JustCare

Tag: Premiums

  • Medicare Advantage overpayments drive up Medicare premiums by $220 billion

    Medicare Advantage overpayments drive up Medicare premiums by $220 billion

    If Republicans are serious about eliminating government waste and protecting Medicare and Medicaid, they will end Medicare Advantage overpayments; in addition to strengthening Medicare, ending these overpayments would lower premiums for older adults and people with disabilities by $220 billion. Ending these overpayments would also add $550 billion to the Medicare Trust Fund.

    Ending government overpayments to Medicare Advantage insurers would put spending in Medicare Advantage on a level playing field with traditional Medicare. Ending overpayments would mean reducing already high MA insurer profits, not Medicare benefits. Reducing overpayments would strengthen the Medicare program.

    Here’s the data revealing the excessive costs of Medicare Advantage relative to traditional Medicare as well as the toll it is taking on the out-of-pocket health care costs of older Americans and people with disabilities and the Medicare Trust Fund. 

    Medicare overpays Medicare Advantage insurers

    • “The MA program has been expected to reduce Medicare spending since its inception—under the original incorporation of private plans in Medicare in 1985, payments to private plans were set at 95 percent of FFS payments—but private plans in the aggregate have never produced savings for Medicare, due to policies governing payment rates to MA plans that the Commission has found to be deeply flawed.”
    • According to the Medicare Payment Advisory Commission (MedPac), the program’s watchdog agency, Medicare Advantage plans cost taxpayers 20% more than traditional Medicare, amounting to a projected $84 billion in 2025.
    • The Committee for a Responsible Federal Budget reports that overpayments to MA plans will total  $1.2 trillion dollars over the next decade.
    • A report by the Wall Street Journal of roughly 2 billion diagnoses covering 84% of the nation’s MA enrollees from 2018-2021 found that MA insurers collected $50 billion in payments for diseases that doctors never diagnosed or treated.

    Medicare Advantage overpayments strips billions from the Medicare Trust Fund

    • The Committee for a Responsible Budget reports that eliminating the overpayments would save the Medicare Trust Fund $550 billion.

    Older adults and people with disabilities pay higher premiums because of Medicare Advantage

    Here’s more from Just Care:

  • Older adults are extremely worried about affording health care

    Older adults are extremely worried about affording health care

    Older adults are extremely worried about affording their health care, concerned they will not be able to pay for the care they need, reports Judith Graham for KFF Health News. Health care affordability is top of mind for older adults as they see prices rising for all their basic needs.

    The National Poll on Healthy Aging found that people over 50 had three major health care concerns: costs, costs and more costs. The cost of medical care, the cost of long-term care and the cost of prescription drugs. People were “very concerned” about these costs.

    People surveyed had other concerns, also related to costs, including the cost of health insurance and Medicare and the cost of dental care. They were also concerned about financial scams.

    People were less concerned about loneliness, being overweight and age discrimination.

    It’s not surprising that older adults are so concerned about health care costs. Twenty-five percent of older adults depend entirely on Social Security for their income, which averages $1,913 a month for an individual. Ten percent of older adults have annual income below the federal poverty level.

    Older adults cannot rely on Medicare, be they in Traditional Medicare or a Medicare Advantage plan, to cover their dental, vision or hearing care or their long-term care. Medicare only covers limited care in a skilled nursing facility or at home if you meet certain criteria. And though Medicare Advantage plans like to tout the dental, vision or hearing care they cover, they tend to offer very limited benefits that are of little help to covering the costs of the services people need.

    People often go without dental care and eyeglasses since Medicare does not cover them. On average, people with Medicare spend about $7,000 a year on medical care. Younger people spend about $4,900 on average.

    People also struggle to pay for long-term care. Nursing home care costs $104,000 on average in 2023. Care in an assisted living facility costs $64,200 on average in 2023. Services at home from home-health aides cost $75,500 a year on average.

    A large proportion of older adults–17 million–live on less than $30,120 a year ($40, 880 for a couple,) twice the federal poverty level. After you pay for Medicare Part B and D premiums and a Medicare supplemental policy, millions of people with Medicare have spent more than 4o percent of their monthly Social Security check, about $468 out of $1,121.

