JustCare

Tag: Medicare

  • Dozens of drug companies owe Medicare rebates from raising prices higher than the inflation rate

    Dozens of drug companies owe Medicare rebates from raising prices higher than the inflation rate

    The Biden Administration just announced that dozens of drug companies owe Medicare rebates from raising prices higher than the rate of inflation. As a result , hundreds of thousands of people with Medicare will save as much as $2,786 per dose of their prescription drugs.

    The Inflation Reduction Act (IRA) prevents drug price gouging–defined as price increases greater than the rate of inflation–by pharmaceutical companies. The IRA also caps out-of-pocket costs for each insulin drug at $35 a month and limits total out-of-pocket drug costs for people with Medicare through Medicare Part D to $2,000 a year beginning in 2025. Yet, Republicans are trying to repeal the IRA.

    In total, the Administration reports that pharmaceutical companies raised prices on 64 drugs more than inflation. For example, the price of Signifor, which treats an endocrine disorder, went up so much that people who use it could see a savings of $311 for a monthly dose of the drug beginning in January.

    President Biden is also heralding his Administration’s decision to allow the government to “March-in” and help bring down the price of drugs developed with federal funding, if the price is unreasonable. This march-in right has always existed but prior administrations have been reluctant to take the position that the government could step in if a pharmaceutical company charged an excessive for the drug.  Of course, the proof of this Administration’s commitment here is in determining that the price of a drug developed with federal money is too high and taking action. Time will tell.

    Meanwhile a story in Becker’s exposes extreme drug price increases for eight drugs, according to ICER.  The story suggests that insurers spent more than $1.3 billion in these drugs in one year. It’s not clear if that means that individuals paid higher premiums to cover the cost of the drugs, but presumably so. The question left unanswered is whether the insurers recouped that money they spent for these drug, through rebates, and left their enrollees’ holding the bag, a likely scenario.

    Herre’s more from Just Care:

  • Insurers overcharge Medicare enrollees for generic drugs

    Insurers overcharge Medicare enrollees for generic drugs

    The biggest health insurers and Pharmacy Benefit Managers (PBMS) offering Part D prescription drug coverage are overcharging Medicare for generic drugs, according to a new JAMA study by researchers at UC San Diego, West Health and the University of Washington. More than 40 million people with Medicare have Part D drug coverage for their outpatient drug needs. As a result of these overcharges, their out-of-pocket coinsurance costs are likely signficantly higher than they should be.

    The researchers find that part of the reason that older adults and people with disabilities face high out-of-pocket drug costs with Medicare Part D is that Rite Aid, Cigna, Centene, CVS Health Humana, and UnitedHealth, which offer Part D coverage, and the Pharmacy Benefit Managers they own or contract with are inflating the costs of some drugs significantly. Pharmacy Benefit Managers or PBMs buy drugs from manufacturers and design the Part D drug formulary–list of covered drugs–that an insurer offers.

    What’s happening? The insurers and/or the PBMs maximize profits by paying pharmacies (often the pharmacies they own and operate) many times the pharmacies’ acquisition cost of a drug. The insurers or the PBMs eventually clawback that overpayment. But, because they pay a high price to the pharmacies, the Part D insurers can charge a much higher copay to their enrollees–based on the inflated price of the generic drugs–driving up enrollees’ costs.

    The researchers found that sometimes, insurers or PBMs pay pharmacies markups of 6,000 percent or 7,000 percent. For example, insurers paid pharmacies $126 for a cancer tablet that costs $4.20 a tablet.

    In 2022, a USC Schaeffer paper also reported generic drug price padding by the PBMs. The authors call for drug pricing transparency. But, that proposal still gives a role to the PBMs and does not fix the system. It would continue to allow PBMs and insurers to keep low-cost generics off their formularies in order to benefit from big rebates they receive from brand-name drug manufacturers for putting their drugs on formulary. And, it would not stop the padding of generic drug prices.

    The simplest way to address inflated drug prices in the US is to open our borders to drugs from verified pharmacies around the world and require insurers to cover them.

    Here’s more from Just Care:

  • AMA unhappy with Medicare payments, silent on health insurer interference in the practice of medicine

    AMA unhappy with Medicare payments, silent on health insurer interference in the practice of medicine

    The AMA President, Jesse Ehrenfeld, MD, says he is concerned about “government interference in the practice of medicine.” He is also unhappy with Medicare payments. But, his complaints focus heavily on the behaviors of the health insurers and corporate interference in the practice of medicine. Why is he not calling out the health insurers?

    The health insurers impose huge administrative challenges on physicians, in the form of paperwork and prior authorization requirements that drive up costs and create obstacles to care, which Ehrenfeld decries.

    In fact, Ehrenfeld claims progress for the AMA because it successfully advocated for some prior authorization fixes in Medicare Advantage, without criticizing the insurers offering Medicare Advantage plans and imposing all sorts of valueless prior authroization requirements. Why is Ehrenfeld withholding criticism of the Medicare Advantage plans when his members have said that the insurers offering these plans are denying, delaying and downgrading needed care to the detriment of their patients?

    One in three AMA members have said that insurers’ prior authorization rules have “led to a serious adverse event for a patient in their care.” One in four physicians have said that prior authorization has led to an unnecessary hospitalization. And, almost one in five physicians have said prior authorization has led to “a life-threatening event or required intervention to prevent permanent impairment or damage.”  Nine percent of physicians report that “PA has led to a patient’s disability/ permanent bodily damage,”

    Ehrenfeld says that physicians are facing a 26 percent revenue cut in Medicare. To what extent are the Medicare Advantage plans to blame for their inadequate payments, as a result of low rates and inappropriate claim denials? We know that the insurers deny payment to physicians inappropriately and, sometimes, often.

    The AMA has a new website called Fix Medicare Now. It opposes proposed cuts to Medicare provider payments. But, it also talks about promoting “value-based” care. In my book, that’s code for give the insurance industry the money to oversee care and coverage, to come between patients and their doctors. I hope that’s not what the AMA is saying.

    Here’s more from Just Care:

  • 2024: Access to Medicare mental health services is expanding

    2024: Access to Medicare mental health services is expanding

    Even with Medicare, it can be hard to see mental health providers. Tens of thousands of mental health providers will not take Medicare because of its low payment rates and, on top of that, for people in Medicare Advantage plans, a lot of administrative burdens. But, beginning in January 2024, Medicare will cover mental health care from marriage and family therapists, mental health counselors, and drug addiction specialists, increasing the pool of mental health providers available for people with Medicare to see, reports Judith Graham for The Washington Post.

    To date, Medicare has only covered care from psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers. They are a small group, and nearly half of psychiatrists and more than half of psychologists, 124,000 mental health providers, have opted out of Medicare. In addition, many Medicare Advantage plans do not contract with adequate numbers of mental health providers, according to a recent report from the Kaiser Family Foundation and a recent Senate Finance Committee survey.

    People in Medicare Advantage plans can struggle to access mental health services as well as a wide range of other services, particularly costly ones such as rehab therapy and nursing home care. Even if they can find a mental health provider who will see them in network, Medicare Advantage enrollees generally need approval from their Medicare Advantage plans before their mental health care will be covered. And, that approval can be hard to come by.

    Inability to get Medicare-covered mental health care has been a huge issue for the more than 15 million people with Medicare who have a mental health condition. Aa many as 7,500 of them do not receive mental health treatment today. The wait for a therapist who accepts Medicare can be six months.

    Medicare’s expansion of mental health services to marriage and family therapists and mental health counselors should mean that people will have less trouble finding a mental health provider who takes Medicare, at least if they are enrolled in Traditional Medicare. An additional 400,000 mental health providers are eligible to see patients with Medicare. In particular, people with Medicare in rural areas should have better access to mental health services.

