JustCare

Tag: Marketing

  • Administration proposes new rule to address myriad problems with Medicare Advantage

    Administration proposes new rule to address myriad problems with Medicare Advantage

    The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule for 2025 with the goal of addressing some of the problems with Medicare Advantage (MA). The rule is intended to “promote healthy competition” because so many Medicare Advantage plans have been failing to meet people’s needs, in a multitude of ways. The problem is that the proposed rule, like the vast majority of Medicare Advantage rules, has no teeth.

    Here are the rule’s major provisions:

    The Administration proposes more guardrails to ensure that insurance brokers and agents are not steering people into Medicare Advantage plans that do not meet their needs. Mountains of evidence reveal that many Medicare Advantage plans are inappropriately delaying and denying care and otherwise restricting access to care, through limited provider networks and large out-of-pocket costs. No one, including insurance agents, has a clue as to which Medicare Advantage plans to avoid–let alone, whether there are any that put patient needs first–because there is no good data to help people understand which Medicare Advantage plans are the bad actors.

    The biggest takeaway of the new proposed marketing “guardrail” is that brokers and agents steer people to the MA plans that pay them the highest commissions. They also steer people away from Medicare supplemental insurance plans that pick up most out-of-pocket costs in traditional Medicare, which don’t pay them as high commissions as MA plans. The MA commission is now as high as $601, with lots of bonuses, and would increase to a fixed rate of $632 in 2025. Bottom line: Don’t trust the advice of insurance agents!

    The proposed rule also proposes better access for people to outpatient behavioral health providers through changes to Medicare Advantage plan’s network adequacy standards. This year, CMS expanded coverage to marriage and family therapists (MFTs) and mental health counselors (MHCs). About 400,000 more therapists will be able to treat Medicare patients if they so choose. Because reports indicate that Medicare Advantage plans do not often offer easy or any access to mental health providers, as required, CMS is setting a special network adequacy standard for Medicare Advantage plans. But, as it is, CMS does not appear to have the resources to assess network adequacy nor does it have the ability to meaningfully penalize MA plans with inadequate networks.

    And, the proposed rule seeks to help people with Medicare make good on the “supplemental benefits” that Medicare Advantage plans offer. Reports indicate that many of these benefits go unused because they come with unaffordable out-of-pocket costs or other burdens on enrollees. CMS allows MA plans to offer food vouchers and transportation services. But, it appears that few use them. So, if the rule is finalized, MA plans would have to let enrollees know of the availability of supplemental benefits midway through the calendar year.

    CMS states it does not want MA supplemental benefits used as a “marketing ploy,” as they so often are. But, the administration overlooks the fact that few people will read the notice from their MA plans and fewer still will be able to take advantage of these benefits even if they know about them. Many people with Medicare have serious mental and physical health conditions as well as low health literacy levels that impede their ability to understand Medicare’s complex rules.

    To address the disproportionate impact that inappropriate delays and denials of care in Medicare Advantage has on  underserved populations, such as people with disabilities, people with Medicaid and people in Medicare Savings Programs, CMS has proposed that Medicare Advantage plans analyze their utilization management (UM) policies and procedures from a health equity perspective.

    And, CMS’ proposed rule attempts to give Medicare Advantage enrollees faster access to appeals; right now, in some cases, people in MA plans have far less timely appeals than people in traditional Medicare. This proposed rule is an improvement that might help a tiny fraction of MA enrollees. However, the overwhelming majority of MA enrollees do not know to value of appealing MA plan denials and do not appeal.

    Lastly, CMS proposes a rule to allow monthly enrollment in MA plans and appears to help insurers push more people with Medicare and Medicaid into an MA plan. That’s insane given all the reports of bad actors in MA and the availability to this population of traditional Medicare with easy access to care and few if any out-of-pocket costs. Thankfully, the rule also gives these “dual eligibles” the ability to switch to traditional Medicare more easily.

    The proposed rule would limit out-of-network cost sharing for D-SNP preferred provider organizations (PPOs) for specific services, beginning in 2026. The proposed rule also would reduce cost shifting to Medicaid, increase payments to safety net providers, expand dually eligible enrollees’ access to providers, and protect dually eligible enrollees from unaffordable costs.

    It’s great that CMS is acknowledging many of the major issues with Medicare Advantage. It’s unfortunate that even when it proposes a good rule, the insurers offering Medicare Advantage plans can effectively ignore the rule with impunity, and many of them do.

    Here’s more from Just Care:

  • Insurers will continue misleading people, notwithstanding new Medicare Advantage marketing rules

    Insurers will continue misleading people, notwithstanding new Medicare Advantage marketing rules

    Rachel Roubein writes for the Washington Post on the new rules the government has put in place to protect older adults and people with disabilities from misleading marketing by corporate health insurers offering Medicare Advantage plans. While the rules are a step in the right direction, you can bet your bottom dollar that they will make little difference. Insurers will continue to mislead people, as will their sales agents.

    The corporate health insurers offering Medicare Advantage plans will have to adopt a new marketing look. But, there’s no way that they will tell people about restrictions on their access to care in Medicare Advantage plans; restrictions that people do not face in traditional Medicare. Nor are the insurers going to explain that people are likely to spend more out of pocket if they need costly health care services and are enrolled in a Medicare Advantage plan than they would in traditional Medicare.

    Since the advent of Medicare Advantage, the insurance company ads have been terribly deceptive.  And, the insurance companies’ sales agents often steer people to plans from which they receive the highest commissions rather than to Original Medicare, even when Original Medicare best meets people’s needs. Complaints about deceptive marketing are rampant.

    The new government rules are intended to keep corporate health insurers from deceiving people into believing their Medicare options are more limited than they are, or that they will get extra benefits that are actually not available to them. That’s good. It’s just not enough.

    Moreover, there are no meaningful penalties on the insurers if they violate the marketing rules. CMS does not exercise its right to penalize Medicare Advantage plans in meaningful ways, let alone cancel contracts with the bad actors. And, a lot of the information people need to distinguish the good MA plans from the bad actors, such is denial rates, delay rates and disenrollment rates, is not available. 

    The new marketing rules do nothing to help people make an informed Medicare choice.  People can’t understand critical differences among their options, such as whether a plan has a high denial rate or has a poor network of providers. All people have to go by is unclear, inaccurate and misleading information.

    Best advice: If you can’t afford to spend $5,000 out of pocket—the typical amount people must spend for in-network care alone if they need critical care in a Medicare Advantage plan—you should consider enrolling in traditional Medicare. If you don’t have Medicaid or retiree benefits that provide Medicare supplemental coverage, you should also consider buying supplemental coverage. You can get low-cost Medicare supplemental (Medigap) coverage with an out-of-pocket cap. Or, you can get comprehensive Medicare supplemental coverage for about $2,500 a year. With Medigap plan G, you’ll have almost all your costs covered. No matter which supplemental insurance you choose, in traditional Medicare you will be able to see the doctors you want to see without needing approval from an insurance company that profits more when it denies coverage for your care. That’s what too often happens in Medicare Advantage.

    Here’s more from Just Care:

  • Ignore Medicare Advantage ads; they misrepresent costs and benefits

    Ignore Medicare Advantage ads; they misrepresent costs and benefits

    Two new reports, one from the Commonwealth Fund and one from the Kaiser Family Foundation, highlight the deceptive marketing in Medicare Advantage, a program administered by corporate health insurers that too often misrepresents their benefits and costs. Many Medicare Advantage plans fail to cover the care, particularly the costly care, their enrollees need. In short, if you want care from the doctors you know and trust, without insurance companies overruling their treating decisions, you should enroll in Traditional Medicare.

    The marketing of Medicare Advantage has meant endless ads everywhere you turn. There’s literally hundreds of billions of dollars in profits available to be reaped by corporate health insurers each year. And, they want as much of these profits as they can get their hands on. The problem is that they profit more when their enrollees get less care.

    With lots of people complaining about countless marketing calls, misleading advertising and unscrupulous sales tactics, the Biden administration has put in place new regulations in the past year. It’s not at all clear that they work, given that the corporate health insurers know that they can get away with a lot and face little if any accountability for their bad acts.

    The Commonwealth Fund survey found that sales agents wrongly asked people for their Social Security or Medicare numbers in many cases.  You should not give this information out; it is not allowed in most instances.

    People are generally overwhelmed by their Medicare choices. They have too many options and it is virtually impossible to distinguish among them. So, they often stay with their current coverage.

    The Kaiser Family Foundation reports that “in 2023, Medicare beneficiaries can choose from an average of 43 Medicare Advantage plans, offered by 9 different insurers, the highest number ever available. Traditional Medicare beneficiaries selecting prescription drug coverage can choose from an average of 24 stand-alone Part D plans.”

    A lot of people turn to friends and family for advice. Others rely on insurance brokers. Don’t trust insurance brokers who profit from steering you to particular Medicare Advantage plans. Contact your state health insurance assistance program, SHIP, or the Medicare Rights Center at 800-333-4114 for free unbiased counseling.

    In the Commonwealth survey, about a third of people with Medicare wanted to know more about their out-of-pocket costs and benefits in a Medicare Advantage plan v. Original Medicare. It’s critical people understand them as there have been a large number of complaints from people with Medicare about misleading information by the Medicare Advantage plans and the insurance brokers they hire about costs and benefits. Unfortunately, costs and benefits are not as simple to understand as they should be.

    Here’s what you need to know: In Medicare Advantage, out-of-pocket costs can be as high as $8,300 in 2023 for in-network care, and you will pay for the full cost of care if you go out of network. Because many plans engage in widespread denials and delays of care and have networks with limited numbers of physicians, it can be hard to get in-network care.

    And, as for the “extra” dental and hearing benefits that many Medicare Advantage plans promote, beware. They sound great in theory, but are often difficult to take advantage of. In many cases, you must use a set of providers who are inconvenient or unavailable or your out-of-pocket costs can be extremely high. The data show that more people in traditional Medicare get dental care than in Medicare Advantage.

    Here’s more from Just Care:

  • Government rules won’t curtail Medicare Advantage bad acts without stiff penalties

    Government rules won’t curtail Medicare Advantage bad acts without stiff penalties

    The Centers for Medicare and Medicaid Services (CMS), the agency charged with overseeing Medicare, recently released a series of proposed rules intended to limit harmful behavior in Medicare Advantage. They aim to curtail misleading marketing as well as to eliminate barriers to care. Many of the rules seem good in theory but, even if finalized, unless CMS enforces them and applies meaningful penalties for violating them, it is hard to imagine that they will do much good.

    For years, Medicare Advantage plans have been violating rules. They have not covered medically necessary services covered in traditional Medicare, as required; they have overcharged the government for their services; they have failed to disclose complete and accurate data that would allow oversight of the quality of care they deliver; they have not maintained accurate provider directories and more. The HHS Office of the Inspector General, the Government Accountability Office and the Medicare Payment Advisory Commission, among others, have called out these issues and urged CMS to address them through new policies, greater oversight, and penalties that are meaningful. CMS has done little to call out the bad Medicare Advantage actors and penalize them appropriately, putting people enrolled in Medicare Advantage plans at risk.

    For example, for more than ten years, Medicare Advantage plans have overcharged the government billions of dollars a year, with projections that the overcharges will total more than $600 billion in the next nine years. And, MA plans have not released the patient data they are required to disclose, Yet, CMS has done little if anything to  address their malfeasances and bad acts, endangering the lives of enrollees and draining the Medicare Trust Fund.

    You can review the CMS enforcement actions over the last decade here. Last month, CMS “punished” Elevance, a Medicare Advantage plan, “for failing to meet its primary responsibility to provide Medicare enrollees with medical services and prescription drug benefits in accordance with Medicare requirements.” CMS found that Elevance overcharged its enrollees. The penalty? $38,512.

    CMS also punished Humana $131,660. “Auditors found that Humana overcharged enrollees for Part D medications and Part C services. Humana’s failures adversely affected (or had the substantial likelihood of adversely affecting) enrollees because they may have experienced increased out-of-pocket costs.”

    Auditors found that “in 2019 Kaiser failed to reprocess prescription drug claims in accordance with enrollee’s LIS levels within 45 days of the receiving complete information regarding the enrollees LIS status. As a result, enrollees were over charged for Part D drugs at the point of sale and Kaiser then failed to ensure refunds were provided to enrollees who overpaid.” The penalty? $27.260.

    Where are the incentives for insurers offering Medicare Advantage plans to do right by Medicare? Where’s the requisite oversight? Where’s the punishment for the wrongful behavior? People go to jail for not paying their medical bills; they go to jail for years for defrauding the government. It appears that the MA plans can do major harm to Medicare, with impunity.

    When will the government stop simply talking the talk and walk the walk?

    Here’s more from Just Care:

  • New Medicare Advantage rules won’t stop the misleading marketing

    New Medicare Advantage rules won’t stop the misleading marketing

    The Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, is implementing new rules regarding marketing of Medicare Advantage plans–corporate health plans offering Medicare benefits. The rules are designed to help protect people with Medicare from joining a Medicare Advantage plan without understanding the risks. These new rules could help at the margins, but there’s no stopping the misleading marketing.

    Medicare Advantage plans are raking in billions of dollars in profits. They’ll do everything they can to expand their market share. Directing their marketing towards enrolling healthy people is the best way to grow their profits. The penalties they face for misleading people are negligible relative to what they gain; they only pay penalties when they are caught.

    CMS does not have the resources to detect a lot of the misleading Medicare Advantage marketing or the power to put the kibosh on it. Medicare Advantage plans have always misled the public about what they offer as compared to Traditional Medicare, and CMS has never succeeded at stopping the misleading marketing. They don’t advertise their out-of-pocket cap amounts, which can be as high as $7,550 a year for in-network care alone; they don’t let people know that network providers might not be taking new patients and can be out-of-network at any time; they don’t explain to people that if they join their MA lan, they might never be able to switch to Traditional Medicare. People have no guaranteed right to supplemental coverage in Traditional Medicare after they have been in an MA plan for more than 12 months, except in Maine, Massachusetts, New York and Connecticut.

    Of course, marketing is by definition misleading. Unless CMS required Medicare Advantage plans to highlight all their limitations–their limited networks, inappropriate delay and denial rates and out-of-pocket costs–in all their communications with enrollees, people have no sense of what they are giving up when they enroll in a Medicare Advantage plan. They cannot compare Medicare Advantage plans with Traditional Medicare in a meaningful way. Moreover, CMS gives 4 and 5 -star ratings to MA plans that have histories of committing bad acts.

    CMS found that the vast majority of sales agents’ communications with people with Medicare were misleading in a secret shopper exercise. Eighty percent of sales agent calls to potential enrollees are “inaccurate or insufficient.”

    At best, CMS’ closer review of sales agents’ calls and Medicare Advantage TV ads before they are aired could help at the margins. When the sales agents are  paid more to steer people to Medicare Advantage than to Medicare supplemental coverage, you can expect that they will steer people to Medicare Advantage. The same is true when sales agents for MA plans administered by the biggest insurers market to people in community MA plans. Curiously, CMS set the start date for tougher reviews of TV ads for January 1, after this year’s open enrollment period is over.

    CMS has never held Medicare Advantage plans to account in meaningful ways. Rather, it has raised payments to them 8.5 percent in 2023, when the data show that they are overpaid 4 percent already. And, CMS has never even identified the Medicare Advantage plans with high inappropriate denial rates or delays, let alone cancelled contracts with them. In fact, CMS’ own 2o23 Medicare and You Handbook misleads people by not mentioning many of the risks of Medicare Advantage, including the maximum $8,300 out-of-pocket limit and the prior authorization hurdles people often face.

    Here’s more from Just Care:

  • Senate Finance Chair looks into deceptive Medicare Advantage marketing practices

    Senate Finance Chair looks into deceptive Medicare Advantage marketing practices

    Senate Finance Committee Chair, Ron Wyden, has written the Oregon Department of Consumer and Business Services and the Oregon Department of Human Services along with several other state insurance departments regarding “potentially deceptive” Medicare Advantage marketing practices. Senator Wyden would like to know more about growing complaints surrounding Medicare Advantage marketing practices that these state agencies might be hearing about. It is unknown whether Senator Wyden has also contacted the Centers for Medicare and Medicaid Services, which is responsible for regulating Medicare Advantage marketing materials.

    As Chair of the Senate Finance Committee, Senator Wyden is responsible for oversight of Medicare Advantage. And, it is good news that he is concerned about MA marketing complaints and aggressive sales practices. Recently, CMS reported a doubling of MA marketing complaints in the year between 2020 and 2021.

    Too often people with Medicare have little clue what they are doing when they enroll in a Medicare Advantage plan. CMS’ review of sales calls showed significant confusion among people with Medicare, including “that the beneficiary may be unaware that they are enrolling into a new plan during these phone conversations.”  That aside, of those people who understand differences between traditional Medicare and MA, few appreciate the grave risks of enrolling in a Medicare Advantage plan.

    We now have compelling evidence from the HHS Office of the Inspector General, the Government Accountability Office and MedPac that Medicare Advantage is in need of an overhaul. A wide range of MA plans are engaged in consumer protection violations and overcharging the federal government for their services. To date, CMS has not been able to address, let alone correct, these serious violations. Moreover, CMS has not disclosed to people which MA plans are the worst actors, which would help protect them from making a dangerous MA choice.

    Senator Wyden recognizes that MA plans have been engaged in misleading ads and fraudulent marketing and sales practices for more than a decade. Hopefully, the Senate Finance Committee will act swiftly to address these bad acts. For now, Senator Wyden simply asks state officials to report on different types of misleading marketing and sales practices in their states. The Senator does not appear to have expressed concern publicly, let alone taken action, regarding threats to the health and well-being of people enrolled in MA plans.

    It’s always smart to create a record. But, time is not on the side of people with Medicare who are misled into joining an MA plan. Already, we know about many types of misleading MA marketing. Moreover, CMS engages in misleading marketing of Medicare Advantage plans by not explaining to people in its Medicare and You handbook and other publications that out-of-pocket costs in most MA plans can be well over $5,000 and could be as high as $7,550, two to three times the cost of Medicare supplemental coverage in traditional Medicare. CMS also fails to explain the administrative hurdles people often face accessing care, as a result of MA plans’ prior authorization requirements.

    Congress and CMS work at a snail’s pace. Some Congressional attention is finally focused on the serious risks facing people in some Medicare Advantage plans, along with billions of dollars in overpayments to MA plans. But, how long will it take for Congress and CMS to act in ways that protect the health and well-being of people in MA from the bad actors? And, how many people will die needlessly during that time?

    Here’s more from Just Care:

  • One in four Medicare Advantage plans engage in misleading marketing

    One in four Medicare Advantage plans engage in misleading marketing

    Allison Bell reports for Think Advisor on the federal government’s decision to hold off issuing a rule imposing an extra penalty on Medicare Advantage plans for misleading marketing. It appears that too many Medicare Advantage plans would be affected. What’s clear is that so long as corporations can cover Medicare benefits, older adults and people with disabilities will be scammed.

    Specifically, the government is not issuing a new penalty on Medicare Advantage plans for misleading marketing that results in people being retroactively disenrolled from Medicare Advantage plans. Its reasoning is that another penalty on Medicare Advantage plans presents too big a change in star-ratings and payments to these plans. It’s a bit like a city determining that it won’t close down restaurants that pose health risks in order to make sure the city has enough restaurants.

    CMS claims it needs to use a formal rulemaking process to impose this new penalty. Too many MA plans would be affected.  “Overall, we found a decrease in the star assignments for almost one-quarter of MA-PD contracts using the changed complaint measure specifications that include marketing misrepresentation complaints.” Put differently, had CMS imposed the extra penalty, 25 percent of Medicare Advantage plans would have seen lower star ratings and lower payments.

    As it is, Medicare star-ratings of Medicare Advantage plans are a farce. No one should rely on them in choosing a plan. A five-star Medicare Advantage plan is about as different from a five-star hotel as night and day. In a five-star Medicare Advantage plan, you can’t count on getting coverage from the doctors and hospitals you want to use, nor can you know whether the copays are affordable.

    Needless to say, insurers are pleased with the CMS decision. They get away with misleading people into signing up with them, claiming they are competing to provide important services and being overpaid. Meanwhile, they do not allow MedPAC to assess the quality of care they offer, engage in widespread inappropriate delays and denials of care, and do not let anyone meaningfully distinguish among them. Had the penalty been implemented, one in four Medicare Advantage plans would have seen their star-rating score fall by 24 percent.

    Will CMS use a formal rulemaking process to impose the extra penalty. Who knows?

    Here’s more from Just Care:

  • Medicare open enrollment: Don’t be misled by ads

    Medicare open enrollment: Don’t be misled by ads

    When it comes to Medicare, every corporate health insurer seems to have an offer you can’t refuse, often from one of your favorite heroes paid to push their products. Don’t be misled by the TV ads and other promotional hype; get impartial information from your State Health Insurance Assistance Program. And, if you are misled, please know that you now have special rights to disenroll.

    Millions of older adults and people with disabilities are receiving misleading information from insurance companies offering Medicare Advantage. These insurers are not telling you the whole story about the health plans they are offering. Medicare Advantage plans offer you coverage from a limited number physicians and hospitals–generally far fewer than it appears from their provider directories–and often with large out-of-pocket costs if you need costly care. And, you are likely to need prior approval for your care, as well as to face delays and denials of care.

    So many people are signing up for these health plans based on misleading information that the Centers for Medicare and Medicaid Services (CMS) has threatened to penalize Medicare Advantage plans if they or the insurance brokers selling their products mislead people, reports Susan Jaffe for California Healthline. Under federal law, they are not allowed to engage in deceptive marketing practices, but that has not stopped them. And, since marketing is always deceptive–highlighting benefits but not costs–what exactly constitutes deceptive marketing?

    CMS is seeing a lot of complaints. Does the punishment CMS is threatening fit the crimes the health plans are committing? The Medicare Advantage plans make so much money off of each enrollee that it can be highly profitable for them to try to sell people a free lunch. When asked, CMS could not name one instance in which it had fined or suspended enrollment in a Medicare Advantage plan for deceptive marketing.

    The good news is that CMS has added new protections for people who are misled into joining a Medicare Advantage plan. You have additional rights to disenroll beyond the first three months of the year. According to CMS, enrollees have a “special enrollment period” if you want to disenroll because of deceptive sales tactics, including “situations in which a beneficiary provides a verbal or written allegation that his or her enrollment in a MA or Part D plan was based upon misleading or incorrect information … [or] where a beneficiary states that he or she was enrolled into a plan without his or her knowledge.”

    Most important: Never give a stranger your Medicare or Social Security number. In some cases, insurance agents are calling people, asking for their Medicare number and enrolling them in a Medicare Advantage plan without telling them.

    If you want health insurance that will meet your needs if you take a bad fall or are diagnosed with a serious condition, traditional Medicare gives you the freedom to see the doctors you want to see and use the hospitals you want to use anywhere in the country, generally with no bureaucratic hassle. The tradeoff is that you will need supplemental coverage, either through Medicaid, a former employer or a Medigap plan in order to protect yourself from out-of-pocket costs that have no cap. But, the cost of Medigap can be as low as $1,500 a year, far lower than the out-of-pocket cap in Medicare Advantage, which averages around $5,000 a year and can be as high as $7,550 for in-network care alone.’

    Here’s more from Just Care:

  • Pharma opera? Drug promotion on TV shows

    Pharma opera? Drug promotion on TV shows

    In the category of “what will pharmaceutical companies think of next to market their high-priced drugs,” the answer could be drug promotion on TV shows. Once dubbed soap operas because soap companies supported these afternoon TV series, they might be called Pharma operas today.

    Julia Belluz reports for Vox News that one company’s drug that treats a rare cancer appeared on General Hospital. We assume it paid for the product placement. Its marketing value is greater than an ad because TV viewers have no clue whether Pharma is behind the drug promotion and do not get a good sense of its side effects.

    As Vinay Prasad and Sham Mailankody explain in this JAMA opinion piece, unlike with TV ads where the FDA requires warnings of side effects, there is no such requirement for TV shows, where the product promotion is considered “disease awareness.”

    In the General Hospital show, one of the leading characters is diagnosed with a rare cancer, affecting just 2 in 100,000 people. No surprise, there is only one drug to treat this condition, and it costs a fortune. Prasad and Mailankody question the value of permitting “education” about this very rare cancer and its treatment.

    In their JAMA piece, they explain that direct-to-consumer advertising, which only the U.S. and New Zealand permit, has no proven public health benefit. Moreover, direct-to-consumer advertising has “suggestive evidence of harm.” It can lead to an increase in people being tested and misdiagnosed for the disease the drug treats and more people taking a toxic drug they don’t need.

    Prasad further explains that over-diagnosis can happen because there generally isn’t one test to determine whether a person has the disease, and many healthy people could be deemed to have an indication for the disease, even when they don’t have the disease. If they end up being treated, on top of the cost, the side effects can be serious, including severe anemia, enhanced likelihood of TB and viral infections.

    Here’s more from Just Care: