medicare
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…
Ask Rusty – Must I take Medicare Part A even if I have VA or Medicaid Coverage?
Dear Rusty: Does everyone need to sign up for Medicare part A, even if you are ex-military? Or only on Medicaid, regardless of whether you are eligible for Social Security or not? Also is there a cost for just part…
The difference in care between Medicare and Medicare Advantage members
With the increasing enrollment by Medicare recipients in Medicare Advantage health plans and the issue of prior authorization requirements and limited provider networks, a team of health policy researchers at Harvard T.H. Chan School of Public Health looked at the…
“Original Medicare” vs. Medicare Advantage – A national picture
In this interesting article, a study found that most seniors living in rural areas tend to rely on the federal government’s “traditional Medicare – Part A and Part B” to provide their healthcare insurance, versus opting for enrollment in private…
When is Medicare Part A free?
For most seniors, the FICA payroll tax they pay when working includes an amount for Medicare’s “Part A” – which is Medicare coverage for inpatient hospitalization services. Those payroll contributions, made for at least 10 years of working, result in…
Medicare boosts reimbursement rates; good news for insurers
Shares for U.S. health insurers went up on the stock market yesterday, based on an announcement by the Centers for Medicare and Medicaid Services (CMS) that they will raise reimbursement rates for Medicare Advantage plans starting in 2026. This is…