    However, a lot turns on the payment rates Medicare sets for these providers. If Medicare’s approved rate is not fair, these providers may refuse to see Medicare patients. And, if Medicare Advantage plans engage in inappropriate denials and delays of care or refuse to pay mental health provider bills, as they too often do, these mental health providers will refuse to contract with them. Often older adults needing mental health services also have multiple chronic conditions. Providing treatment for them is not as simple as caring for younger adults.

    Medicare will also cover as much as 19 hours a week of outpatient mental health care for people most in need of outpatient mental health services–people with severe mental illness and people in need of substance use disorder care. Medicare will also enable some people to get mental health treatment in their homes through an expansion of mobile crisis services.

    Since the Covid pandemic began, people with Medicare can receive mental health services through telehealth, on the phone or through a computer. Medicare pays providers the same rates for telehealth services as for in-office appointments.

    Graham raises the question of whether Medicare will ever have mental health parity as is required for private insurance plans. Given so many other issues with Medicare mental health coverage, it’s not clear how much difference it would make, beyond an important symbolic one. But, at least it would eliminate Medicare’s 190-day lifetime limit on psychiatric hospital care. Medicare has no lifetime coverage limit on hospital care.

    Here’s more from Just Care:

  • People under 65 with Medicare less satisfied than people over 65

    People under 65 with Medicare less satisfied than people over 65

    People under 65 with disabilities are less satisfied with Medicare than adults over 65, reports Kaiser Family Foundation. The reason is likely that people with disabilities need a lot more health care than older adults and face obstacles to care that people who are relatively healthy do not face. Still, people under 65 with Medicare are more satisfied with their health care coverage than people who have Medicaid, employer coverage or coverage through a state health insurance exchange.

    Medicare covers about 66 million people. Nearly eight million (12 percent) of them are under 65 and enrolled in Medicare because of long-term disabilities, including End-Stage Renal Disease and ALS. People with disabilities on Medicare are more likely to be people of color, people with lower incomes and lower education levels; they also tend to be people in worse health than people over 65 in Medicare.

    No matter how you qualify for Medicare, you are supposed to get the same Medicare benefits. But, people under 65 are not guaranteed the right to Medicare supplemental insurance or Medigap–coverage that generally picks up most or almost all of people’s out-of-pocket costs–from a commercial insurer. So, unless people qualify for Medicaid or a Medicare Savings Program, they could have large out-of-pocket costs in Traditional Medicare and in Medicare Advantage. Not surprisingly, people with disabilities on Medicare report greater struggles getting and paying for care as well as less satisfaction with Medicare than people over 65.

    Overall satisfaction with Medicare jumps from 79 percent for people with disabilities to 92 percent for people over 65. Much of the concern among people with disabilities is around their ability to get care from good quality physicians and hospitals. Seven in ten of them reported having a problem with Medicare in the last year, whereas far fewer people over 65 (five in ten) say they experienced a problem with Medicare.

    It’s important to keep in mind that it’s a lot easier for people who do not use the health care system much or at all to be satisfied with their Medicare coverage than people who have complex conditions, as many people with disabilities under 65 do. About half of people with disabilities say they are in fair or poor physical health. Just 19 percent of people over 65 report that they are in fair or poor physical health. In fact, about half of people with Medicare use little or no health care in any given year.

    About 3o percent of people with disabilities say they have fair or poor mental health, as compared with just nine percent of people over 65. Twenty seven percent of them struggled to get mental health treatment they needed but was not covered, as compared with seven percent of people over 65. Eighteen percent said that they could not get medicines they thought they needed, as compared with five percent of people over 65.

    Nearly three in ten people with disabilities report having a hard time getting their Medicare plan to approve critical care, as compared with nine percent of people over 65. While the Kaiser Family Foundation does not distinguish those in Medicare Advantage plans from those in Traditional Medicare, only Medicare Advantage plans require prior approval before getting critical care.

    Twenty-four percent of people with disabilities reported not having their insurance pay for their care that they thought was covered, as compared to eight percent of people over 65. More than one in three people under 65 said they struggled to pay a medical bill as compared to nine percent of older adults.

    People under 65 experienced more difficulty getting care than older adults. They were more likely to skip or delay getting dental care, prescription drugs and medical care because of the cost than people over 65.  People under 65 also reported greater difficulty enrolling and understanding their options relative to people over 65.

    Here’s more from Just Care:

  • What are your Medicare premiums in 2024?

    What are your Medicare premiums in 2024?

    Medicare only covers about half of a typical person’s health care costs. People with Medicare generally pay a monthly Medicare Part B premium, more than 20 percent of their medical and inpatient costs out of pocket (or through Medigap or Medicaid,) as well as most or all of the cost of dental, vision, hearing and long-term care services. Medicare Part B premiums and other out-of-pocket costs are rising in 2024. Here’s what you need to know.

    Part B premiums in 2024:
    In 2024, people whose modified adjusted gross income from two years ago as reported on their federal tax return is $103,000 or less pay a monthly Part B premium of $174.70, an increase of $9.80.

    People with incomes above $103,000–about eight percent of the Medicare population–pay a Medicare Part B premium of:

    • $244.60 a month, if their income is above $103,000 and no more than $129,000.
    • $349.40 a month, if their income is above $129,000 and no more than $161,000.
    • $454.20 a month, if their income is above $161,000 and no more than $193,000.
    • $559 a month, if their income is above $193,000 and less than $500,000.
    • $594 a month, if their income is $500,000 or more.

    For couples with combined incomes of $386,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples filing jointly with annual incomes above $386,000 and less than $750,000 each pay a $559 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $594 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $240, an increase of $14 from the annual deductible of $226 in 2023.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2024 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse are among the 99 percent of people with Medicare who have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $278 a month, the same as in 2023; if you don’t have at least 30 quarters, the premium is $505 a month, a $1 decrease from 2023.
    • The Medicare Part A inpatient hospital deductible is $1,632, in 2024 an increase of $32 from 2023, and  coinsurance for hospitalizations after day 60 is $408 a day in a benefit period; coinsurance for lifetime reserve days is $816 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $204, an increase of $4.00 from $200 in 2023.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through Medicaid and the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    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:

  • 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:

  • 2023: Four things to know if your income is low and you have Medicare

    2023: Four things to know if your income is low and you have Medicare

    Today, 12.3 million older adults and people with disabilities are enrolled in both Medicare and Medicaid.  Almost three out of four of them (71.1 percent) are eligible for full Medicaid benefits, the remaining 28.9 percent are enrolled in a Medicare Savings Program. While Medicare is an earned health care benefit for people over 65 and people with disabilities, Medicaid is a means-based benefit for people with limited incomes and savings. Medicare and Medicaid work together to provide a more comprehensive set of benefits for people with low incomes.

    1. Medicaid picks up many health care costs that Medicare does not cover: Depending upon your income and assets, along with which state you live in, you might qualify for full Medicaid benefits in addition to Medicare. Medicaid would be your secondary insurance, paying after Medicare.  It generally covers the gaps in Medicare, including the Part B premium, the Part D drug premium, deductibles and coinsurance. It sometimes covers routine dental care and travel to and from the doctor’s office and some long-term care. No matter where you live, if you meet state-specific criteria, you will have coverage for nursing home care.  Depending which state you live in, and your care needs, you might also be eligible for home or community-based care.  In addition, there are several Medicaid/Medicare demonstration projects underway testing new ways to deliver home care for people with Medicare, in one project with the help of therapists, nurses and handymen.
    2. Your state Medicaid office or SHIP program can help you know whether you qualify for full Medicaid or other low-income assistance.  Even if your income or assets are over the limit, many states have what are called “spend-down” programs that allow you to qualify for Medicaid after you have spent some of your own money for health care.  If you own a home, Medicaid does not count your home as an asset. To contact your state Medicaid office, click here and to learn about free and low-cost resources, including the State Health Insurance Programs (SHIP), click here.
    3. Some states enroll people with Medicaid and Medicare in commercial managed care plans: These Medicare Advantage plans might create obstacles to care through limited networks and inappropriate delays and denials of care. But, no matter what state you live in, you should have the right to disenroll and switch to traditional Medicare if you’d like. If you have both Medicare and Medicaid, your out-of-pocket costs in traditional Medicare should be very little or nothing. Contact your state Medicaid office to learn about options in your state.
    4. Even if your income or assets are too high to qualify for full Medicaid benefits, Medicare Savings Programs, (administered by state Medicaid programs), may cover some of the gaps in Medicare. Four different Medicare Savings Programs fill different Medicare coverage gaps, depending upon your income and assets. For example, in 2023, the Qualified Medicare Beneficiary Program, QMB, picks up the cost of Part A premiums; Part B premiums, deductibles, coinsurance, and copayments. To qualify, your individual monthly income cannot exceed $1,235 (married $1,663) and assets $9,090 (married $13,630) plus $1,5oo for burial funds. To learn more about these programs and which health care costs they pick up, click here.

