JustCare

Tag: Coverage

  • Few psychiatrists accept Medicare

    Few psychiatrists accept Medicare

    If you and your spouse are not working, you likely need to enroll in Medicare at 65. But, as with many health insurance policies, it is extremely difficult to find psychiatrists who will accept Medicare coverage, reports Eugene Rubin, M.D. for Psychiatry Today.

    A study by John Havlik et al., reported in JAMA Network, finds that just over 18,000 psychiatrists were willing to bill Medicare for their services, out of a total of more than 56,000 psychiatrists nationwide.  The number willing to bill Medicare decreased by nearly 4,000 over eight years between 2014 to 2022.  That’s a 16.8 percent decrease in the number of shrinks willing to bill Medicare. Overall, only about one in three psychiatrists take Medicare.

    The researchers could not study the number of psychiatrists who contract with Medicare Advantage plans. But, overall, fewer physicians agree to work with Medicare Advantage plans than traditional Medicare. And, Medicare Advantage plans do not tout their great mental health coverage. So, it’s more than likely that it’s even harder to see a shrink in Medicare Advantage than in traditional Medicare.

    Other research has shown that people with Medicare can wait up to six months to see a therapist. But, Medicare now covers mental health care from marriage and family therapists, mental health counselors, and drug addiction specialists, as well as psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers, increasing the pool of mental health providers available for people with Medicare.

    People with employer coverage and in state health insurance plans also struggle to get insurance coverage for visits to the shrink. Fewer than three in five shrinks accept any health insurance.

    To be clear, access to Medicare coverage for visits to the shrink differs depending on where you live. In Wyoming, for example, there are just 13.8 shrinks who take Medicare for every 100,000 people with Medicare, in Mississippi, 22.1 shrinks, and Montana, 27.4 shrinks. In Rhode Island, there are 174.7 shrinks for every 100,000 people with Medicare. In nine states, there are fewer than 40 shrinks for every 100,000 people with Medicare.

    While Medicare Part B covers mental health services for people enrolled in Medicare Advantage and traditional Medicare, the federal mental health parity laws do not apply to Medicare. They should!

    Here’s more from Just Care:

  • Poll: Few Americans are happy with health care quality

    Poll: Few Americans are happy with health care quality

    Who could possibly be happy with the quality of care in the United States? Almost no one. A recent Gallup poll should raise alarm bells.

    The cost of health insurance is insane. Insurer restrictions on the physicians and hospitals they will cover is limited and, with deceptive provider directories, misleading. Insurer requirements for preapproval of costly procedures is burdensome. Delays in prior authorization are often harmful to people’s health. And, copays can be exorbitant.

    Findings from a December 6, 2024 Gallup poll underscore the degree of American dissatisfaction with our health care system. Notwithstanding the Affordable Care Act and high levels of insurance coverage, people in the US believe that the quality of care is the worst it has been since 2001, when Gallup first began asking the question.

    1. 89 percent of Americans did not consider US health care to be “excellent.”

    2. One third of Americans (33 percent) consider health care quality “good;” in 2020, 43 percent said it was good.

    3. Nearly four in ten Americans (38 percent) said quality is “only fair.”

    4.  Sixteen percent of Americans consider health care quality to be “poor.”

    5. Only about half of Democrats have a positive view of health care quality. Eight percent fewer Republicans had a positive view.

    6. Americans think less of health care coverage in the US than health care quality. Not even one in three Americans (28 percent) rated health care coverage as “excellent” or “good.” People polled consider  health care coverage worse by four points than in 2001.

    7. As for health care costs, not even two in ten Americans (19 percent) were satisfied. People polled consider health care costs worse by three points than in 2001. Nearly one in four Americans (23 percent) said costs were the top health care problem.  Health care access was the second biggest (14 percent) health care problem.

    Here’s more from Just Care:

  • Will the Trump administration support Medicare coverage of Ozempic?

    Will the Trump administration support Medicare coverage of Ozempic?

    Among his final acts as President of the United States, Joe Biden proposed Medicare coverage of Ozempic for obese individuals. It will be up to the Trump administration to decide whether to finalize this proposal or kill it. What would RFK Jr. do about Medicare coverage of Ozempic if he is confirmed as head of the US Department of Health and Human Services posits Jonathan Cohn for The Huffington Post?

    Cohn explains that Medicare coverage of Ozempic would be consequential for millions of people. It would deliver potentially significant benefits to them. At the same time, it could cost the Medicare program a tremendous amount of money.

    Ozempic is a glucagen-like peptide or GLP-1 agonist because it works just like a hormone in our bodies that reduces our blood sugar and desire to eat. GLP-1’s have delivered health benefits since the early 2000’s. They became popular when they could be taken once a week. They are also sometimes referred to as semaglutide.

    Semaglutide–marketed in some cases as Ozempic or Wegovy–treats diabetes, heart disease as well as weight loss. But, it is quite costly, with prices as high as $1,000 a month.

    Today, Medicare only covers semaglutide for people with diabetes and heart disease. By law Medicare covers medically reasonable and necessary treatments for health conditions, with a few exceptions, including weight-loss. The Biden administration is now arguing that when people are found to be obese, it threatens their health, and a semaglutide affords them medically reasonable and necessary treatment.

    If the Trump administration finalizes coverage of semaglutide, the price tag is projected to be around $40 billion over ten years. More than ten percent of the 65 million people with Medicare are obese. But, if the Trump administration does not repeal Biden’s Inflation Reduction Act, which allows for Medicare drug price negotiation, the federal government would have the power to pay a lower price for the drug beginning in 2027.

    RFK Jr. has said that he opposes coverage of semaglutide. He argues that obesity stems from malnutrition. We should be spending taxpayer dollars on healthy meals for Americans, not using it to boost Pharma profits.

    To be clear, the evidence shows that people are obese for a number of reasons, and many of those reasons have nothing to do with healthy eating.

    Here’s more from Just Care:

  • Medicare Advantage offers less care at greater cost

    Medicare Advantage offers less care at greater cost

    In a paper for JAMA Network, Adam Gaffney et al. suggest the time is ripe for cutting our losses in Medicare Advantage and strengthening traditional Medicare for two reasons. People in Medicare Advantage face obstacles to care and coverage that they need, endangering their health, that patients in traditional Medicare do not face. And insurers offering Medicare Advantage are charging the government tens of billions of dollars more than we spend in traditional Medicare, driving up Medicare costs.

    No question mountains of data support Gaffney’s position. Just as people with commercial health insurance, people in Medicare Advantage face lots of challenges getting needed care. They must overcome myriad prior authorization requirements, especially when they need costly care, unlike people in traditional Medicare. And, they often struggle to see physicians and access hospitals they want to use.

    Gaffney further suggests that incremental reforms to the MA payment and coverage systems will not fix these big problems. They are always too small. And, insurers find ways around them. Between 2007 and 2023, the government paid insurers $612 billion extra for covering their enrollees than it would have paid had these enrollees been in traditional Medicare. Of the money, $592 billion — 97 percent — went to insurer overhead and profits.

    Today, people in Medicare Advantage plans receive nine percent fewer Medicare-covered services than people in traditional Medicare. For sure, these are the people who most need care. These are the people that Medicare Advantage plans try to avoid enrolling and, if they enroll, encourage to disenroll.

    Moreover, Medicare Advantage plans do not have to set up shop in areas where they see few profits, and there’s no way to make them do so. The model is flawed at its core.

    There’s no denying that people, overall, are happy in their Medicare Advantage plans. That’s because they have an out-of-pocket maximum rather than a need to buy supplemental coverage, as people in traditional Medicare do. And, it’s because they often get free gym memberships or some dental care or eyeglasses.

    If people are healthy, they might be better off in Medicare Advantage. But, Medicare is paying an average of $13,000 on them, even though they don’t need care; they cost little or nothing. If they become ill, it can be a struggle for them. That’s not a workable health insurance model, particularly for older, frailer and more vulnerable Americans.

    Here’s more from Just Care:

  • How other wealthy countries deliver superior health care coverage to the US

    How other wealthy countries deliver superior health care coverage to the US

    Aaron Carroll, President and CEO AcademyHealth, writes about our broken health care system on the Commonwealth Fund blog and explains how other wealthy countries do better for their citizens and offer them near total protection from health care costs. He suggests that if we look to other countries, we can find ways to fix our health care system without moving to single-payer or keeping things as they are. Hmmmm….

    Carroll points out that insurance is designed to pool resources so that we share the cost of unforeseen health needs. With insurance, we should be able to afford our care and not face financial ruin. In the US, even with the Affordable Care Act, we have 26 million uninsured Americans. Every other wealthy and many middle and low-income countries have universal coverage.

    In Switzerland, Carroll says that there is no program like Medicare or Medicaid but rather private insurance only throughout the course of each citizens’ life. They have insurance independently of their employment. Insurers are prohibited from profiting from this “basic” insurance. People have high out-of-pocket costs. It’s not clear from Carroll’s description whether the government mandates these costs. Insurers can profit from supplemental insurance.

    Singapore offers its citizens catastrophic coverage to protect them against financial ruin. People largely pay for doctors’ visits and other outpatient care themselves. They are required to contribute some of their earnings to health savings accounts, which they can then use to cover their outpatient care. For inpatient services such as hospital care, Singapore offers different insurance coverage levels. The basic level is relatively inexpensive to ensure essential health care needs are met. For a higher cost, you get better coverage, such as faster access to care.

    Canada covers everyone directly through the government; it’s a single-payer system called Medicare. Taxes cover most costs. The government sets the rules of coverage. Medically necessary inpatient and outpatients services, as well as dental services are covered, but not prescription drugs or vision care.

    Australia, like Canada, covers everyone directly for citizens who use the public delivery system. It’s a single-payer system that is also called Medicare. It covers most inpatient and outpatient care as well as preventive care and community services. However, people can forego public care in favor of private care, better care access, and improved benefits such as vision care, at additional cost; about one in three Australians do. Taxes, based on income, along with copays, cover the costs of the single-payer system.

    New Zealand offers government coverage, much like Australia, though it focuses more on community-based care and public health initiatives. It covers inpatient and outpatient care and prescription drugs. Taxes cover most costs, along with copayments. People can opt for a private system that delivers speedier access to non-urgent care as well as improved benefits; about one in three New Zealanders do.

    France offers government coverage of inpatient and outpatient services as well as long-term care and prescription drugs. It’s system is called Social Security. Payroll taxes and other taxes cover the cost. Regional health agencies are charged with arranging coverage and care  delivery. Patients pay coinsurance, copayments, and physician charges above what the government covers. Virtually everyone buys private supplemental insurance, mostly from nonprofit companies, which pick up a lot of the out-of-pocket costs. Supplemental insurance also covers dental, hearing, and vision care.

    England‘s National Health Service (NHS) offers health care to all residents. It covers inpatient and outpatient services with no out-of-pocket costs. Taxes cover most costs and there is a global health care spending budget. No one is at risk of bankruptcy.

    Here’s more from Just Care:

  • Cigna medical directors given little incentive to review prior authorization denials thoroughly

    Cigna medical directors given little incentive to review prior authorization denials thoroughly

    A new Pro Publica report exposes how Cigna requires its medical directors to review prior authorization denials at breakneck speed, preventing patients from getting critical care. One medical director at Cigna revealed that, as of about five years ago, she was required to review so many coverage denials in a day as to keep her from ensuring patients received appropriate coverage for their care. This is yet another reason why enrolling in a Medicare Advantage plan entails significant risk if you develop a costly condition.

    Some states allow health insurance company nurses to decide whether someone in the US should get treatment without oversight by a physician. But, some states do not allow insurers to deny claims without a doctor reviewing them. In those states, a medical director must review the nurses’ decisions; but, health insurers can determine how long their medical directors spend on these reviews.

    A few years ago, Cigna began hiring nurses in the Philippines to make coverage determinations. Cigna’s medical directors in the US reviewed their denials. Dr. Debby Day, a Cigna medical director, explains that Cigna was not giving her the requisite time to do so.

    According to Dr. Day, the nurses in the Philippines have increasingly been inappropriately denying Cigna enrollees coverage. She refused to rubber stamp the nurses’ denials or “click and close” them as many of her fellow medical directors did.

    “Deny, deny, deny. That’s how you hit your numbers,” said Dr. Day, who worked for Cigna until the late spring of 2022. “If you take a breath or think about any of these cases, you’re going to fall behind.”

    In response to a Pro Publica query, Cigna claimed that its medical directors were not permitted to click and close nurses’ care denials. But, Cigna shared information about the number of case reviews each medical director was performing—“the productivity dashboard”– with all of them as a way to boost their productivity. The medical directors who performed fewer reviews were considered less productive.

    Companies in many industries typically study the efficiency of their workers. But, in health care, speedy reviews can lead to inappropriate denials of critical care or coverage for services.

    In January and February 2022, Cigna gave medical directors four minutes to review a prior authorization decision for an expensive treatment. Cigna gave them as little as two minutes to review a request for drug coverage. And, it gave medical directors just four and a half minutes to determine whether a patient should be discharged from hospital.

    As has been previously reported, Cigna and other insurers often use an algorithm to reject certain claims collectively.  On average, medical directors spend 1.2 seconds on those claims.

    Dr. Day spent more time reviewing coverage determinations than most of her peers. She felt that Cigna rewarded those who spent less time reviewing these determinations, without considering the quality of their work.

    In response to a question from Pro Publica about incentives to deny claims, Cigna argued that it took less time to approve them, failing to acknowledge that their nurses did the time-consuming work to “justify” denials and that clinicians simply had to click and close.

    Dr. Day explained that during the first several years she worked at Cigna, she was able to take the time she needed to review cases appropriately, but that all changed a few years ago. Once Cigna hired nurses in the Philippines to conduct the initial case review, Dr. Day found  a lot of mistakes in their case reviews that could lead to inappropriate denials. For example, nurses mistook a patient’s parent for the patient, a patient’s hip for her neck, and a patient’s STD for toenail fungus.

    Dr. Day said that Cigna was not focused on her correcting its nurses’ erroneous denials; rather, it was focused on her need to be more efficient. Cigna told her that if she did not review more cases and boost her productivity score, she could be fired. It’s no surprise she left the company.

    Here’s more from Just Care:

  • Medicare Advantage cannot rely exclusively on AI to deny coverage

    Medicare Advantage cannot rely exclusively on AI to deny coverage

    For some time now, UnitedHealth and other health insurance companies are reported to have been using artificial intelligence tools to broadly deny coverage in certain instances for people enrolled in Medicare Advantage plans. Insurers claim that the tools simply help them determine whether to deny a service. Use of these tools appears to have led to large numbers of inappropriate denials of care for Medicare Advantage enrollees, and the Biden administration is now stepping in reports SkilledNursingNews.

    The Centers for Medicare & Medicaid Services (CMS), which oversees Medicare, is restricting insurers’ ability to use AI tools to deny claims for Medicare Advantage enrollees. It issued an FAQ to insurers offering Medicare Advantage plans to ensure insurers understand that Medicare Advantage plans cannot deny care without considering individual patient’s needs.

    The FAQ explains how insurers can use algorithms and AI in Medicare Advantage. And, it clarifies coverage requirements for post-acute care to help ensure patients aren’t wrongly denied critical care. Insurers can use prior authorization, but not in an emergency or urgently needed care situations or for out-of-network services they cover.

    While insurers can use AI in determining whether to cover a service, they are responsible for making sure that the AI complies with the Medicare coverage rules. And, they can’t rely exclusively on AI. Insurers offering MA must consider each individual enrollee’s situation, including the enrollee’s medical history and treating physician’s recommendation, in deciding whether care is medically necessary. And, before an insurer ends services for MA enrollees, their individual conditions must be reevaluated.

    Furthermore, insurers must publicly release their coverage criteria on a website and cannot change it as they please, according to CMS. And, if your doctor says you need post-acute care in a rehab facility, your health insurer cannot second-guess that decision so long as you meet Medicare coverage criteria for such care.

    If an insurer still denies coverage, it bears the burden of proof on appeal that care is not medically necessary through a detailed explanation. And, a provider with expertise in that care must issue the denial.

    Here’s more from Just Care:

  • Employer-based health care doesn’t work for people with lower incomes

    Employer-based health care doesn’t work for people with lower incomes

    About 60 percent of people who are not over 65 have employer-sponsored health insurance, reports the Kaiser Family Foundation. But, a significant portion of people eligible for employer coverage, primarily people with incomes under 200 percent of the federal poverty level, do not take it because of the cost.

    Nearly 165 million people or about half the US population has employer-based health insurance. More than four in five employers offer coverage. As health care costs continue to rise and insurers delay and deny care and narrow their health care provider networks, even with insurance it can be hard to get care.

    The high cost of health insurance and the ability of employers to charge their workers for it mean that our health care system discriminates against people with lower incomes even when they are eligible for employer coverage. Not even one in four (23.9 percent) people with incomes under 200 percent of the federal poverty level, who are eligible for employer-sponsored health insurance, elect it. Six in ten eligible (59 percent) people with incomes between 200 and 400 percent of the federal poverty level elect it. But, more than eight in ten (84,2 percent) people with incomes above 400 percent of the federal poverty level elect it.

    Similarly, people with incomes under 200 percent of the poverty level were far less likely to work at a job that offered employer-sponsored health insurance than people with incomes over 4oo percent of the poverty level, 60.6 percent versus 88.2 percent. Because employers do not have to offer health insurance to all their workers, people with lower incomes end up less likely to have a job that offers them health insurance. About half of workers (49.5 percent) with incomes under 200 percent of the poverty level were eligible for coverage as compared to 84.6% of workers with incomes above 400% of the federal poverty level.

    Employer-based health insurance also leads to racial discrimination, benefiting White individuals far more than non-White people. Black people, Hispanic people and American Indians are significantly less likely to take advantage of employer-based coverage than White people. Not even four in ten American Indians (39.6 percent) get employer-based coverage for which they are eligible, as compared to 68.4 percent of White people. Forty-five percent of Hispanic people and 52.6 percent of Black people get employer-based coverage.

    Disparities in access to health insurance also exist by profession. People working in different industries have significantly different access to employer-sponsored health insurance. People working in fishing, farming and forestry are least likely to be offered employer-sponsored health insurance. Only 41.4 percent of them had access to coverage. In stark contrast, more than 85 percent of people working as professionals or in finance, business and other management positions had access to employer-coverage.

    Here’s more from Just Care:

  • 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan

    2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan

    The Annual Medicare Open Enrollment period begins October 15 and ends December 7. If you have Medicare, you are likely to see endless ads and receive lots of mail from an assortment of insurers chomping at the bit to get you to sign up with one of their Medicare Advantage plans. That’s how they rake in the big bucks, tens of billions of dollars a year. Unfortunately, our government does a poor job of helping you to understand differences between traditional Medicare, which is administered by the Centers for Medicare and Medicaid Services (CMS), and Medicare Advantage plans, which are administered by corporate health insurers that contract with the government. And, you can’t trust the corporate health insurers or their sales agents to tell you what you need to know.
    There are five basic differences between Traditional Medicare and Medicare Advantage that you need to understand.
    1. Coverage:
    Traditional Medicare. With traditional Medicare, you are covered for the medicallyreasonable and necessary care your providers believe you need. An insurance company is not second-guessing your doctors.
    Medicare Advantage. Medicare Advantage plans are supposed to cover the same benefits as traditional Medicare, but they cover significantly fewer, as has been documented over and over again. They often engage in widespread inappropriate delays and denials of care and generally require you to get approval before they will pay for most costly services. That’s how they maximize profits. If you think you might get sick or need costly health care at some point, even if you don’t need it now, think twice before signing up with a Medicare Advantage plan. No one provides you with the information you need to know to distinguish the good Medicare Advantage actors from the bad ones. And, there appear to be a lot of bad ones.
    2. Health care providers:
    Traditional Medicare. With traditional Medicare, you can see almost all doctors and use virtually all hospitals anywhere in the United States. Almost all take Medicare and more than 90 percent “take assignment,” accept Medicare’s approved charge as payment in full. The most they can charge is 15 percent above that amount.
    Medicare Advantage. With Medicare Advantage, your care is generally only covered when you use “in-network” providers. They can be few and far between and are often only located in your community. If you travel or spend time away from your primary residence, a Medicare Advantage plan usually will not cover your care, except in emergencies, Also, you might find that the providers in their directories are not taking new patients or have left the network. So, if you are thinking of joining a Medicare Advantage plan or are in one now, talk to any of the doctors you know you want to continue seeing to confirm that you will still be able to have your care covered when you see them. Keep in mind that a lot of the Medicare Advantage plans have lower quality providers in their networks and might not have a cancer center of excellence as part of their network.
    3. Costs:
    Traditional Medicare. With traditional Medicare you must pay your Part B monthly premium. You are generally liable for a hospital deductible and 20 percent of the cost of your medical care, unless you have supplemental coverage, either Medigap, which you buy in the individual market, Medicaid, or retiree coverage from a former employer. If you have supplemental coverage, most if not all of your costs will be covered. Traditional Medicare does not have an out-of-pocket maximum.
    Medicare Advantage. With Medicare Advantage, you pay your Medicare Part B premium and you might have no additional premium, but your out-of-pocket costs can be sky high. You cannot buy supplemental coverage to pick up your out-of-pocket costs. Your costs turn on the Medicare Advantage plan you choose, the care you need, and what the Medicare Advantage plan charges you for your care. You generally will have to pay a copay when you are hospitalized or need medical services. Your out-of-pocket costs can be over $8,000 for in-network care alone if you need costly care. But, each Medicare Advantage plan has its own out-of-pocket maximum. If you go out-of-network for your care, you will be liable for the full cost of your care, unless you are in a PPO (preferred provider organization), in which case you generally will be liable for 40 percent of the cost.
    4. Drugs:
    Traditional Medicare. With traditional Medicare, you will need to buy Medicare Part D prescription drug coverage if you want drug coverage. That typically costs about $55.50 a month.
    Medicare Advantage. With Medicare Advantage, your drug coverage is usually included in your plan’s monthly premium.
    Whether you’re in traditional Medicare or a Medicare Advantage plan, be sure to look at differences in your drug costs among Medicare Part D drug plans. And, keep in mind that it is possible, even likely, that you might spend less getting some of the drugs you take from Costco or another mail-order pharmacy than paying the copay for them through your Part D plan. Part D plans can have higher copays than the total cost of the drug from a low-cost pharmacy.
    5. Quality:
    Traditional Medicare. If you want control over the quality of your health care providers, you probably want to be in Traditional Medicare, where you choose the providers you see.
    Medicare Advantage. In a Medicare Advantage plan, the plan restricts your access to providers. And, even when you see a provider you want to see, the Medicare Advantage plan might not let your physician or hospital provide the care that they think is best for you. For example, if your doctor thinks you need 50 days of inpatient rehab therapy, your Medicare Advantage plan still might decide you only need 10 and will only cover 10 days.

