Negotiations between the federal government and the manufacturers of ten prescription drugs over prices for the Medicare program are moving forward. The American Hospital Association reported on Oct. 3, 2023 ("CMS: Makers of selected drugs agree to participate in Medicare price negotiation"):"The companies that make the first 10 Medicare Part D drugs selected to participate in the Medicare Drug Price Negotiation Program have agreed to participate in the program’s price negotiations, the Centers for Medicare & Medicaid Services announced. CMS in August selected 10 high-cost drugs for the first negotiation cycle, which will run until next August for prices effective in…
Medicare and Medicare Advantage
Medicare is a complicated system that mixes public and private insurance providers. As reported by the Scripps News Service on Oct. 21, 2022 ("Why Is Medicare So Complicated?"):"By the government's last count in 2021, 64 million adults were enrolled in Medicare. But that doesn't mean it's simple to navigate. The Medicare maze is growing more entangled over the years, as Congress adds new benefits, exceptions, and penalties."As KFF explains in its Sept. 18, 2023 issue brief, What to Know about the Medicare Open Enrollment Period and Medicare Coverage Options:"People with Medicare may choose to receive their Medicare benefits through traditional…
Medicare Open Enrollment Season Runs October 15 – December 7
Open enrollment season for Medicare is October 15 through December 7. According to the federal Centers for Medicare and Medicaid Services (last accessed Oct. 15, 2023):"Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs."As KFF explains in its brief on Medicare open enrollment and plan options including Medicare Advantage plans, What to Know about the Medicare Open…
List of Drugs For Which Medicare Will Negotiate Prices Announced
September 1, 2023 On August 30, 2023, Kaiser Health News reported ("5 Things to Know About the New Drug Pricing Negotiations"):"The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans."Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare & Medicaid Services will…
Medicare Part B
"Part B covers physician visits, outpatient services, preventive services, and some home health visits. Many Part B benefits are subject to a deductible ($185 in 2019), and, typically, coinsurance of 20 percent. No coinsurance or deductible is charged for an annual wellness visit or for preventive services that are rated ‘A’ or ‘B’ by the U.S. Preventive Services Task Force, such as mammography or prostate cancer screenings." Source: Issue Brief: An Overview of Medicare. Kaiser Family Foundation. February 2019. http://files.kff.org/attachment/issue-brief-an-overview-of-medicare
Medicare Part C
"Part C refers to the Medicare Advantage program, through which beneficiaries can enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), and receive all Medicare-covered Part A and Part B benefits and typically also Part D benefits. Enrollment in Medicare Advantage plans has grown over time, with more than 20 million beneficiaries enrolled in Medicare Advantage in 2018, or 34 percent of all Medicare beneficiaries (Figure 3)."
Medicare Part D
"Part D covers outpatient prescription drugs through private plans that contract with Medicare, including stand-alone prescription drug plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs). In 2019, beneficiaries have a choice of 27 PDPs and 21 MA-PDs, on average. The Part D benefit helps pay for enrollees' drug costs and provides coverage for very high drug costs. Additional financial assistance is available for beneficiaries with low incomes and modest assets. Enrollees pay monthly premiums and cost sharing for prescriptions, with costs varying by plan. Enrollment in Part D is voluntary; in 2018, 43 million people on Medicare…
Medicare Premiums and Other Costs
"Most persons aged 65 or older are automatically entitled to premium-free Part A because they or their spouses paid Medicare payroll taxes for at least 10 years. Persons under the age of 65 who receive cash disability benefits from Social Security for at least 24 months and individuals of any age with end-stage renal disease (ESRD) are also entitled to Medicare Part A. Eligible individuals who are not entitled to premium-free Part A may obtain coverage by paying a monthly premium."All persons entitled to Part A may enroll in Part B by paying a monthly premium ($135.50 in 2019). Some…
Total Medicare Spending
"Medicare spending is driven by a variety of factors, such as the level of enrollment, the complexity of medical services provided, health care inflation, and life expectancy. The Congressional Budget Office (CBO) estimates that total Medicare spending in 2019 will be about $772 billion; of this amount, about $749 billion will be spent on benefits."CBO estimates that the federal portion of Medicare spending (after deduction of beneficiary premiums and other offsetting receipts) will be close to $637 billion in 2019, accounting for about 14% of total federal spending and 3% of GDP. Over the next 10 years, Medicare spending is…
Medicare Financing
"The Medicare program has two separate trust funds—the Hospital Insurance (HI) Trust Fund, which finances Part A, and the Supplementary Medical Insurance (SMI) Trust Fund, which finances Parts B and D. (Part C payments are made in appropriate parts from both the HI and SMI Trust Funds.) Both funds are maintained by the Department of the Treasury and overseen by a Board of Trustees, which reports annually to Congress."Similar to Social Security, the HI portion of Medicare was designed to be self-supporting and is financed through dedicated sources of income. The primary source is payroll taxes paid by employees and…