Author: Elizabeth Blessing
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Medicare’s negotiated price for Xifaxan falls to $1,000 from $2,696 in January
Few conditions land a patient in a pharmacy line for a drug that costs more than a used car every month. Hepatic encephalopathy, a buildup of toxins in the blood tied to advanced liver disease, is one of them, and the antibiotic most often prescribed to control it, Xifaxan, has carried one of the steepest…
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Medicare’s negotiated price for diabetes pill Tradjenta falls to $78 from $488 in January
Type 2 diabetes is common enough among Medicare enrollees that a single pill’s price can move real money through the Part D program. Starting January 1, the government-set price for a month’s supply of the diabetes drug Tradjenta drops from $488 to $78, an 84% cut that comes from the second round of Medicare’s drug…
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Medicare keeps covering telehealth visits from home through December 31, 2027, under the spending law that ended the partial shutdown
A telehealth appointment that Medicare would have refused to pay for just a few years ago now stays covered, from a patient’s own living room, through the end of 2027. The extension survived because of a spending bill that Congress passed in the final days of a partial government shutdown, and it keeps several pandemic-era…
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Iowa Medicaid expansion members must meet new work rules by December 1, but caregivers of a child under 14 are exempt
Certain members of Iowa’s Medicaid expansion program will have to start meeting a monthly work or activity requirement by December 1, 2026, under a state rule taking effect this fall. Not every member is subject to the requirement: caregivers responsible for a child under 14, along with several other groups, are exempt. The rule marks…
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Fairview stops scheduling UnitedHealthcare Medicare Advantage patients January 1, and says Blue Cross, HealthPartners and Medica plans remain in network
M Health Fairview, the Minneapolis-based health system, has told patients it will stop scheduling appointments for anyone enrolled in a UnitedHealthcare Medicare Advantage plan starting January 1, 2027. The health system’s own patient-update page names three other insurers, Blue Cross Blue Shield of Minnesota, HealthPartners and Medica, along with Original Medicare, as the coverage that…
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Social Security plans to move every beneficiary off paper checks this year, saying paper is 16 times likelier to be lost or stolen
Sixteen times more likely to be lost, stolen, altered or returned undeliverable: that is how the Social Security Administration itself describes the risk of continuing to mail a paper benefit check rather than pay it electronically. The agency has set a deadline for closing that gap entirely, aiming to move every remaining beneficiary onto direct…
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A spouse can get up to half of the benefit a worker would collect at full retirement age, Social Security says
Marriage alone does not automatically hand a spouse a Social Security payment; Social Security requires at least a year of marriage plus one more condition before the up-to-half figure even applies. Once that bar is cleared, the payment tops out at half of what the worker would collect at full retirement age, calculated as a…
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Medigap Plans C and F are closed to people new to Medicare since 2020
Two of the most complete Medigap policies on the market, Plan C and Plan F, are not available to everyone who wants one. Anyone who became eligible for Medicare on or after January 1, 2020, cannot buy either plan for the first time, no matter how many years have passed since. CMS’s own consumer guide…
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Most of Humana’s 2027 Medicare Advantage exits involve plans rated 3.5 stars or lower
The Medicare Advantage plans Humana is exiting for the 2027 plan year are concentrated among its lower-performing options: most carry a quality rating of 3.5 stars or below, according to a trade-press review of the same investor materials Humana used to disclose the roughly 600,000-member exit. Star ratings are the federal government’s own scorecard for…
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Medicare’s Part B late penalty adds 10% for each year a person could have signed up but didn’t, for as long as they have Part B
Waiting to enroll in Medicare Part B beyond the window when someone first qualifies carries a specific, permanent cost. For every full 12-month period a person could have had Part B but didn’t sign up, Medicare tacks on an extra 10% to the standard monthly premium, and that surcharge keeps getting billed for as long…