risk could drive up the cost of monthly premiums for many of the 65 million adults enrolled in the federal health insurance program, experts warn. How much of a price jump isn’t yet known. The premium increase would depend on how many millions qualify for the popular medication, which is priced at around $1,300 a month. (Lovelace Jr., 4/2)
Newsweek:
Medicare Recipients Lose Thousands To 'Phantom Billing'
Seniors relying on Medicare to pay for their health care are being targeted by a widespread "phantom billing" scam that has the potential to rob them of thousands of dollars. Phantom billing occurs when fraudulent charges are filed to Medicare by health care providers/doctors and medical equipment companies without the recipient's knowledge. Some seniors targeted reported being billed for urinary catheters they never asked for. (Blake, 4/1)
Stat:
Medical Bills So High, Medicare Adding Extra Digits To Claim Forms
Health care costs are getting so high that prices are literally running off of the page. Medicare on a couple of occasions recently has had to deal with billing forms that don’t provide adequate space for prices. (Wilkerson, 4/2)
In news about Obamacare and Blue Cross Blue Shield —
KFF Health News:
ACA Plans Are Being Switched Without Enrollees’ OK
Some consumers covered by Affordable Care Act insurance plans are being switched from one plan to another without their express permission, potentially leaving them unable to see their doctors or fill prescriptions. Some face large IRS bills for back taxes. Unauthorized enrollment or plan-switching is emerging as a serious challenge for the ACA, also known as Obamacare. (Appleby, 4/2)
Axios:
ACA Enrollment Surge Brings Tradeoffs For Kids
More kids than ever are covered through the Affordable Care Act as the law's insurance markets help catch those affected by the nationwide Medicaid enrollment purge that began a year ago this week. Why it matters: The transition to the ACA marketplaces from Medicaid or a sister program just for kids comes with tradeoffs that hundreds of thousands of families may be discovering about their child's new coverage. (Goldman, 4/2)
Reuters:
Blue Cross Blue Shield Must Face Ford Motor Antitrust Claims, US Judge Rules
Blue Cross Blue Shield Association and its Michigan affiliate must face a lawsuit from Ford Motor accusing them of artificially inflating the automaker’s costs for health insurance, a U.S. judge has ruled. U.S. District Judge Linda Parker in a ruling on Saturday in Detroit federal court said Ford had adequately alleged for now that it was overcharged for commercial health insurance products purchased from Blue Cross. (Scarcella, 4/1)
