Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Medicare and Health Care Reform

Final Rule Expands Medicare Access to Formerly Incarcerated Individuals

In the recently published 2025 Hospital Outpatient Prospective Payment (OPPS) rule, the Centers for Medicare and Medicaid Services (CMS) narrowed the description of “custody” and revised the special enrollment period (SEP) criteria for formerly … [Read more...] about Final Rule Expands Medicare Access to Formerly Incarcerated Individuals

Medicare Announces Results of First Round of Historic Drug Price Negotiations, Effective 2026

The Inflation Reduction Act of 2022 (IRA) includes a number of provisions aimed at reducing prescription drug costs for the Medicare program, its beneficiaries and taxpayers.  Among these changes is an out-of-pocket cap that is in effect for 2024 but … [Read more...] about Medicare Announces Results of First Round of Historic Drug Price Negotiations, Effective 2026

Information Requested on “Corporate Greed in Health Care”

The Federal Trade Commission and the Departments of Justice and Health and Human Services have “launched a cross-government public inquiry into private-equity and other corporations’ increasing control over health care.” They held a joint virtual … [Read more...] about Information Requested on “Corporate Greed in Health Care”

Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care

In order to manage costs, Medicare Advantage (MA) plans are able to restrict their enrollees to a contracted network of health care providers that is “sufficient to provide access to covered services to meet the needs of the population served.”* Some … [Read more...] about Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care

Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options

Building on several recent studies that have found massive overpayments to Medicare Advantage (MA) plans, the Center for Medicare Advocacy released a report outlining how policymakers can look to utilize cost savings by reining in overpayments to … [Read more...] about Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options

More Medicare Prescription Drug Help for Beneficiaries in 2024 – Including Out-of-Pocket Cap

The Inflation Reduction Act of 2022 (IRA), signed into law by President Biden on August 16, 2023, is already providing cost-savings for Medicare beneficiaries in 2023, including a monthly cap of $35 for covered insulin and free vaccines for certain … [Read more...] about More Medicare Prescription Drug Help for Beneficiaries in 2024 – Including Out-of-Pocket Cap

Medicare Drug Price Negotiation Program Begins After Encouraging Court Decision

A federal court has rejected a bid by the pharmaceutical industry and its allies to stop the newly established Medicare drug price negotiation program before it starts. On September 29, 2023, Judge Michael J. Newman of the U.S. District Court for … [Read more...] about Medicare Drug Price Negotiation Program Begins After Encouraging Court Decision

Senate Finance Committee Confirms Medicare Home Health Coverage Can Be Long-Term

At a September 19, 2023 hearing, held by the Subcommittee on Health Care of the Senate Finance Committee and entitled “Aging in Place: The Vital Role of Home Health and Access to Care,” Subcommittee Chair Senator Benjamin L. Cardin (D – MD) confirmed … [Read more...] about Senate Finance Committee Confirms Medicare Home Health Coverage Can Be Long-Term

Inflation Reduction Act (Medicare Drug Law) Updates – Including Part D Low Income Subsidy

HHS Actions to Increase LIS EnrollmentAmong other changes aimed at reducing drug costs for both Medicare beneficiaries and the Medicare program at large, a provision of the Inflation Reduction Act of 2022 (IRA) expands access to the Part D Low … [Read more...] about Inflation Reduction Act (Medicare Drug Law) Updates – Including Part D Low Income Subsidy

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