Julie Carter

Senior Federal Policy Associate

Spending and Prescribing Patterns Across Medicare, Medicaid, and Large Employer Drug Coverage

Drug prices have been in the news lately, and a timely analysis from the Kaiser Family Foundation gives valuable insight into prescription drug spending across large employer plans, Medicaid, and Medicare Part D. By understanding spending and prescribing patterns across these payers, policymakers can make better decisions about lowering the cost of medications for consumers.

Coming Soon to a TV Near You: Drug Prices

The Centers for Medicare & Medicaid Services (CMS), the agency that oversees the Medicare and Medicaid programs, have put a rule in place that will change the look of television ads for prescription medications. Last week, CMS announced that most drugs that are covered by Medicare or Medicaid must soon include pricing information in their TV ads.

CMS Maintains Important Changes in Draft 2020 Medicare & You Handbook

Last year, the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, released a draft version of the annual “Medicare & You” handbook that contained several glaring inaccuracies. In a significant advocacy success, Medicare Rights and our allies convinced CMS to correct these major errors and release a final 2019 handbook that was greatly improved.

New Models May Tweak how Medicare Works, but Beneficiaries Must Remain the Priority

The Centers for Medicare & Medicaid Services (CMS), the agency that oversees the Medicare program, released information about eight new payment and delivery models this week. Five of these models, collectively known as the CMS Primary Cares Initiative, will test new ways to pay Medicare primary care and other providers while the other three would explore ways for Medicare and Medicaid to better work together to provide coverage.

Once Again, Medicaid Work Requirements are Found Impermissible

Yesterday, a federal judge blocked efforts by two states to impose onerous paperwork and employment requirements on Medicaid recipients as a condition of maintaining coverage. For the second time, the judge found that Kentucky’s plan was not permissible under the Medicaid statute, and that similar rules in Arkansas — that have already led to thousands of Arkansans losing coverage — could not stand. The rulings are a set back for the Trump Administration, which has sought to reshape the Medicaid program by allowing states to implement such restrictions.

Electronic Health Records Can Be Useful for Patients, but Concerns Remain

Electronic Health Records (EHRs) allow providers and hospitals to input information about a patient’s health, diagnoses, and treatments into a computer system. These records can, when used correctly, help physicians keep track of patient histories and preferences and improve quality of care. They also give patients more access to their own data, increasing their ability to seek second opinions, better understand their health issues, and make corrections where needed. The use of EHRs has exploded in recent years, with 9% of hospitals using them in 2008 and 96% today.

Lack of Dental Coverage has Real Costs and Consequences for People with Medicare

This week, the nonpartisan Kaiser Family Foundation (KFF) released an issue brief examining the issue of oral health for people on Medicare. It describes the consequences of foregoing dental care, current sources of dental coverage, use of dental services, and related out-of-pocket spending.

Despite the evidence that oral health is related to physical health, Original Medicare does not cover most dental care needs. While some Medicare Advantage plans may offer dental benefits, this coverage is often limited, and its availability can vary considerably across plans. As a result, many people with Medicare often lack adequate oral health coverage, which exposes them to serious health complications and high out-of-pocket spending.

Why Do People Leave Medicare Advantage for Original Medicare?

This week, researchers released an analysis of patterns in Medicare showing that people with high needs—like significant chronic illness—and people with both Medicare and Medicaid coverage choose to leave their Medicare Advantage (MA) plans more often than people without similar health issues or Medicaid coverage. The researchers sought to discover why these patterns exist and what the implications might be for MA going forward.

Many Older Adults with Medicare Not Getting the Long-Term Help They Need

A new study by the Commonwealth Fund examines the use of long-term services and supports (LTSS) among Medicare beneficiaries age 65 and older, and finds that the Medicare program is falling behind in offering the supports many older adults need. Currently, Medicare does not broadly cover most types of LTSS that could help older adults and people with disabilities remain in their homes and communities as they age. While Medicare Advantage does cover some limited LTSS, this coverage is spotty, and does not apply to the approximately two-thirds of Medicare beneficiaries who rely on Original Medicare.