    In addition to Medicaid and Medicare Savings Programs, there are thousands of government and charitable programs that provide free and low-cost services across the country.

    Here’s more from Just Care:

  • People in Medicare Advantage struggle to afford their care

    People in Medicare Advantage struggle to afford their care

    Medicare offers very good coverage of inpatient and outpatient medical services, but it comes with significant out-of-pocket costs. A new report from The Commonwealth Fund lays out how these additional costs affect access to care for older adults and people with disabilities. In sum, people in Medicare Advantage are as likely to struggle to afford their care as people in Traditional Medicare.

    Unless they qualify for Medicaid or a Medicare Savings Program, people with Medicare generally pay monthly Medicare Part B premiums, deductibles, coinsurance and copays. They also generally pay all or most of the cost of dental, hearing, vision and long-term care services.

    Nearly 20 percent of people with Medicare face burdensome out-of-pocket costs–they are underinsured–based on their income. Whether they are in Traditional Medicare or Medicare Advantage, particularly people whose income is under twice the federal poverty level ($27, 180 for an individual and $36,620 for a couple in 2022) but who do not qualify for Medicaid, struggle to pay for their care. About 21 million people with Medicare have incomes under 200 percent of the federal poverty level.

    The Commonwealth Fund survey found that 38 percent of people with Medicare reported one or more problems accessing care during the year. As a result, these Americans might have not filled a prescription or gone to the doctor or dentist. People in Traditional Medicare and Medicare Advantage experienced access to care problems at the same rate. People with annual incomes above $55,000 experienced fewer problems accessing care.

    Medicare Part B premiums alone are substantial. And, 23 percent of people with Medicare reported that it is a challenge to pay these premiums. Nearly four in ten people with incomes under 200 percent of the federal poverty level reported a challenge paying these premiums.

    If you’re in a Medicare Advantage plan, out-of-pocket medical and inpatient costs can be as high as $8,300 a year in 2023 for in-network services alone, depending upon the Medicare Advantage plan you’re enrolled in. If you’re in Traditional Medicare, these costs are very limited if you have Medicare supplemental coverage or Medigap, retiree coverage from a former employer or Medicaid. But, if you do not have this extra coverage, your costs are uncapped.

    And, while people often join a Medicare Advantage plan believing they will get help with the cost of dental care, often that help appears better than it is. The data show that 30 percent of people in Medicare Advantage plans do not get dental care because of the cost as compared with 24 percent of people in Traditional Medicare. More people in Medicare Advantage plans have incomes under 200 percent of the federal poverty level than people in Traditional Medicare.

    Medical debt is another challenge facing older adults. One in six people with Medicare said they struggled with a medical bill or medical debt. People enrolled in Medicare Advantage plans faced significantly more medical bill problems and medical debt problems than people in Traditional Medicare, particularly people with incomes between 200 and 4oo percent of the federal poverty level.

    Twenty-eight percent of people facing medical debt and medical bills reported depleting their savings.

    Here’s more from Just Care: