Medicare

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.

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.

After a small number of practices joined the Enhancing Oncology Model (EOM) in 2023, CMS has made some changes and opened the model back up for new practices to join.

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.

The Center on Health Equity & Access provides the latest news, research, and expert opinions on the state of equity in health care.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Accounting for 32% of all Medicare enrollees in 2019, high-need beneficiaries were more likely to be in traditional Medicare than Medicare Advantage.

Julie Patterson, PharmD, PhD, senior director of research at the National Pharmaceutical Council, discussed potential impact of the Inflation Reduction Act of 2022 (IRA) on small molecule drug research and development investments toward subsequent indications.

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.

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.

Increases in Medicare Advantage market share over the past 10 years are largely caused by an increased preference for managed care among Medicare beneficiaries.

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.

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.

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.

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.