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Proposed Medicare Advantage Changes Cannot Accurately Be Called ‘Cuts,’ Experts Say

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CMS advanced two proposed changes that could affect Medicare Advantage plans. One would allow the government to recover past overpayments. As a result, it could reduce those insurers鈥 profits, leading them to increase enrollees’ out-of-pocket costs or reduce benefits. But it’s inaccurate to characterize the changes as “cuts.”

Millones en riesgo de perder Medicaid, mientras terminan protecciones por la pandemia

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Los estados se est谩n preparando para remover a millones de personas de Medicaid, a medida que expiran las protecciones que se implementaron al comienzo de la pandemia de covid-19.

Nursing Home Owners Drained Cash During Pandemic While Residents Deteriorated

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As the federal government debates whether to require higher staffing levels at nursing homes, financial records show owners routinely push profits to sister companies while residents are neglected. 鈥淎 dog would get better care than he did,鈥 one resident鈥檚 wife said.

Medicare Pay Cuts Will Hurt Seniors鈥 Care, Doctors Argue

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New reductions in Medicare payments in 2023 will drive more doctors away from accepting Medicare patients, physicians say. They are again pushing back on efforts largely designed to control government spending.

How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions

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Facing rare scrutiny from federal auditors, some Medicare Advantage health plans failed to produce any records to justify their payments, government records show. The audits revealed millions of dollars in overcharges to Medicare over three years.

KHN Investigation: The System Feds Rely On to Stop Repeat Health Fraud Is Broken

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A months-long KHN examination of the system meant to bar fraudsters from Medicaid, Medicare, and other federal health programs found gaping holes and expansive gray areas through which banned individuals slip to repeatedly bilk taxpayer-funded programs.

KHN鈥檚 鈥榃hat the Health?鈥: Congress Races the Clock

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Sen. Raphael Warnock鈥檚 re-election in Georgia will give Democrats a clear-cut Senate majority for the first time in nearly a decade. Meanwhile, the current Congress has only days left to tackle major unfinished business on the health agenda, including fending off scheduled pay cuts for doctors and other health providers in the Medicare program. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Anna Edney of Bloomberg News, and Sandhya Raman of CQ Roll Call join KHN鈥檚 Julie Rovner to discuss these topics and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Audits 鈥 Hidden Until Now 鈥 Reveal Millions in Medicare Advantage Overcharges

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Taxpayers had to foot the bills for care that should have cost far less, according to records released after KHN filed a lawsuit under the Freedom of Information Act. The government may seek to recover up to $650 million as a result.

Path Cleared for Georgia to Launch Work Requirements for Medicaid

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Federal officials have apparently stopped fighting Georgia鈥檚 plan for a limited Medicaid expansion that includes work requirements. The plan, a key policy of Republican Gov. Brian Kemp鈥檚, would cover a much smaller portion of the population: those who can work or volunteer 80 hours a month.

C贸mo el optimismo puede cerrar la brecha de cobertura de Medicaid

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M谩s de 2 millones de personas de bajos ingresos, la mitad de ellos en Florida y Texas, no tienen seguro porque est谩n atrapados en una brecha de cobertura. Y sus estados no han expandido Medicaid.

How Optimism Can Close the Medicaid Coverage Gap

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Low-income residents in states that haven鈥檛 expanded Medicaid are in a tough spot: They don鈥檛 qualify for the subsidies that people with slightly higher incomes get to buy marketplace plans because of a glitch in the federal health law. But a court decision last year makes it easier for them to make good-faith estimates of a pay increase, and there is no financial penalty if they don鈥檛 hit that figure.

Medicare Plan Finder Likely Won鈥檛 Note New $35 Cap on Out-of-Pocket Insulin Costs

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In August, Congress approved a $35 cap on what seniors will pay for insulin, but that change came too late to add to the online tool that helps Medicare beneficiaries compare dozens of drug and medical plans. Federal officials say beneficiaries who use insulin will have the opportunity to switch plans after open enrollment ends Dec. 7.

After Congress Fails to Add Dental Coverage, Medicare Weighs Limited Benefit Expansion

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Medicare can pay for some dental care if it is medically necessary to safely treat another covered medical condition, and federal officials have asked for suggestions on whether that list of conditions should be expanded.

Lawsuit by KHN Prompts Government to Release Medicare Advantage Audits

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The lawsuit was filed three years ago to learn about vast overcharges by the popular health plans that are detailed in audits the government refused to release to the public.

Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers

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Private Medicare Advantage health plans are increasingly ending coverage for skilled nursing or rehab services before medical providers think patients are healthy enough to go home, doctors and patient advocates say.

Rapper Fat Joe Says No One Is Making Sure Hospitals Post Their Prices

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A TV and social media ad offers a reason to check on the enforcement of a sweeping rule that requires hospitals to post information about what they charge insurers and cash-paying patients.