# Medicare * **Definition:** A federal health insurance program in the United States for people aged 65 and older, certain younger individuals with disabilities, and those with End-Stage Renal Disease, providing coverage for hospital stays, outpatient care, and various medical services. * **Taxonomy:** Healthcare Topics / Medicare ## News * Selected news on the topic of **Medicare**, for healthcare technology leaders * 37.1K news items are in the system for this topic * Posts have been filtered for tech and healthcare-related keywords | Date | Title | Source | | --- | --- | --- | | 5/26/2025 | [**Defaulting Into Medicare Advantage: What It Could Mean For Medicare And Its Beneficiaries**](https://www.healthaffairs.org/content/forefront/defaulting-into-medicare-advantage-could-mean-medicare-and-its-beneficiaries) | [[Health Affairs]] | | 4/28/2025 | [**When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too**](https://californiahealthline.org/news/article/hospitals-abandon-medicare-advantage-plans-members-quit-too/) | [[California Healthline]] | | 4/23/2025 | [**Need Help Enrolling in Medicare? Free Resources - Retirement Daily on TheStreet**](https://www.thestreet.com/retirement-daily/social-security-medicare/need-help-enrolling-free-resources) | [[TheStreet]] | | 4/22/2025 | [**PureWick External Catheters and Medicare**](https://www.aol.com/lifestyle/purewick-external-catheters-medicare-005900216.html) | [[AOL]] | | 4/17/2025 | [**LifeMD Expands Insurance Acceptance to Medicare Beneficiaries for Qualifying Virtual ...**](https://finance.yahoo.com/news/lifemd-expands-insurance-acceptance-medicare-120000951.html) | [[Yahoo Finance]] | | 4/14/2025 | [**Medicare Supplement Plans in Colorado in 2025**](https://www.aol.com/medicare-supplement-plans-colorado-2025-064245980.html) | [[AOL]] | | 4/14/2025 | [**Does Medicare cover glasses and contact lenses? - Yahoo**](https://www.yahoo.com/lifestyle/does-medicare-cover-glasses-171622957.html) | [[Yahoo]] | | 4/11/2025 | [**Medicare Supplement Plans in Montana in 2025**](https://www.aol.com/medicare-supplement-plans-montana-2025-070602850.html) | [[AOL]] | | 4/11/2025 | [**Medicare's allowable rates - AOL.com**](https://www.aol.com/medicares-allowable-rates-002500652.html) | [[AOL]] | | 4/3/2025 | [**Medicare Advantage is covering more and more Americans some because they don't get ...**](https://theconversation.com/medicare-advantage-is-covering-more-and-more-americans-some-because-they-dont-get-to-choose-251796) | [[The Conversation]] | | 4/3/2025 | [**Medicare in Nevada: What to Know in 2025 - AOL.com**](https://www.aol.com/medicare-nevada-know-2025-143654593.html) | [[AOL]] | | 3/25/2025 | [**What to Know About the Pros and Cons of Privatizing Medicare**](https://www.healthline.com/health/medicare/privatizing-medicare-pros-and-cons) | [[Healthline]] | | 3/18/2025 | [**Oz Intensifies Spotlight on Medicare Insurers' Payments Practice - Bloomberg Law News**](https://news.bloomberglaw.com/pharma-and-life-sciences/oz-intensifies-spotlight-on-medicare-insurers-payments-practice) | [[Bloomberg Law]] | | 3/2/2025 | [**Rewarding Medicare Advantage D-SNPs That Provide The Best Value**](https://www.healthaffairs.org/content/forefront/rewarding-medicare-advantage-d-snps-provide-best-value-dually-eligible-individuals) | [[Health Affairs]] | | 2/24/2025 | [**Understanding Medicare Advantage**](https://www.aol.com/health/medicare/medicare-advantage-guide/) | [[AOL]] | | 2/20/2025 | [**Medicare Advantage plans are hurting rural hospitals: Report**](https://www.chiefhealthcareexecutive.com/view/medicare-advantage-plans-are-hurting-rural-hospitals-report) | [[Chief Healthcare Executive]] | | 2/14/2025 | [**How Much Does Medicare Advantage (Part C) Cost?**](https://www.forbes.com/advisor/health-insurance/medicare/medicare-advantage-cost/) | [[Forbes]] | | 12/26/2024 | [**The Medicare Advantage Program: Public Money Insurance Companies**](https://www.jdsupra.com/legalnews/the-medicare-advantage-program-public-2206337/) | [[JD Supra]] | | 12/18/2024 | [**The pros and cons of Medicare Advantage plans**](https://www.aol.com/finance/pros-cons-medicare-advantage-plans-160945729.html) | [[AOL]] | | 12/17/2024 | [**The pros and cons of Medicare Advantage plans - Fortune Well**](https://fortune.com/well/article/medicare-advantage-part-c-plans-pros-cons/) | [[Fortune]] | | 12/17/2024 | [**The pros and cons of Medicare Advantage plans - Yahoo**](https://www.yahoo.com/lifestyle/pros-cons-medicare-advantage-plans-160945541.html) | [[Yahoo]] | | 12/3/2024 | [**Dec. 7 Medicare enrollment deadline nears: Last chance to enroll or update plans for Jan. 1 coverage**](https://www.globenewswire.com/news-release/2024/12/03/2990904/0/en/Dec-7-Medicare-enrollment-deadline-nears-Last-chance-to-enroll-or-update-plans-for-Jan-1-coverage.html) | [[Globe Newswire]] | | 9/20/2024 | [**What Is the Medicare Qualified Disabled and Working Individuals (QDWI) Program?**](https://www.aol.com/medicare-qualified-disabled-working-individuals-081500987.html) | [[AOL]] | | 9/6/2024 | [**Original Medicare vs. Medicare Advantage: What's The Difference?**](https://www.forbes.com/health/medicare/original-medicare-vs-medicare-advantage/) | [[Forbes]] | | 8/30/2024 | [**Qstic accuracy in the ED for Medicare beneficiaries with and without Alzheimer's disease**](https://www.msn.com/en-us/health/other/q-a-diagnostic-accuracy-in-the-ed-for-medicare-beneficiaries-with-and-without-alzheimer-s-disease/ar-AA1pJar2) | msn.com | ## Topic Overview (Some LLM-derived content — please confirm with above primary sources) ### Key Players - **Medicare**: A federal health insurance program primarily for individuals aged 65 and older, but also for younger individuals with disabilities or specific diseases. - **Centers for Medicare and Medicaid Services (CMS)**: The federal agency that administers Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), responsible for overseeing Medicare Advantage plans and implementing policy changes. - **Medicare Advantage Plans**: Private insurance plans that provide Medicare benefits, often including additional services beyond Original Medicare. - **Centers for Medicare & Medicaid Services (CMS)**: The federal agency responsible for administering Medicare and overseeing Medicare Advantage plans. - **Private Insurance Companies**: Companies like UnitedHealthcare and Aetna that offer Medicare Advantage plans, providing additional benefits beyond Original Medicare. - **Better Medicare Alliance**: An organization that advocates for Medicare Advantage and conducts research on its benefits. - **UnitedHealthcare**: One of the largest providers of Medicare Advantage plans, accounting for a significant portion of enrollment. - **Humana**: Another major player in the Medicare Advantage market, providing various health plans to beneficiaries. - **UnitedHealth Group**: A major player in the Medicare Advantage market, benefiting significantly from differential coding patterns that lead to higher payments. - **Medicare Advantage Insurers**: Private insurance companies that offer Medicare Advantage plans, providing an alternative to Original Medicare, including companies like Aetna, Humana, and UnitedHealthcare. ### Partnerships and Collaborations - **Forbes Advisor**: Provides market snapshots and resources for individuals considering Medicare Advantage plans, helping them understand options and costs. - **Bezzy Communities**: Offers a platform for individuals with chronic conditions to connect, enhancing support for Medicare beneficiaries. - **LifeMD and Medicare**: LifeMD has expanded its virtual care services to Medicare beneficiaries, enhancing access to essential healthcare services. - **CMS and State Health Insurance Assistance Programs (SHIP)**: Collaboration to provide personalized counseling and assistance to Medicare beneficiaries, helping them navigate their options. - **Fair Square Medicare**: A tech-enabled service that assists seniors in navigating Medicare options, recently launched an AI platform to enhance the enrollment experience. - **Health Affairs Forefront**: A series focused on Medicare and Medicaid integration, aiming to inform policies for integrated care for individuals eligible for both programs. - **Clover Health and Healthcare Providers**: Clover Health aims to enhance patient access and collaboration with healthcare providers to ensure Medicare beneficiaries receive necessary care. - **New York StateWide Senior Action Council**: Works to raise awareness about Medicare fraud and provides resources to help seniors protect themselves. - **KFF (Kaiser Family Foundation)**: Conducted analyses on Medicare beneficiaries' behaviors and coverage options, highlighting the need for better engagement during open enrollment. - **SelectHealth**: A nonprofit healthcare company offering Medicare Advantage plans, promoting community health through partnerships and volunteerism. - **CMS and ACOs**: CMS collaborates with ACOs to enhance care delivery for Medicare beneficiaries while reducing costs through shared savings programs. - **Braven Health**: Founded by Horizon Blue Cross Blue Shield of New Jersey, Hackensack Meridian Health, and RWJBarnabas Health, focusing on Medicare Advantage offerings. - **Vermont Healthcare 911**: A group addressing high healthcare costs in Vermont, highlighting financial losses faced by UVM Medical Center on Medicare patients. - **Local Healthcare Systems**: Collaborations with local health systems to provide comprehensive care and address social determinants of health. ### Innovations, Trends, and Initiatives - **Expansion of Coverage**: Medicare is expanding to include community health services, addressing social determinants of health. - **Shift towards Medicare Advantage**: An increasing number of beneficiaries are choosing Medicare Advantage plans over Original Medicare, with projections indicating that 54% will enroll in 2024, up from 37% in 2018. - **Medicare Advantage Growth**: As of 2024, 54% of eligible beneficiaries are enrolled in Medicare Advantage plans, reflecting a significant trend towards private insurance options. - **Special Supplemental Benefits for the Chronically Ill**: Recent expansions in Medicare Advantage plans allow for tailored benefits catering to individuals with specific health needs. - **Medicare Coverage of Innovative Technologies (MCIT)**: A proposed program to provide automatic coverage for breakthrough devices approved by the FDA, aimed at improving access to new technologies. - **Customer Satisfaction Trends**: Medicare Advantage plans outperform commercial health plans in customer satisfaction, driven by ease of access and low out-of-pocket costs. - **Medicare Drug Price Negotiation Program (MDPNP)**: Aims to lower drug costs for seniors but raises concerns about access to medications for independent pharmacies. - **Out-of-Pocket Cap**: Starting in 2025, a $2,000 cap on out-of-pocket costs for Medicare Part D will be implemented, benefiting those with high prescription drug expenses. - **Capping Insulin Copays**: New legislation caps insulin copays for Medicare patients at $35, enhancing affordability for chronic disease management. - **FDA Drug Approvals**: Recent approvals of Alzheimer's medications have prompted discussions on how Medicare can manage the costs associated with dementia care. - **Capping Out-of-Pocket Costs**: Starting in 2025, Medicare Part D will cap out-of-pocket prescription drug costs at $2,000, providing financial relief to beneficiaries. - **Prior Authorization Reforms**: CMS has introduced new rules to reduce denials in Medicare Advantage plans, aiming to improve access to necessary healthcare. - **Truvada Coverage**: Proposed updates may allow Truvada, a medication for HIV prevention, to be covered under Medicare Part B, reducing costs for beneficiaries. - **Annual Enrollment Period**: The open enrollment period from October 15 to December 7 allows beneficiaries to review and change their Medicare plans, with significant changes expected in 2025. - **AI in Medicare Enrollment**: The introduction of AI platforms like Vox aims to streamline the Medicare enrollment process and improve customer service. - **Telehealth Coverage Extension**: The federal government has extended Medicare telehealth coverage, ensuring access to essential healthcare services for millions. ### Challenges and Concerns - **Medicare Advantage Costs**: Criticized for being costly to taxpayers, with estimates suggesting it overcharges between $88 billion to $140 billion annually. - **Access to Care**: Beneficiaries on Medicare Advantage often struggle with accessing and affording care compared to those on traditional Medicare, particularly in rural areas. - **Privatization Debate**: The ongoing discussion about the potential privatization of Medicare raises concerns about access to care and the quality of services for beneficiaries. - **Medicare Advantage Limitations**: While Medicare Advantage plans offer lower out-of-pocket costs, they often come with restricted provider networks and potential for unexpected costs. - **Medicare Advantage Network Adequacy**: Concerns regarding the adequacy of narrow network plans in Medicare Advantage, particularly for individuals with complex health needs. - **Scams Targeting Beneficiaries**: Increased scams during the Medicare open enrollment period, with scammers posing as Medicare representatives to exploit vulnerable individuals. - **Fraud and Scams**: Medicare fraud remains a significant issue, costing taxpayers billions annually, necessitating ongoing education and prevention efforts. - **Privatization Risks**: Debates over the potential privatization of Medicare through increased reliance on Medicare Advantage plans, which may lead to higher costs and restricted care options. - **Enrollment Complexity**: Beneficiaries face challenges in understanding their options between Original Medicare and Medicare Advantage, including hidden costs and provider network limitations. - **Quality of Care in Medicare Advantage**: Reports indicate that Medicare spends significantly more on beneficiaries who switch from Medicare Advantage to traditional Medicare, raising questions about the adequacy of care in Medicare Advantage plans. - **Awareness of Benefits**: Many seniors enrolled in Medicare Advantage are unaware of supplemental services, such as dental and vision coverage, leading to questions about the value of these plans. - **Insurance Consolidation**: Mergers and market exits among insurers are reducing the number of available Medicare plans, leading to higher costs and fewer options for beneficiaries. - **Medicare Advantage Denials**: High rates of service denials and prior authorization issues in Medicare Advantage plans lead to delays in care and increased out-of-pocket costs for patients. - **Access to Mental Health Care**: A decline in psychiatrists billing Medicare, raising concerns about access to mental health services for Medicare enrollees. - **Potential Depletion of Medicare Trust Fund**: The Medicare hospital trust fund may deplete by 2035, raising concerns about the program's long-term financial sustainability and the need for reforms. - **Access to Care Issues**: Medicare Advantage enrollees may face limited access to healthcare providers due to changing networks. - **Provider Network Issues**: Medicare Advantage plans may limit access to providers and require referrals, complicating care for enrollees with high healthcare needs. - **Cost Justification**: The federal government spends significantly more on Medicare Advantage plans than on traditional Medicare, raising concerns about the justification for these increased costs. ## Related Topics [[Medicare Advantage]]; [[Medicaid]]