medicare
White House Statement about reducing Medicaid Fraud
In an effort to clarify (in the face of relentless media reports of potential healthcare cuts to needy Americans) the White House has released a statement about finding fraud, waste and abuse in the nation’s Medicaid program (not to be…
The next batch of drugs under negotiations
The Centers for Medicare and Medicaid Services (CMS) issued a draft guidance on May 12th for the third round of Medicare drug negotiations. The government has until the end of November to announce the agreed-upon Medicare prices, with the lower…
When is the Medicare initial enrollment period?
Medicare initial enrollment period (IEP) occurs three months before your 65th birthday, the month of your 65th birthday, and the three months after your 65th birthday. You can enroll in Original Medicare, which includes Parts A and Part B. Once…
Ask Rusty – I’m a Retired Veteran; Why must I pay for Medicare?
Dear Rusty: I’m a retired Navy veteran who is going to be turning 65 years old this year. My question is concerning mandatory Medicare sign-up requirements. Why do I have to sign up for Medicare coverage at 65 when I…
Improving Seniors’ Timely Access to Care Act
Improving Seniors’ Timely Access to Care Act of 2025 was reintroduced by U.S. Senators Roger Marshall, M.D. and Mark Warner on May 20, 2025. The bill if passed will establish requirements with respect to the use of prior authorization under…
How do you qualify for a grocery allowance through Medicare Advantage?
We have all seen TV ads or social media posts about seniors qualifying for a grocery allowance, but who qualifies? First, you must be enrolled in original Medicare Parts A and B and choose to enroll in a Medicare Advantage…
About Fraud in Medicare and Medicaid
Seeking fraud and eliminating government waste seem to be popular buzz words today, and the primary targets on the potential fraud list are Medicare and Medicaid. Indeed, the U.S. Government Accountability Office recently suggested that the federal government loses between…
“Most favored nation” pricing model for certain drugs
According to a recent poll, three in four adults in the United States say the cost of medications is unaffordable. With drug prices in the U.S. higher than in other countries as much as 10 times, President Trump is expected…
Should CMS monitor biosimilar coverage on formularies?
The U.S. Department of Health and Human Services Office of Inspector General (OIG) released a study that found many Medicare Part D formularies included Humira Biosimilars for 2025. Humira is one of the best-selling prescription drugs in the world. However,…
Original Medicare covers most but not all healthcare services
Medicare is the government health insurance program for adults 65 and older and individuals under 65 with certain disabilities. However, Medicare does have its drawbacks. Original Medicare covers most, but not all, of the costs for approved health care services…