Medicare

The Affordable Care Act (ACA) led to reductions in out-of-pocket costs and improvements in health among adults entering Medicare.

Semaglutide (Ozempic) is 1 of 15 medications that will be included in yearly price negotiations between Medicare and manufacturers.

ACA enrollment rate hits a milestone, though IRA subsidies may not extend beyond 2025; network adequacy standards fail to translate into efficient access to mental health care for Medicaid enrollees; research examines racial disparities in postpartum hypertension and vaccine uptake.

High-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.

The health care provisions include key reforms targeting pharmacy benefit managers, extensions of Medicare telehealth flexibilities, and measures aimed at combating the opioid crisis and preparing for future pandemics.

The authors evaluate features of the Transforming Episode Accountability Model and discuss its benefits and limitations.

The authors discuss multiple challenges to the production of policy-relevant results from evaluation of Medicare accountable care organizations (ACOs).

Lindsay Bealor Greenleaf, JD, MBA, of ADVI Health, weighs in on what to expect in key health care policy areas in the wake of the election.

This research is not the first to uncover duplicative and wasteful spending on health care for veterans who receive care primarily through the Veterans Health Administration as they are also enrolled in Medicare Advantage plans.

CMS is creating infrastructure to improve coverage of prescription digital therapeutics (PDTs), and new legislation would also drive uptake of PDTs.

Patients with Medicare coverage and whose incomes fall between 100% and 400% or less of the federal poverty level may find themselves in a tricky financial situation concerning their ability to pay the Medicare Part A hospital deductible.

Medicaid, Medicare, and private insurance programs all showed significant variability in expenditures based on social and nonclinical factors.

CMS made improvements for the Enhancing Oncology Model (EOM) over the Oncology Care Model (OCM), but there remains a delay in data and the challenge of high-cost, novel therapies, explained Stuart Staggs, vice president, Transformation and Shared Services, McKesson.

A review of positions and track records of Vice President Kamala Harris and former President Donald Trump on reproductive health, the future of the Affordable Care Act, prescription drug costs, health care consolidation, and a proposed Medicare home health benefit.

A new letter signed by more than 230 members of the House urges Congress to not only block the scheduled 2.8% reimbursement cut, but also reform the Medicare Physician Fee Schedule.

Between 2011 and 2020, the Veterans Health Administration spent $78 billion on health services for veterans also enrolled in Medicare Advantage.

The Supreme Court’s decision, paired with the newest data demonstrating the public impact of the opioid crisis, illustrates the legal potential in addressing the crisis and the ongoing public health challenges of treatment access.

Average Medicare drug premiums for older Americans will drop next year for those enrolled in traditional Medicare plans or who have coverage through Medicare Advantage, with opinions divided along party lines on the economic implications.

After a small number of practices joined the Enhancing Oncology Model (EOM) in 2023, CMS has made some changes and opened the model back up for new practices to join.

There are concerns that the negotiated drug prices under the Inflation Reduction Act (IRA) are leading to large provider reimbursement cuts, explained Nick Ferreyros, managing director, Community Oncology Alliance.

The Center on Health Equity & Access provides the latest news, research, and expert opinions on the state of equity in health care.

Medicare has not clearly defined what constitutes "established cardiovascular disease," leading to variability in potential patient eligibility; therefore, researchers aimed to estimate the number of Medicare beneficiaries who would become newly eligible for semaglutide under different definitions.