Medicare

The AJMC® Medicare compendium is a comprehensive resource for clinical news and expert insights on issues that affect Medicare beneficiaries with a focus on polypharmacy, reimbursement challenges, and other topics related to seniors.

Latest News

Inflation Reduction Act | Image Credit: wladimir1804-stock.adobe.com
Community Oncology Bracing for IRA Impact

May 31st 2025

Community oncology faces significant challenges from the Inflation Reduction Act's (IRA) drug pricing changes, risking financial stability and patient access to care.

Veteran health. | Image Credit: Africa Studio - stock.adobe.com
Strategies to Address Veteran Health Disparities Beyond the Battlefield

May 30th 2025

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Health Policy in Flux: Trump Administration Updates

May 20th 2025

AJMC
Health Outcomes Under Full-Risk Medicare Advantage vs Traditional Medicare

May 9th 2025

AJMC
Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

May 7th 2025

Examining the Benefit of an Innovative Enhanced Medication Therapy Management Model

In this series of articles, the authors present the MedWise Risk Score, an enhanced medication therapy management model, and its impact on medication safety reviews and health care outcomes.

AJMC Supplement Cover for Examining the Benefit of an Innovative Enhanced Medication Therapy Management Model

More News

soldier camouflage, military uniform, money | Image credit: Angelov – stock.adobe.com
October 8th 2024

Government May Be Paying Twice for Veterans’ Health Care in Medicare Advantage Plans

Hayden E. Klein
Between 2011 and 2020, the Veterans Health Administration spent $78 billion on health services for veterans also enrolled in Medicare Advantage.
White pills - neirfy - stock.adobe.com_AdobeStock_226352071
October 2nd 2024

Corporate Accountability and Public Health: Sackler Ruling and Treatment Gaps in the Opioid Crisis

Giuliana Grossi
The Supreme Court’s decision, paired with the newest data demonstrating the public impact of the opioid crisis, illustrates the legal potential in addressing the crisis and the ongoing public health challenges of treatment access.
Price drop questioned | Image Credit: © Fokussiert-stock.adobe.com
September 30th 2024

Lower Drug Costs on the Horizon for Medicare Beneficiaries

Maggie L. Shaw
Average Medicare drug premiums for older Americans will drop next year for those enrolled in traditional Medicare plans or who have coverage through Medicare Advantage, with opinions divided along party lines on the economic implications.
Nick Ferreyros of Community Oncology Alliance during a video interview
September 10th 2024

IRA Negotiated Drug Prices Can’t Come “On the Backs of Providers”

Alexandra Gerlach Laura Joszt, MA
There are concerns that the negotiated drug prices under the Inflation Reduction Act (IRA) are leading to large provider reimbursement cuts, explained Nick Ferreyros, managing director, Community Oncology Alliance.
Center on Health Equity and Access
September 7th 2024

Health Equity & Access Weekly Roundup: September 7, 2024

Giuliana Grossi
The Center on Health Equity & Access provides the latest news, research, and expert opinions on the state of equity in health care.
Semaglutide Ozempic injection blood sugar obesity - myskin - stock.adobe.com.jpeg
August 26th 2024

Medicare Semaglutide Coverage: Millions May Gain Access That Could Cost $145 Billion

Giuliana Grossi
Medicare has not clearly defined what constitutes "established cardiovascular disease," leading to variability in potential patient eligibility; therefore, researchers aimed to estimate the number of Medicare beneficiaries who would become newly eligible for semaglutide under different definitions.
COA seal | Image : COA
August 16th 2024

Revised EOM Offers More Favorable Opportunities for Community Practices, Experts Say

Mary Caffrey
Prescription drugs on a money banknotes. Concept of healthcare costs - Vitalii - stock.adobe.com
August 5th 2024

Survey Exposes Pervasive Billing Errors, Aggressive Tactics in US Health Insurance

Giuliana Grossi
Almost half of insured Americans report receiving unexpected medical bills, leading to financial strain and contributing to worsening health outcomes for many patients, The Commonwealth Fund report reveals.
Stethoscope and US dollar banknotes on chart or graph paper, Financial, account, statistics and business data medical health concept - amazing studio - stock.adobe.com
July 11th 2024

CMS Unveils Proposed 2025 Physician Fee Schedule, Maternal Health Standards

Giuliana Grossi
The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.
Stack of wood blocks with insurance and health care icons | Image credit: A stockphoto - stock.adobe.com
June 24th 2024

Medicare Advantage Plans Provide No Substantial Cost Savings Over Traditional Medicare

Laura Joszt, MA
Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.
Center on Health Equity & Access
June 15th 2024

Health Equity & Access Weekly Roundup: June 15, 2024

Giuliana Grossi
The Center on Health Equity & Access shares the latest news, research, and expert insights on developments related to health disparities, gaps in care, and initiatives to address them.
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June 12th 2024

US Health Spending Hits $4.8 Trillion, Insurance Coverage Peaks in 2023 Projections

Giuliana Grossi
New estimations show a historic increase in health spending last year, which is projected to account for 19.7% of the gross domestic product by 2032.
Health equity | Image Credit: Tarik Vision - stock.adobe.com
June 12th 2024

CMS Innovation Center's Latest Moves: Embedding Equity Into Value-Based Care

Giuliana Grossi
During the CMS Health Equity Conference, health care leaders shared groundbreaking strategies to integrate health equity into value-based care models, aiming to enhance patient outcomes and reduce costs.
Stethoscope on money | Image credit: utah51 - stock.adobe.com
May 6th 2024

Medicare Trust Fund Extends Solvency Another 5 Years

Laura Joszt, MA
The Medicare trust fund is now expected to deplete in 2036, with the Inflation Reduction Act being credited for at least some of the extension.
Medicare and Medicaid stamps | Image credit: Olivier Le Moal – stock.adobe.com
April 30th 2024

Medicaid, Medicare Policy Changes Could Lead to More Than 25,000 Additional Deaths, Study Says

Hayden E. Klein
Researchers also estimated that more than 700,000 Americans with diabetes could lose insurance coverage if these proposed retractions are put into place, with some new policies already in effect.
AJMC
April 8th 2024

High-Need Beneficiary Enrollment Patterns in Medicare Advantage and Traditional Medicare

Aig Unuigbe, PhD Inna Cintina, PhD Julia Sheriff, MAS Lane Koenig, PhD
Accounting for 32% of all Medicare enrollees in 2019, high-need beneficiaries were more likely to be in traditional Medicare than Medicare Advantage.
Technology Helps Community Oncology Practices Implement PCM, CCM
February 14th 2024

Technology Helps Community Oncology Practices Implement PCM, CCM

Cameron Santoro
Pills on top of money | image credit: Cagkan - stock.adobe.com
January 9th 2024

Americans Often Pay 3 Times More for Medicare Drugs Up for Negotiation Than Comparable Countries

Laura Joszt, MA
Based on a comparison of prices for drugs up for Medicare price negotiations, there is a long way to go to reach the prices of 7 comparable countries.
Gavel and Stethoscope | Image credit: Andy Dean - stock.adobe.com
October 5th 2023

Alleged Medicare Fraud: Fresenius Vascular Care Faces Civil Lawsuit for Unnecessary Surgeries

Giuliana Grossi
Fresenius Vascular Care's own research reportedly showed these surgeries not only failed to benefit patients with end-stage renal disease, but also potentially damaged their ability to receive essential dialysis treatment.
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April 25th 2023

Understanding Factors Associated With Increases in Medicare Advantage Enrollment, 2007-2018

Adam Atherly, PhD Roger Feldman, PhD Eline M. van den Broek-Altenburg, PhD Bryan Dowd, PhD
Increases in Medicare Advantage market share over the past 10 years are largely caused by an increased preference for managed care among Medicare beneficiaries.
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April 4th 2023

Part D Beneficiaries’ Incentives and Responses Under Preferred Pharmacy Networks

Jianhui Xu, PhD Erin Trish, PhD Geoffrey Joyce, PhD
Under preferred pharmacy networks, unsubsidized Part D beneficiaries faced substantial incentives and moderately switched toward preferred pharmacies, whereas subsidized beneficiaries were insulated and demonstrated little switching.
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March 15th 2023

Eliminating Defects in Value: Turnaround of an MSSP ACO

Peter J. Pronovost, MD, PhD Patrick Runnels, MD, MBA Mark E. Schario, MS, RN Tomasina Green, MPH Kelsey A. Fuller, MS Heather M. Byrne, MPA-HSA, CNMT Valerie Reese, MEd Tyler D. Barnett, MHSA Kaitlin Mabin, BA George Topalsky, MD
A health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.
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March 9th 2023

Development of a Medicare Plan Dashboard to Promote Health Equity

Steven C. Martino, PhD Megan Mathews, MS Megan K. Beckett, PhD Denis Agniel, PhD Katrin Hambarsoomian, MS Sarah Hudson Scholle, DrPH Sierra Collins, MHA Denise D. Quigley, PhD Biayna Darabidian, BA Marc N. Elliott, PhD
Health plans use data to decide on quality improvement initiatives. Having a dashboard that characterizes how equitably plans are serving their enrollees would promote health equity.
humana logo
February 23rd 2023

Humana Leaving Commercial Business, Will Focus on Government-Funded Programs

Laura Joszt, MA
Over the next 18 to 24 months, Humana is exiting the commercial health plan business to focus on government-funded programs, like Medicare Advantage, and specialty businesses.
Evidence-Based Oncology logo
December 2nd 2022

Breaking New Ground in Episodes of Care, Including CAR T-Cell Therapy

Mary Caffrey
Coverage from the Institute for Value-Based Medicine® session with Astera Cancer Care in Edison, New Jersey, held November 3, 2022.
Patient in hospital.
October 25th 2022

Updated Clinical Practice Guidelines for CDI Show Improved Outcomes, but Adherence Issues Remain

Matthew Gavidia
Improved outcomes associated with fidaxomicin compared with vancomycin suggest benefits from its greater use in Medicare patients, although uptake remains low despite its recommended use.
Population health.
September 30th 2022

Panel Reviews Health Inequities and Opportunities for Innovation Through Population Health Delivery

Matthew Gavidia
A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.
New Enhancing Oncology Model Builds on Knowledge From the OCM
August 15th 2022

New Enhancing Oncology Model Builds on Knowledge From the OCM

Stuart Staggs, MSIE
OCM Successor Puts Focus on Equity in Cancer Care—With Fewer Dollars for Services
August 15th 2022

OCM Successor Puts Focus on Equity in Cancer Care—With Fewer Dollars for Services

Mary Caffrey
Contributor: How Medication Risk Scores Improve Health for Medicare Beneficiaries
July 27th 2022

Contributor: How Medication Risk Scores Improve Health for Medicare Beneficiaries

Michael S. Awadalla
Medication risk scores analyze an individual’s medication regimen to look for the potential for simultaneous, multi-drug interactions, which can cause adverse drug events and other medication-related harms.
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