    Bottom line: With traditional Medicare, your doctors and hospitals have every incentive to provide you with all the care they think you need and traditional Medicare will cover it. Medicare Advantage plans receive a fixed amount from the government to cover your care regardless of how much they spend on your care. Consequently, they have an incentive to withhold needed care and to incentivize their physicians to limit the care they provide you. The less money a Medicare Advantage plan spends on your care, the more money the Medicare Advantage plan has for its shareholders. Since there’s no good data to distinguish the good Medicare Advantage actors from the bad ones, you are gambling with your health and well-being when you enroll in a Medicare Advantage plan. To learn more, read this blog post by Diane Archer and Theodore Marmor on the fundamental difference between traditional Medicare and private insurance.

    Here’s more from Just Care:

  • Medicare now covers power seat lifts for wheelchairs in some cases

    Medicare now covers power seat lifts for wheelchairs in some cases

    Medicare is required by law to cover all medically reasonable and necessary health care services with certain exceptions, such as vision, hearing, dental and long-term services and supports. Of course, when it’s not black and white, our government decides which services are medically reasonable and necessary and should be covered. The Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, has decided that power seat lifts should be covered.

    Of course, every time Medicare covers a product or service that makes people’s lives easier and improves their health and well-being, it’s a huge benefit. Yet, as Medicare covers more costly items, Part B premiums rise and out of pocket costs for people with Medicare become increasingly unaffordable. To keep costs down, Congress needs to step in and negotiate better prices for many products Medicare covers, including prescription drugs, as well as eliminate overpayments to Medicare Advantage plans.

    Medicare has always covered wheelchairs and, in certain cases, power wheelchairs, for people who are unable to get around their homes without one. But, Medicare had not covered the power seat lift that allows people in a wheelchair to sit at a counter or access items they could not otherwise access in their homes. The government’s argument back in 2006 was that the power seat elevation system was not primarily medical in nature.

    The industry making the seat-lift device, along with the disability community, lobbied hard for its coverage. They argued that from a health equity perspective, lower income people can experience worse health outcomes than people with more income are not because they can afford to pay for the seat lift themselves. “Allowing beneficiaries with a permanent disability to access technology to stand, reach, and function in their home and community, is not a luxury, nor is it an item of convenience, but a necessity.”

    The health equity argument is compelling.  On those grounds, however, Medicare should be spending as much on people in Traditional Medicare as it does on people in Medicare Advantage, giving traditional Medicare an out-of-pocket spending limit, among other things. Instead, most people with Medicare cannot afford to enroll in Traditional Medicare and are forced into Medicare Advantage plans. They do not have the meaningful choice between Traditional Medicare and Medicare Advantage, which is available to people with higher incomes.

    Of note, Medicare still does not cover the power standing device that would allow wheelchair-bound people to stretch their legs and bear weight, which also has significant health benefits, according to some experts.

    Here’s more from Just Care: