JustCare

Tag: Medicare

  • Trump’s executive order on prescription drugs does not reduce drug prices for Americans

    Trump’s executive order on prescription drugs does not reduce drug prices for Americans

    A new Arnold Ventures poll finds that nearly nine out of 10 voters believe the government should have the power to negotiate prescription drug prices. And, more than 75 percent say that it is very important for the government to reduce drug prices, including seven in 10 Trump supporters. Unfortunately, President Trump’s recent Executive Order on prescription drug prices and tariffs are likely to raise drug prices for Americans.

    More specifically, the vast majority of Americans support capping drug price increases to the rate of inflation and Medicare negotiating drug prices for all drugs. Indeed, 86 percent say that they do not want people with Medicare to pay more for their drugs than people in other wealthy nations. But, Trump’s executive order undermines Medicare’s limited efforts to negotiate drug prices, much less expand Medicare’s authority to negotiate drug prices.

    Bottom line: Your prescription drug costs are probably not coming down any time soon. President Trump’s tariffs on China could lead to higher drug costs for all Americans, as pharmaceutical manufacturers import ingredients from China. Meanwhile, Trump’s new Executive Order on prescription drug prices appears to favor the pharmaceutical industry’s interests, allowing drug companies to continue to set prices sky high and calling for changes to the Inflation Reduction Act that would drive up drug prices for people with Medicare.

    Here are some of the key provisions of the Executive Order.

    On a positive note, with caveats:

    • It aims to reduce the cost of insulin and injectable epinephrine at community health centers for uninsured and some low-income individuals. It’s not clear by how much.
    • It asks the FDA to make it easier for states to import drugs. But, it’s not at all clear that this provision will help Americans at the pharmacy. Today, the FDA has only granted permission to Florida to import drugs from Canada, and Florida appears not to have begun importing drugs. Moreover, Florida’s program is not designed to help its residents. It would only help lower the state’s costs a small amount for Medicaid recipients and for the state’s health and corrections departments.
    • It calls for more generics and biosimilars–lower-cost alternatives to brand name drugs. But, the Trump administration has cut FDA staffing drastically. It eliminated the office that was tasked with speeding up generic drug approvals,  slowing down drug approvals. Moreover, the administration has also cut NIH funding, which supports virtually all new drug development. So, while the president’s goal is laudable, it does not seem doable. 

    On a negative note:

    • It is projected to drive up Medicare drug costs by $6 billion and force people with Medicare to pay $1.5 billion more for their drugs. How? The Executive Order buys into a pharmaceutical industry claim that the Inflation Reduction Act discriminates against pills. Discriminates? Well, let’s just say that the law gives license to pharmaceutical companies to charge high prices for injectable drugs for a longer period of time than for pills. The IRA permits drug price negotiation over pills on the market for nine years and injectable drugs on the market after 13 years. The Executive Order asks Congress to allow pharmaceutical companies the same 13 years of protection for pills as for injectables. If the Republican majority complies, more than half the drugs for which the Centers for Medicare and Medicaid Services is negotiating lower prices would no longer have lower negotiated prices.
    • It calls for better transparency around the fees drug middlemen receive from pharmaceutical companies, which does not bring down drug prices for Americans.

    The Trump administration also ended a Biden initiative that would have permitted people with Medicare to buy generic drugs for $2. And, it is denying Medicare coverage of anti-obesity drugs, as the Biden administration had proposed.

    Here’s more from Just Care:

  • Poll: Costs remain a major barrier to care

    Poll: Costs remain a major barrier to care

    When you’re looking at people’s opinions about health care, it’s important to keep in mind that 85 percent of adults in the US say that their health is good or better than good. These people tend to be satisfied with their health insurance because they use it relatively little. Still, a lot of Americans remain concerned about high health care and prescription drug costs and medical bills, according to recent Peterson-KFF polling.

    Forty-five percent of adults in the US are worried about their ability to pay medical bills. Twenty-eight percent of adults said that they delayed or went without care because of the cost. Eleven percent struggled to pay medical bills. And, 11 percent said that they did not have a usual source of care.  

    Adults who were uninsured, in poorer health, Black adults, and Hispanic adults, were much more likely to forego or postpone care because of the cost than others. Thirty-six percent of Hispanic adults, 32 percent of Black adults and 25 percent of white adults said they delayed or went without care because of the cost, underscoring health care inequities.

    Of course, the uninsured generally face higher out-of-pocket costs than people with health insurance. And, people with lower incomes struggle more than people with higher incomes to cover insurance deductibles and copays. 

    Twenty one percent of adults said they went without dental care because of the cost. Sixteen percent said they went without mental health care, drugs or medical care because of the cost. 

    Likely because Medicare tends to provide better financial protection from health care costs than employer coverage and coverage on the state health insurance exchanges, fewer older adults delayed or went without care than adults under 65. One in five adults over 65 said they delayed or went without care because of the cost. Three in ten adults under 65 said they delayed or went without care because of the cost.  

    Here’s more from Just Care:

  • 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:

  • Will Trump give his supporters the lower health care costs they want?

    Will Trump give his supporters the lower health care costs they want?

    As we know, Trump supporters, like most Americans want to see lower prices on basic necessities, like gas and eggs. They also want to see lower health care costs, reports Noam Levey for NPR.

    What could Trump do? He could lower the out-of-pocket maximum on health care costs for working people. But, that would also likely drive up people’s premiums. And, the Republicans opposed the new $2,000 a year maximum on outpatient prescription drug costs for people with Medicare.

    But, the polls indicate that, unlike 10 or 15 years ago, a lot of Trump supporters now want more government involvement to rein in health care costs. People recognize that the “free market” for health care is not their friend. People no longer think that government should stay away.

    In fact, Republicans want the government to step in and limit drug prices and hospital charges. They also want the government to regulate and restrict health care providers from going after medical debt according to recent polls. More than eight in ten support a $2,300 annual cap on medical debt collection.

    Republicans still don’t support Medicare for all. In fact, that would do most to lower their health care costs and ensure they received the health care they needed. One size fits all means that it works for everyone. Other options will not work for people in some or more instances, and there’s no telling when you buy insurance whether that restriced insurance coverage will work for you over time.

    Republicans also overall support Medicaid. Medicaid is especially critical for lower and middle income older adults who need long-term nursing home care. Yet, the House Budget resolution puts in place a plan that will likely slash Medicaid spending and with it push many people off Medicaid.

    Today, Republicans more often hold corporate health insurers, pharmaceutical companies and hospitals responsible for high costs than the government. They see the greed and profiteering in our corporate health care system.

    One poll shows that 75 percent of people who voted for Trump want the government to limit hospital charges. They also want the Trump administration to do more Medicare drug price negotiation, not less.

    Right now, Republicans in Congress are not focused on any of their supporters’ cost-cutting health care priorities. They are poised to slash Medicaid and end subsidies for plans in the state health insurance exchanges, both of which will drive up health care costs for millions.

    Here’s more from Just Care:

  • 2025: Will Congress extend Medicare telehealth coverage?

    2025: Will Congress extend Medicare telehealth coverage?

    Congress will decide whether to extend Medicare Coverage of telehealth services this year. Ruth Reader and Erin Schumaker report for Politico that cost should not be an issue. The latest findings, published in JAMA Internal Medicine, show that Medicare telehealth actually results in lower Medicare spending.

    Congress first expanded Medicare coverage of telehealth services to everyone with Medicare and for a range of services during the COVID pandemic. Until then, Medicare telehealth coverage was largely restricted to people in rural communities. At the end of March of this year, expanded Medicare telehealth coverage will expire unless Congress acts.