    Medicare Savings Programs can help cover Medicare premiums and out-of-pocket costs. You can apply through your Medicaid office. You qualify based on your income and assets, but many people are unaware of the programs. Six million people qualify who are not enrolled, according to Graham.

    You can check out additional programs that lower your health care costs here.

    Here’s more from Just Care:

  • Humana and CVS will raise costs for Medicare Advantage enrollees in 2025

    Humana and CVS will raise costs for Medicare Advantage enrollees in 2025

    Humana and CVS intend to raise premiums and reduce benefits on their MA plans in 2025, reports Rebecca Pifer for Health Care Dive. They want to increase their profits further, even though the government already overpays them billions of dollars a year.

    As many as 700,000 CVS and Humana MA enrollees could switch to other plans, and CVS and Humana don’t seem to care. UnitedHealth is likely to grow its business in the process, depending upon whether it decides to cut benefits and/or raise premiums. The insurers offering Medicare Advantage are unlikely to increase their out-of-pocket caps and their deductibles, which people with Medicare apparently care most about.

    We won’t know what these insurers will decide to do until October. To be clear, CVS and Humana, like all of the big insurers, are first and foremost in the Medicare Advantage business to generate profits for their shareholders. Enrollee needs are secondary. They will exit markets where they don’t see good profits.

    CVS, Humana and UnitedHealth all own medical provider groups. So, they are likely to continue their MA businesses in counties in which those groups have clinics and they can generate better profits. 

    Insurers are most likely to raise copays for specialty care, which people can’t really wrap their heads around before enrolling and needing specialty care. Insurers also could cut supplemental benefits, such as money for home improvements and pet care.

    The insurers have a lot of discretion, but they can’t change anything they want. The government limits their ability to change “total beneficiary cost,” which is limited to $40 per enrollee each month. 

    Here’s more from Just Care:

  • CVS plans to raise Medicare Rx premiums a lot in 2025

    CVS plans to raise Medicare Rx premiums a lot in 2025

    In an op-ed for MarketWatch, Brett Arens’s Roi warns about rising Medicare Part D premiums.

    The CFO at CVS is alerting people that Medicare Part D premiums will increase significantly in 2025. How much of that increase amounts to more profits for CVS? It’s already profiting from pocketing pharmaceutical company rebates instead of passing them on to its Part D enrollees in the form of lower out-of-pocket costs.

    A series of articles over the last few years highlight tactics CVS uses to maximize profits. For example, it sometimes makes its Part D enrollees buy brand-name drugs, for which CVS earns more. So, it’s no surprise that CVS is planning another premium hike. Premiums will be “much, much higher” says Thomas Cowhey, the CFO.

    CVS knocked up Part D premiums 20 percent this past year. This time round, the higher premiums will allow CVS to protect its profits from rising costs resulting from the $2,000 out-of-pocket cap for Part D coverage that goes into effect in 2025.

    CVS believes that more people will be filling their prescriptions once Part D has a $2,000 out-of-pocket cap. Costs will no longer be a barrier for some, after they spend $2,000 out of pocket. The question then becomes how many people have $2,000 to spend to reach that out-of-pocket cap when they need to?

    As of now, about one in seven people with Medicare say they are not filling their prescriptions because of the cost.

    Some analysts believe that the new $2,000 out-of-pocket cap in Part D will steer more people into Medicare Advantage plans. Medicare Advantage plans almost always include prescription drug coverage in their premiums. Medicare Advantage plans are likely to look less expensive than Traditional Medicare, where people would have to buy a stand-alone Part D prescription drug plan.

    Here’s more from Just Care:

  • Poll: Health care costs are a top economic priority for voters

    Poll: Health care costs are a top economic priority for voters

    As you’ve likely been reading, voters continue to have negative views about the US economy. High health care costs (and inflation, which is actually in check) feed into that view, with voters saying they are big concerns. The Kaiser Family Foundation’s latest poll finds that voters want to hear President Biden and former President Trump discuss these issues.

    Americans believe that their cost of living, including housing, is rising; health care costs also represent a piece of that expense. They do not seem to consider that unemployment is low and the stock market has been climbing. Almost three in four Americans are concerned about paying unexpected medical bills; more than half are worried that they won’t be able to afford their prescription drugs and nearly half express concern about paying their health insurance premiums.

    What’s particularly noteworthy is that even though former President Trump would likely cut some of the benefits voters enjoy and President Biden has worked hard to boost them, nine in ten Republicans say they would vote for former President Trump. Curiously, Republican voters believe that former President Trump did more to address high health care costs than President Biden, although not enough. Nearly six in ten Republicans (59 percent) say Trump did enough to address health care costs, whereas only one third (33 percent) of Democrats say Biden has done enough.

    Voters who say they support Trump recognize that he does not have a vision for replacing the Affordable Care Act, only for ending it. But, they don’t appreciate that President Biden was the Vice President when the ACA was passed and played a significant role in its passage.

    The ACA is not well understood, likely because only a fraction of the population benefits from it today. Most people don’t appreciate the protections it offers people who lose their employer coverage or who are self-employed, particularly those who have pre-existing conditions, and why it needs to be strengthened. Many Republicans suggest they would be happy to see it cut or repealed.

    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:

  • 2022 Trustees’ report on Social Security and Medicare shows slight improvements in their finances

    2022 Trustees’ report on Social Security and Medicare shows slight improvements in their finances

    The 2022 Social Security and Medicare Trustees’ report shows slight improvements in the finances of both Medicare and Social Security.

    According to Dean Baker, senior economist at the Center for Economic and Policy Research, the Affordable Care Act helped Medicare’s finances. He says: “This is hugely important, and little appreciated. The reduced payments to private [Medicare Advantage] plans operating within the Medicare program are attributed to the Affordable Care Act (ACA) reining in health care cost growth.

    Baker finds that the current estimated shortfall for Social Security is not much greater than the projected savings to Medicare as a result of the Affordable Care Act.

    Social Security is seeing small improvements because fewer people are receiving disability benefits and the US recovered quickly from the recession caused by the COVID-19 pandemic. Consequently, Social Security’s shortfall over the next 75 years dropped to 3.42 percent of payroll from 3.54 percent of payroll.

    That said, we know that the Trump administration made it harder for people to receive Social Security disability benefits. So, Social Security’s better financial footing might stem from fewer people receiving disability benefits than should.

    Medicare’s financial footing improved in part because its spending declined. Its premiums rose substantially because the government factored in payment for an expensive Alzheimer’s drug that it ultimately decided not to cover, except in the most limited situations. The premium hike underscores the power of the pharmaceutical industry to set sky high prices at the expense of taxpayers and people with Medicare.

    According to the Trustees, the federal government is seeing higher tax income, which also helps the financial condition of Social Security and Medicare.  Social Security reserves are expected to last until 2035–a year longer than projected last year–as of now. Medicare’s Part A Hospital Insurance (HI) trust fund reserves are expected to last until 2028. That’s two years later than previously projected. Medicare’s long-term financial situation also improved slightly, with a 75-year shortfall in the Hospital Insurance Trust Fund now at .70 percent of taxable payroll, down from .77 percent.

    Even with all reserves depleted, both Medicare and Social Security will continue. Social Security could pay about 80 percent of benefits with its annual income from payroll contributions. Medicare Part A could pay about 90 percent of benefits. Medicare Parts B and D costs in addition to premiums are paid for with general revenue, so are fully funded.

    In its 2022 budget, the Biden Administration proposed closing a tax loophole that would strengthen the Medicare Part A trust fund for a long time. It would require high-income taxpayers with pass-through business income to pay the Medicare tax on self-employment income and the net investment income tax on unearned income. This additional tax money would go to the Part A trust fund.

    We now need Congress to slow down Medicare spending. It could do so through allowing Medicare to negotiate drug prices. It could also do so by ending overpayments to Medicare Advantage plans.

    We also need to strengthen Social Security through additional tax revenues. Congress should lift the cap on Social Security payroll contributions. Medicare payroll contributions are not capped, nor should Social Security contributions be.

    Here’s more from Just Care:

  • Can Congress incentivize drugmakers to lower insulin prices voluntarily?

    Can Congress incentivize drugmakers to lower insulin prices voluntarily?

    Senators Jeanne Shaheen and Susan Collins think they have a way to bring down the price of insulin without needing to pass legislation regulating its price. Stat News reports that their proposal takes into consideration that drugmakers must pay insurers to give their drugs preferential treatment, driving up drug prices. It also assumes that drugmakers would voluntarily lower their list prices if legislation frees them from paying insurers. Really?

    The Shaheen-Collins proposal would forbid pharmaceutical companies from paying insurers for preferential treatment. It would also limit people’s monthly out-of-pocket insulin costs. It would impose an out-of-pocket limit if insulin makers lowered their prices to $68 a vial, its 2006 price. Insulin now costs $300 or so a vial.

    Shaheen and Collins don’t know whether manufacturers would agree to their proposal. If not, some people with insurance would still benefit, as the proposal would require insurers to offer at least one insulin product for no more than $35 out-of-pocket a month. However, people with diabetes need to use different insulin products, so that backstop would only benefit people who needed the one insulin product with a $35 max out-of-pocket cap.

    Today, people with Medicare already have the option of capping their monthly insulin costs at $35 through their Part D drug plans. That said, about one in four of them still paid more than $35 a month for their insulin.

    Few people benefit from an out-of-pocket cap of no more than $35. Many people’s out-of-pocket costs with insulin each month can be more than $150. At least one in four people who need insulin are paying more than $35 a month for it.

    The Shaheen-Collins proposal would only help people who are uninsured if manufacturers lowered their list prices. Most likely, they would only do so voluntarily if the amount they no longer paid insurers to include their products on their formularies exceeded the difference between what they charge now for insulin and what they charged in 2006.

    Many large advocacy groups think the Shaheen-Collins proposal is ridiculous. Drug manufacturers are not going to lower their prices voluntarily. And, if they don’t, the Shaheen-Collins proposal would cost the federal government billions. It would also increase health insurance premiums for everyone. as insurers would not eat the cost of a $35 monthly out-of-pocket limit, they would shift it. Moreover, the proposal would encourage insulin manufacturers to raise their prices further since they would know that any price increase would not affect people’s out-of-pocket insulin costs.

    Congress needs to pass legislation that lowers all drug prices for everyone. In the meantime, for lower drug prices, check out Mark Cuban’s cost plus discounted drug pharmacy. You might also check out pharmacychecker.com for verified pharmacies selling drugs at far lower rates than in the US. And, then, there’s always the opportunity to pick up low-cost drugs on a trip to Mexico, Canada, Japan or Australia, among many other countries.

    Here’s more from Just Care:

  • Coronavirus: How to help workers who become uninsured?

    Coronavirus: How to help workers who become uninsured?

    Back in April 2020, early in the pandemic, the US suffered from tremendous unemployment. With that, came millions of uninsured. Paul Fronstin and Stephen Woodbury report for The Commonwealth Fund that even though millions of Americans lost their jobs since March 2020, fewer than anticipated lost their health insurance. Whatever the number of uninsured, the Biden administration should ensure coverage for the uninsured and offer workers the choice of health coverage not tied to their work.

    President Biden proposes that the government pay the health insurance premiums–COBRA–for people who have lost their health insurance along with their jobs during this pandemic. That will definitely help the insurers. But, giving people back the high-deductible, high-copay health insurance they had when they were employed is a far cry from helping them when they have little or no income and limited savings.

    Recent estimates suggest that about 7.7 million people who lost their jobs during the pandemic also lost their employer coverage. Including their family members who lost coverage, closer to 14.6 million people lost employer insurance. Both for their individual health and the public health, they should be able to get care without worry about the cost.

    Paying people’s COBRA premiums is out of line with Biden’s desire to provide free COVID-19 testing and treatment for everyone. To provide this coverage, there’s a far better proposal on the table, the Health Care Emergency Guarantee Act. sponsored by Congresswoman Pramila Jayapal, Senator Bernie Sanders and others. It would have the Department of Health and Human Services cover the full cost of care for everyone who lacks health insurance, along with the copays, deductibles and other out-of-pocket costs for people with public or private insurance. That policy solution would ensure that everyone got free COVID care.

    The cost of the Health Care Emergency Guarantee Act would likely be far less than paying for people’s health insurance through COBRA. Estimates are that half of people who were laid off were able to keep their health insurance coverage. More than four in ten businesses that had to let go of workers continued to pay some of their workers’ premiums. Even with COBRA, how many of workers skipped care because the out-of-pocket costs were high?

    Many more workers are likely to lose their health insurance in the coming months. It’s hard to imagine that employers will continue to pay premiums for workers they had to let go. And, it’s likely that in this next wave of the pandemic, fewer employers will pay premiums for workers who they are forced to lay off.

    The best solution for ensuring everyone gets free COVID care and access to all needed care is to improve and expand Medicare to everyone. Short of that, President Biden should support, and Congress should pass, the Health Care Emergency Guarantee Act.

    Here’s more from Just Care:

  • What are the major differences between Medicare for all and a public option?

    What are the major differences between Medicare for all and a public option?

    The latest Kaiser Family Foundation health tracking poll reveals substantial public confusion about various health reform proposals. Americans do not understand major differences between Medicare for all and a public option. Here’s a cheat sheet.

    Would both Medicare for All and a public option cover all Americans? Would they both require people to pay monthly premiums? No. Medicare for All is designed to guarantee all Americans health care coverage automatically. It would be paid for much like Social Security, public schools, and police departments. Medicare for All does not require people to pay monthly premiums.

    Rather, with Medicare for All, premium contributions that once went to private health insurers would go to the government in the form of taxes, based largely on income. Everyone would be covered by single-payer, public health insurance. Instead of paying private premiums, you would pay an income-based tax, effectively a public premium. Yet, 44 percent of people surveyed did not understand that they would not need to pay monthly health insurance premiums with Medicare for All.

    In stark contrast, a public option, which could be designed in a variety of ways, would likely work more like private health insurance today, requiring you to pay a monthly premium. Still, 50 percent of people surveyed did not understand that they would have to pay a monthly premium for their coverage. Moreover, 53 percent of people surveyed thought the public option would cover everyone, which is not at all clear.

    A public option would not likely guarantee coverage to all Americans, unless the federal government increased taxes enormously to pay for it. And, no one is proposing a sizable tax increase to cover the cost of the public option; rather, proponents, like Pete Buttigieg, are saying that a public option would not raise taxes significantly. Consequently, people could opt not to pay their premiums. And, it’s more than likely many people would not be able to afford their premiums, since the public option would not rein in health care costs substantially.

    Would both Medicare for All and a public option require people to pay deductibles and copays? No. Medicare for All eliminates deductibles and copays. But, more than six in ten Americans don’t understand that people would not pay deductibles or copays with Medicare for All. And, more than three in ten Americans do not understand that people would continue to pay deductibles and copays with a public option, as the do today.

    How about unrestricted access to doctors and hospitals?  With Medicare for All, you can use whichever doctors and hospitals you would like. But, a public option builds on our current system and likely would allow provider networks, restricting access to doctors and hospitals.

    What about costs? Only Medicare for All reins in health care costs substantially. It is estimated to save middle-income households 9.6 percent of their annual income. Medicare for All creates significant savings because it eliminates private health insurers and, with that, about $600 billion a year in administrative costs. It also cuts prescription drug costs in half. A public option could not save much money. It would cut prescription drug costs, but it keeps all the administrative waste in our health care system.

    And, what happens to private health insurance? With Medicare for All, your primary insurance is public insurance; you could not keep your private health insurance. Still, almost half of Americans do not understand that Medicare for All would not allow them to keep their current health insurance; that’s key to bringing down costs. About 40 percent believe that a public option would not allow them to keep their current health insurance either, though it would.

    Here’s more from Just Care: