A Medicare claim denial has to clear a specific dollar threshold before it can reach an administrative law judge instead of a lower-level reviewer. The Centers for Medicare and Medicaid Services (CMS) confirmed in a Federal Register notice that the threshold stays at $200 for 2027, unchanged from the year before. A separate, higher threshold…

Congress built a speed limit into one of Medicare’s most closely watched annual numbers. The Centers for Medicare & Medicaid Services says the Part D base beneficiary premium, the reference figure insurers use in pricing stand-alone drug plans, cannot grow by more than 6% in any year from 2024 through 2029. For 2027, that base…

Medicare requires a plan that will not return for the next coverage year to tell its members before the annual shopping season gets underway. Medicare.gov’s guidance on plan non-renewal says that notice goes out in October, and it tells a member plainly to find a new plan for coverage starting the following January. Nothing in…

Turning 65 does not force a Medicare Part B enrollment on someone who is still working and covered by a group health plan through an employer. Medicare.gov’s rules give that person an eight-month window to sign up for Part B without penalty once the job or the group coverage ends, whichever happens first. Electing COBRA…

A Medicare Advantage plan that leaves the Medicare program entirely triggers one of the stronger consumer protections built into Medigap: a right to buy certain Medicare Supplement policies with no health questions asked. Medicare.gov sets that window at 60 days before the old coverage ends through 63 days after it ends. Miss both ends of…

A Medicare Advantage plan that stops operating for 2027 does not leave its members without a next step. Medicare.gov’s special enrollment rules set a window for switching to a new plan or falling back to Original Medicare, running from December 8 through the last day of February. A member who lets that window close is…

Every October, a subset of Medicare Advantage members opens a piece of mail unlike what most other enrollees receive that month: a notice stating that the plan will not continue into the next year and instructing the member to find new coverage. Medicare’s own guidance describes the notice in plain terms, and it is a…

Roughly 116,000 people with Medicare rely on the antipsychotic Vraylar to manage conditions that range from bipolar disorder to schizophrenia, and every one of them is about to see the government’s own price for that drug drop by nearly half. On January 1, the maximum fair price CMS negotiated for Vraylar takes effect, cutting the…

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…

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…