    Many policymakers appear to believe that telehealth is driving up Medicare spending and leading to worse health outcomes. But, this new research suggests otherwise. Researchers found that patients received less low-value care or, put differently, higher quality care at lower cost.

    The researchers looked at the records of 2.3 million people with Medicare across 286 health systems. Medicare spending for those patients using telehealth was lower. Patients in health systems using telehealth visited the doctor more but received fewer low-value tests and less unneeded care.

    What were the Medicare savings? The researchers projected at least $66 million. Telehealth visits generally cost less than in-person visits. That said, the Congressional Budget Office projects that two additional years of Medicare coverage of telehealth services will cost about $4 billion.

    Another study published in Health Affairs last year found that people who receive telehealth treatment saw their physicians on an ongoing basis and were more likely to comply with their prescription drug regimens. They also were responsible for fewer emergency room visits.

    Here’s more from Just Care:

  • 2025: Programs that lower your costs if you have Medicare

    2025: Programs that lower your costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs, leaving people with average annual out-of-pocket costs of $7,000. So, even with Medicare, many people struggle to afford premiums, deductibles and other costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Click here or contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible for any of these programs and how to apply.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2025, but vary somewhat by state. You might qualify for these programs in your state even if your income or assets are higher than the federal amounts listed below. States sometimes exclude certain income and assets when determining your eligibility. You should apply through your state Medicaid office.

    • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan. It should cover premiums, deductibles, coinsurance and copays for Medicare-covered services.
      • Income limit monthly depends upon where you live but is around
        • $1,325 for individuals
        • $1,783 for couples
      • Asset limit
        • Individuals: $9,660
        • Couples: $14,470
    • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20. SLMB helps pay your Medicare Part B premium, if you have Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,585 for individuals
        • $2.135 for couples
      • Asset limit
        • Individuals: $9,660
        • Couples: $14,470
    • Qualifying Individual (QI)—135 percent of FPL +$20, helps pay your Medicare Part B premium if you have Medicare Part A and Part B.
      • Income limit monthly depends upon where you live but is around
        • $1,781 for individuals
        • $2,400 for couples
      • Asset limit
        • Individuals: $9,660
        • Couples: $14,470

    Several valuable items are not counted as income and assets. No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, slightly more than half the people over 65 who qualify for the Qualified Medicare Beneficiary program (53%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (32%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You will automatically qualify for the Extra Help program, which is administered by Medicaid, if you qualify for Medicaid or any of the above low-income programs or receive Supplemental Security Income benefits. You can also apply for Extra Help independently. Extra Help pays for some or all of the cost of your Part D drug coverage and is estimated to be worth around $5,100 a year. The amount of help with cost-sharing depends on the level of your income and assets. In 2025, you may qualify if you have up to $1,976 in monthly income ($2,664 for couples) and up to $17,600 in assets ($35,130 for a married couple). With Extra Help your drug costs are no more than $4.90 for each generic/$12.15 for each brand-name covered drug, if your monthly income is above $1,325. Your drug costs are no more than $1.60 for each generic/$4.80 for each brand-name covered drug, if your monthly income is below $1,325. If your total drugs costs–what you and your health plan pay) go above $2,000 this year, you’ll pay nothing more. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)

    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-fee scale. They might waive the Medicare deductible and coinsurance, depending upon your income.

    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Government should be spending more on Medicare and Medicaid

    Government should be spending more on Medicare and Medicaid

    A new KFF tracking poll shows that a large majority of Americans–Republicans, Democrats and Independents–support Medicare and Medicaid. And, twice as many Americans believe the government should be spending more on Medicare and Medicaid than believe we should be spending less. Still, Republicans are looking at slashing Medicaid, and possibly cutting Medicare as well.

    Out-of-pocket costs in Medicare are formidable. They keep people from getting care or lead people to delay needed care, compromising their health So, major support for Medicare expansion is not surprising. (It should go hand in hand with ending the waste and fraud in Medicare Advantage, which is costing taxpayers tens of billions of dollars a year, eroding the Medicare Trust Fund and driving up Medicare Part B premiums.)

    There is general agreement among Americans across the political spectrum that we should know a lot more about healthcare prices. But, what people don’t appreciate is that knowing these costs offers them little if any protection. The surgery costs at one hospital might be higher than another, but the anesthesia cost could be lower. Moreover, the specialists at one facility might deliver more medical services than at the other, affecting a patient’s total costs.

    The simplest and fairest way to ensure everyone can afford their care is a government-administered system for everyone. Such a system could keep costs down through low deductibles and copays, as well as by ensuring everyone pays the same price for a given procedure in a given community. Suggesting that people can shop around for the best health care prices is insane.

    Most people receiving care need care urgently. Those people cannot shop around. But, even people who are receiving elective procedures are hard-pressed to determine where they will save money on care.

    Republicans and Democrats alike also favor regulation of health insurer prior authorization rules. Health insurers are using prior authorization to delay and deny care, inappropriately and with impunity. Through prior authorization, they can spend less and profit more.

    Lastly, Republicans and Democrats support lower prescription drug prices in Medicare through negotiation. Americans should overwhelmingly support drug-price negotiation for more Medicare drugs; we pay as much as four or five times what people in other wealthy countries pay for the same drugs.

    The vast majority of Americans do not support as a priority removing fluoride from our water, as Robert Kennedy Jr. recommends. They also do not support reducing access to abortions or lower federal support of Medicaid as priorities.

    Here’s more from Just Care:

  • Medicare prices for all?

    Medicare prices for all?

    It’s as yet unclear what the Trump administration and the Republican Congress will do to Medicare. The Heritage Foundation’s Project 2025, if adopted, would appear to let traditional Medicare wither on the vine and force new Medicare enrollees into Medicare Advantage. But, that’s a politically fraught agenda that would also drive up Medicare spending significantly, as Medicare Advantage costs a lot more than traditional Medicare.

    If Republicans are looking for ways to fund their massive tax cuts, they could address the massive overpayments in Medicare Advantage, which are projected to cost more than $1.4 trillion over the next decade. Republican Senators Cassidy, Blackburn and Braun all see the need for this reform. Taking some of the savings to put an out-of-pocket cap in traditional Medicare would help level the playing field between Medicare Advantage and traditional Medicare and promote competition–but strengthening traditional Medicare is likely a bridge too far for Republicans.

    If Republicans want to lower health care costs and raise wages for Americans, without hurting industry, they might consider Phil Longman’s proposal this week in the Washington Monthly–Medicare prices for all. The idea is simply to have employer-sponsored health plans pay providers Medicare prices–not the current average of 254 percent of Medicare. And, then, Longman would require corporations to share the savings with their workers in the form of higher salaries.

    Of course, hospitals and specialists would push back. But, the data suggests that they would suffer little as a result, according to Longman. Most hospitals are non-profit and could manage on Medicare rates.

    Medicare prices for all would neither raise taxes nor require people to give up their private insurance. It would simply eliminate predatory health care prices to the benefit of Americans. Is there a Republican in Congress who would support it?

    Here’s more from Just Care:

  • Congress extends Medicare telehealth coverage through March 31, 2025

    Congress extends Medicare telehealth coverage through March 31, 2025

    Shortly after the onset of the Covid pandemic, Medicare began covering telehealth services for all of its enrollees. It has been doing so ever since. Last week, Congress continued the Medicare telehealth program through the end of March 2025, reports Paula Span for the New York Times.

    Medicare’s telehealth coverage allows older adults and people with disabilities to see their doctors without ever leaving their homes. Consequently, a cancer patient with severe pain in Indianapolis can receive palliative care from a physician in Manhattan, and Medicare will cover it. Palliative care focuses on the comfort and quality of life of the patient.

  • 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: