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Medicare Watch

Medicare Watch articles are featured in Medicare Rights’ weekly newsletter, which helps readers stay updated on Medicare policy and advocacy developments and learn about changes in Medicare benefits and rules. Subscribe now by visiting www.medicarerights.org/newsletters.

Legislative Outlook for Health Care Issues in 2019

When the 116th Congress convened in January, it ushered in a dramatic shift in political dynamics. For the first time in eight years, Democrats have a majority in the U.S. House of Representatives. With Republicans still in control of the U.S. Senate, the two chambers of Congress will be divided for at least the next two years.

Under split-party control, legislation will require bipartisan support in order to pass. The need for this agreement greatly, if temporarily, blunts the acute legislative threats to Medicare, Medicaid, and the Affordable Care Act (ACA) that dominated the last Congress.

With extensive program overhauls unlikely to succeed this year, we expect lawmakers to instead focus on areas of shared consensus and concern. This includes “must-pass” items, like expiring health care programs, as well as those that are a top priority for both chambers, such as high prescription drug prices.

Read More »

CMS Announces New Model to Reduce Unnecessary Emergency Department Use

Today, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced a new model within traditional Medicare that could help people with Medicare avoid unnecessary trips to the Emergency Department. This new model would allow emergency transportation services to take individuals to their primary care doctor or urgent care, or to deliver treatment in place, when the person does not need to be seen in an emergency room.

Read More »

Cardiovascular Preventive Medicine Saving Lives and Saving Medicare Money

Though it’s well known that preventive care can improve health and save lives, establishing that preventive care can also save money has been more difficult. Until now, researchers have consistently found that preventive services do not end up saving money in the long term, but a new study shows that cardiovascular treatment seems to be the exception.

Read More »

Medicare Rights Comments on CMS Proposal to Give Drug Plans Additional Flexibility

The Medicare Rights Center recently responded to a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would, in part, allow Part D and Medicare Advantage (MA) prescription drug plans greater flexibility in managing their formularies.

According to CMS, the proposed policies are intended to “remove administrative hurdles to offer lower cost options to seniors and provide support for private sector partners by providing them the tools to lower the cost of prescription drugs.”

While we agree with the need to address high and rising drug prices, we strongly disagree with the agency’s proposed approach, which seeks to do so by weakening the protected classes protections and permitting step therapy for Part B drug coverage. Such changes have the dangerous potential to disrupt or even end access to some medications for people with Medicare.

Read More »

KFF Brief Highlights Financial Burden of Part D Specialty Drugs

While Medicare Part D has made prescription drugs more affordable for people with Medicare, many beneficiaries continue to face affordability challenges, in part because there is no hard cap on out-of-pocket spending under Part D. A new resource from the Kaiser Family Foundation examines the financial burden this places on Part D enrollees who rely on high-cost medications.

Read More »

CMS Completes Rollout of New Medicare Cards Ahead of Schedule

Last week, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced that they finished the rollout of new Medicare cards to 61 million people with Medicare ahead of the original deadline of April, 2019. This means that all people with Medicare should now have Medicare cards that include a random Medicare Beneficiary Identifier (MBI) instead of a number based on their Social Security number.

Read More »
a roll of bills from which spill out pills of many colors

Medicare Announces New Model to Test Changes to Part D Payments

This week, the Centers for Medicare & Medicaid Services (CMS) )—the agency that oversees the Medicare program—announced a new model to test changes to prescription drug payments and incentives. The CMS Center for Medicare and Medicaid Innovation (CMMI) will create a voluntary, five-year model in which Part D Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MAPDs) may apply to participate.

According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”

Read More »

New Enrollment Period Now Available for People with Medicare Advantage

Older adults and people with disabilities who are currently enrolled in a Medicare Advantage (MA) plan have until March 31 to switch to another MA plan or to Original Medicare with or without a stand-alone prescription drug plan (Part D) during the new Medicare Advantage Open Enrollment Period (MA OEP).

The MA OEP occurs each year from January 1 through March 31, and it is only available to people who have a Medicare Advantage plan. One change can be made during this period, which will take effect the first of the month following the month you enroll. For example, if you switch to a new Medicare Advantage Plan in February, your new coverage begins March 1.

Read More »

Medicaid Changes Likely in 2019

As 2019 gets underway, the Medicaid program continues to be in the spotlight. This week, the Kaiser Family Foundation (KFF) released an issue brief that highlights some of the major program changes that states, the Administration, and Congress may pursue in 2019.

Over 66 million people receive their health coverage through Medicaid, including older adults, people with disabilities, children, low-income parents, and other adults. Any changes to the program, therefore, have the potential to affect millions of families.

Read More »

Legislative Outlook for Health Care Issues in 2019

When the 116th Congress convened in January, it ushered in a dramatic shift in political dynamics. For the first time in eight years, Democrats have a majority in the U.S. House of Representatives. With Republicans still in control of the U.S. Senate, the two chambers of Congress will be divided for at least the next two years.

Under split-party control, legislation will require bipartisan support in order to pass. The need for this agreement greatly, if temporarily, blunts the acute legislative threats to Medicare, Medicaid, and the Affordable Care Act (ACA) that dominated the last Congress.

With extensive program overhauls unlikely to succeed this year, we expect lawmakers to instead focus on areas of shared consensus and concern. This includes “must-pass” items, like expiring health care programs, as well as those that are a top priority for both chambers, such as high prescription drug prices.

CMS Announces New Model to Reduce Unnecessary Emergency Department Use

Today, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced a new model within traditional Medicare that could help people with Medicare avoid unnecessary trips to the Emergency Department. This new model would allow emergency transportation services to take individuals to their primary care doctor or urgent care, or to deliver treatment in place, when the person does not need to be seen in an emergency room.

Cardiovascular Preventive Medicine Saving Lives and Saving Medicare Money

Though it’s well known that preventive care can improve health and save lives, establishing that preventive care can also save money has been more difficult. Until now, researchers have consistently found that preventive services do not end up saving money in the long term, but a new study shows that cardiovascular treatment seems to be the exception.

Medicare Rights Comments on CMS Proposal to Give Drug Plans Additional Flexibility

The Medicare Rights Center recently responded to a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would, in part, allow Part D and Medicare Advantage (MA) prescription drug plans greater flexibility in managing their formularies.

According to CMS, the proposed policies are intended to “remove administrative hurdles to offer lower cost options to seniors and provide support for private sector partners by providing them the tools to lower the cost of prescription drugs.”

While we agree with the need to address high and rising drug prices, we strongly disagree with the agency’s proposed approach, which seeks to do so by weakening the protected classes protections and permitting step therapy for Part B drug coverage. Such changes have the dangerous potential to disrupt or even end access to some medications for people with Medicare.

KFF Brief Highlights Financial Burden of Part D Specialty Drugs

While Medicare Part D has made prescription drugs more affordable for people with Medicare, many beneficiaries continue to face affordability challenges, in part because there is no hard cap on out-of-pocket spending under Part D. A new resource from the Kaiser Family Foundation examines the financial burden this places on Part D enrollees who rely on high-cost medications.

CMS Completes Rollout of New Medicare Cards Ahead of Schedule

Last week, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced that they finished the rollout of new Medicare cards to 61 million people with Medicare ahead of the original deadline of April, 2019. This means that all people with Medicare should now have Medicare cards that include a random Medicare Beneficiary Identifier (MBI) instead of a number based on their Social Security number.

a roll of bills from which spill out pills of many colors

Medicare Announces New Model to Test Changes to Part D Payments

This week, the Centers for Medicare & Medicaid Services (CMS) )—the agency that oversees the Medicare program—announced a new model to test changes to prescription drug payments and incentives. The CMS Center for Medicare and Medicaid Innovation (CMMI) will create a voluntary, five-year model in which Part D Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MAPDs) may apply to participate.

According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”

New Enrollment Period Now Available for People with Medicare Advantage

Older adults and people with disabilities who are currently enrolled in a Medicare Advantage (MA) plan have until March 31 to switch to another MA plan or to Original Medicare with or without a stand-alone prescription drug plan (Part D) during the new Medicare Advantage Open Enrollment Period (MA OEP).

The MA OEP occurs each year from January 1 through March 31, and it is only available to people who have a Medicare Advantage plan. One change can be made during this period, which will take effect the first of the month following the month you enroll. For example, if you switch to a new Medicare Advantage Plan in February, your new coverage begins March 1.

Government Shutdown Threatens Programs for Older Adults and People with Disabilities

As the government shutdown continues, so do its impacts on older adults, people with disabilities, and their families. While Medicare and Medicaid are fully funded for the year, other critical programs—like affordable housing, food assistance, and transportation services—are not. This threatens the health and economic security of millions of Americans.

Medicaid Changes Likely in 2019

As 2019 gets underway, the Medicaid program continues to be in the spotlight. This week, the Kaiser Family Foundation (KFF) released an issue brief that highlights some of the major program changes that states, the Administration, and Congress may pursue in 2019.

Over 66 million people receive their health coverage through Medicaid, including older adults, people with disabilities, children, low-income parents, and other adults. Any changes to the program, therefore, have the potential to affect millions of families.