Yesterday, Medicare Rights Center President Fred Riccardi testified at a hearing of the U.S. House Committee on Energy & Commerce, Subcommittee on Health, titled “Legislative Proposals To Support Patient Access To Telehealth Services.” The COVID-19 outbreak spurred significant changes in Medicare telehealth. Early in the pandemic, it was clear that Medicare beneficiaries were at high risk. Policymakers responded quickly, temporarily relaxing restrictions so more beneficiaries could obtain telehealth through more types of technology, from more providers, and at more locations, tha ..read more

Late last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule for Medicare Advantage (MA) and Part D prescription drug plans that will have a number of positive effects for enrollees and the program. This includes limiting insurance broker payments to make rates more rational and the playing field between plans more even; curtailing sales of some beneficiary information between marketing organizations; improving network adequacy for behavioral health; boosting enrollee awareness of the supplemental benefits available to them; and strengthening alignment between Medica ..read more

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the 2025 payment rates for Medicare Advantage (MA) and Part D plans. The final policies largely align with those proposed in the Advance Notice and are expected to increase Medicare payments to MA plans by 3.7%—over $16 billion—next year. The Medicare Rights Center appreciates the finalization of provisions that would help rein in soaring and unnecessary MA costs, and  additional, comprehensive reforms.  The research from independent experts is clear: Medicare overpays MA plans by billions of d ..read more

As of today, 41 states and the District of Columbia have expanded Medicaid coverage to adults between the ages of 19 and 64. Georgia is one of the holdouts. Though the state has taken steps to adopt a modified expansion, that approach has been unsuccessful, rife with significant eligibility and enrollment barriers, burgeoning costs, and few enrollees. This effort began in July 2023, when Georgia launched Georgia Pathways to Coverage, a program to extend Medicaid only to applicants able to meet and document onerous work, school, or other administrative requirements. So far, the state reports th ..read more

This week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to make enrolling and staying in Medicaid easier, especially for older adults and people with disabilities. This rule is a companion to one finalized last fall that streamlined enrollment into Medicare Savings Programs (MSPs). Medicaid is a joint federal and state program with many different categories of coverage, each with its own eligibility rules and processes. These pathways include coverage for pregnant people, children, low-income adults between 19 and 64 who are not Medicare eligible (expansion Medicaid ..read more

The Affordable Care Act (ACA), passed 14 years ago this week, strengthened Medicare and Medicaid and created important coverage guarantees and consumer protections for people of all ages. From expanding access to affordable care to preventing discrimination based on health status, as well as improving Medicare’s financial status, the ACA made significant improvements to the nation’s health care infrastructure. These advances are especially important for older adults, who are more likely than younger adults to have health problems that cause them to rely on the ACA’s consumer protections. Some ..read more

Direct care workers are vital to ensuring older adults and people with disabilities can safely remain in their homes and communities. Such workers, as formally classified by the Department of Labor, include certified nursing assistants, home health aides, personal care aides, caregivers, and companions. Medicaid funds many direct care workers, including those employed by home care agencies or as compensated family caregivers. Despite their essential role and the growing demand for home-based services as the population ages, they tend to have low wages and work in challenging conditions. This m ..read more

A new study from University of Southern California (USC) researchers shows that Medicare Part D plans have been increasingly restricting access to some prescription drugs through the years. Plans have used prior authorization, step therapy, and formulary restrictions to curb beneficiaries’ ability to take certain important prescriptions. The study covered 10 years, from 2011 to 2020, and showed plan adoption of each of these utilization management practices steadily gaining traction. Plans can exclude some drugs from their formularies entirely, meaning enrollees either must pay out of pocket o ..read more

On Monday, the White House released President Biden’s budget request to Congress for fiscal year (FY) 2025, which begins on October 1. Presidential budgets are important policy and messaging tools that articulate the administration’s goals and are often used to guide reforms, introduce or refine ideas, and stake out positions. They are typically comprehensive and detailed, including spending levels for nearly every federal agency and activity as well as legislative priorities. This year’s budget follows suit, offering both specific ideas and a broad vision for the future. Among the o ..read more

Many people with Medicare Part D drug coverage—in particular those who reach the catastrophic coverage phase—may experience unexpected costs and significant confusion as their out-of-pocket obligations change throughout the year. The Inflation Reduction Act (IRA) brings much-needed consumer protections and predictability to these coverage phases, limiting financial exposure for everyone and generating significant savings for those with extreme costs. As of 2024, Part D enrollees are no longer required to pay 5% coinsurance after they reach catastrophic coverage. This threshold is set ..read more