On August 27, 2023, as part of the Inflation Reduction Act, Medicare announced they have chosen the first 10 drugs that will be negotiated for 2026: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/Novolog.
June, 2023, CMS is notifying people of a data breach the occurred at Maximus Federal Services, one of Medicare’s contractors. Up to 11 million people, including 612,000 Medicare beneficiaries, were affected. You can read more here. https://www.cms.gov/newsroom/press-releases/cms-responding-data-breach-contractor
Piedmont Hospital System has announced that effective September 6, 2023, they are no longer in network with Humana Medicare Advantage plans. As there is no special enrollment to make a change you will want to find doctors in your network.
Effective February 2023, the Medicaid Redetermination process will begin. The Medicaid Redetermination process was halted in 2020 due to Covid. This allowed people who did not qualify to remain on the program.
As of 2/13/2023, the following hospitals are not in compliance with a federal law requiring all hospitals to post rates for services online:
- Grady Memorial Hospital
- Emory Decatur Hospital
- Emory Saint Joseph’s Hospital
- Emory University Hopital
- Midtown Fairview Park Hospital
- Wellstar Cobb Hospital
- Wellstar Kennestone Hospital
- Wellstar West Georgia Medical Center
CMS has announced 2023 Medicare premium information. Click here for more information.
Last year, CMS approved the 2022 standard Part B premium of $170.10 to help pay for the Alzheimer’s drug, Aduhelm. Last week, CMS announced that due to lower-than-expected spending, they expect to lower the Part B for 2023.
September 27, 2022: CMS announced 2023 Medicare premium and deductible information. Typically, this is released in November each year.
The standard 2023 Part B Premium will go down to $164.90 each month, a decrease of $5.20. The 2023 Part B Deductible will go down to $226, a decrease of $7.
On the other hand, the 2023 Part A Premium will be $506 each month, a $7 increase. Most people DO NOT pay a Part A premium so this should not concern most people. The 2023 Part A Deductible is increasing by $44 and will be $1600 per benefit period (a benefit period is 60 days). Even if you do not pay a Part A Premium you will be affected by the Part A Deductible unless you have a Medicare Supplement or Medicare Advantage Plan that takes care of it for you.
July, 2022: Centers for Medicare & Medicaid Service (CMS) has delayed implementation of a ruling requiring that pharmacies pass price concessions received for a Part D covered drug on to a Part D member at the point of sale. Currently, if a pharmacy receives a performance related price concession, they keep it. Expected to go into effect January 1, 2024.
May 27, 2022: Last year, CMS approved the 2022 standard Part B premium of $170.10 to help pay for the Alzheimer’s drug, Aduhelm. Last week, CMS announced that due to lower-than-expected spending, they expect to lower the Part B for 2023.
April 29, 2022: Centers for Medicare & Medicaid Service (CMS) has proposed a ruling requiring that pharmacies pass price concessions received for a Part D covered drug on to a Part D member at the point of sale. Currently, if a pharmacy receives a performance related price concession, they keep it.
March 29, 2022: Anthem, a subsidiary of BCBS, has been fined $5 Million by the Georgia Insurance Commissioner for claims processing errors dating back to 2015. Just one of the claims processing errors caused claims for services by in-network providers to be billed as out-of-network.
January, 2022: Anthem BCBS is in contract negotiations with Northside Hospital System. Coverage has been extended to April 15, 2022. If you are on an Anthem Medicare Advantage Plan or other HMO/PPO you are affected by these negotiations. Those on Anthem Medigap and BCBS Medigap plans are not affected.
The Biden Administration has had talks about cutting funding for Medicare Advantage plans in order to help fund their infrastructure package. Cutting funds to MA plans would greatly increase the cost of these plans for beneficiaries and could greatly reduce benefits.
CMS has announced the Medicare Part B Premium will go up to $170.10 (Standard) and the Part B Deductible will be $233 in 2022. Keep in mind, you will receive a 5.9% COLA increase on your Social Security.
Effective January 1, 2022, the entire Wellstar Hospital system, including Wellstar providers, are out-of-network with UnitedHealthcare. All contract requests were agreed to by UnitedHealthcare with the exception of one: group plans would see an increase in reimbursements by as much as 50% making it unaffordable to employees. Wellstar is already the highest paid hospital system in Georgia. Read more about it here
October 27, 2021: Some media outlets are reporting that the Biden Administration has had talks about cutting funding for Medicare Advantage plans in order to help fund their infrastructure package. Cutting funds to MA plans would greatly increase the cost of these plans for beneficiaries and could greatly reduce benefits.
October 12, 2021, UnitedHealthcare has confirmed Wellstar Health System in-network access has been extended to December 31, 2021. Wellstar’s contract with UnitedHealthcare ended October 3, 2021, and negotiations are ongoing.
October 8, 2021: Centers for Medicare and Medicaid has issued guidance to insurers regarding deceptive marketing practices. Statistically, 62.6 million people are enrolled in Medicare and marketing to this group is rampant with fraud. At the heart of this fraud are commercials and call centers. The commercials feature well known spokespersons who promise “free benefits” not available for most people and play upon fears. Additionally, phone calls and door knockers are included in this group. It remains to be seen when changes will occur.
In Georgia, Wellstar Health Systems may be out of network for UnitedHealthcare Medicare Advantage Plans effective October 3, 2021. Contract negotiations are ongoing. Wellstar Health Systems is seeking a reimbursement increase of over 20%, making their services 50% higher than other hospitals in Georgia.
June 7, 2021: Aduhelm, a new infusion therapy drug purported to treat mild Alzheimer’s, has been rushed through FDA approval despite serious concerns about its effectiveness as well as side effect including swelling and brain bleeding during clinical trials. If ineffective, this infusion therapy would cost thousands in out-of-pocket costs for Medicare Advantage members.
Medicare recipients in Georgia, Alabama, Florida, North Carolina, Tennessee and Virginia may be eligible for a Special Election to make a plan change. Please contact us for further information.
Biden Adminsitration has approved a Special Enrollment Period for individual health plans. If you missed the annual enrollment, you now have until August 15, 2021, to choose a plan.
June 16, 2019: Legislation that would establish electronic prior authorization for Medicare Advantage plans has been introduced to House of Representatives. Improving Seniors’ Timely Access to Care Act (H.R. 3107) would establish electronic prior authorization for Medicare Advantage plans allowing for real-time decisions on tests and services commonly approved. Electronic PA would improve patient access to timely care and reduce paperwork and appeals.