Category: Medicare

Medicare patients waiting days or weeks for drug plan approvals could see that timeline shrink to hours. The Centers for Medicare & Medicaid Services (CMS) has proposed rule CMS-0062-P, which would force Medicare drug plans to issue standard prior authorization decisions within 72 hours and urgent decisions within 24 hours. Public comments on the proposal…

Veterans diagnosed with hypertension, monoclonal gammopathy of undetermined significance (MGUS), male breast cancer, urethral cancer, or cancer of the paraurethral glands can now file for service-connected benefits without assembling individual proof of toxic exposure during deployment. The Department of Veterans Affairs added all five conditions to its PACT Act presumptive list, shifting the burden of…

Millions of people enrolled in Medicare Advantage, Medicaid, CHIP, and federal marketplace plans could see drug prior authorization decisions arrive days faster under a proposed federal rule now open for public comment until June 15, 2026. The Centers for Medicare & Medicaid Services (CMS) wants to require health plans to approve or deny standard drug…

A cancer patient waiting on chemotherapy approval. A diabetic whose insulin switch sits in a queue. A psychiatrist watching a patient destabilize while paperwork bounces between a clinic and an insurer’s review desk. These are not hypotheticals. According to the American Medical Association’s 2024 Prior Authorization Physician Survey, 94% of physicians say prior authorization delays…

A Medicare beneficiary filling a specialty cancer prescription that costs $15,000 a year will, at some point in 2026, walk up to the pharmacy counter and owe nothing. Not a reduced copay. Not a percentage of the list price. Zero. That moment arrives when their qualifying out-of-pocket spending on covered Part D drugs crosses $2,100…

A retired teacher in suburban Ohio who reported $108,900 of modified adjusted gross income on her 2024 tax return will pay $202.90 a month for Medicare Part B in 2026. Her former colleague down the street, who reported $109,100 after a modest Roth IRA conversion, will pay $284.10. That $200 gap in annual income triggers…

The voice on the line sounds official. The caller identifies himself as a Medicare fraud investigator, recites a case number, and warns that suspicious charges have appeared on the beneficiary’s account. To “secure” it, he asks the person to read back the Medicare Beneficiary Identifier printed on their card. The caller ID even shows a…

Picture a couple, both 65, both in good health, retiring this year with solid savings and Medicare cards in hand. According to Fidelity Investments, they should still expect to spend roughly $345,000 of their own money on health care before they die. That figure, drawn from Fidelity’s closely watched annual Retiree Health Care Cost Estimate,…

A retired teacher in suburban Phoenix sells the house she bought in 1987, pockets a six-figure gain, and moves into a smaller condo. Two years later, her Medicare Part B premium jumps by nearly $1,000 for the year. She has not gone back to work. Her pension has not changed. The only thing different on…

That caller telling seniors they’re owed a “Part D refund” from Medicare’s new $2,100 drug cap is a scam — real Medicare never calls uninvited or collects bank routing numbers The phone rings mid-morning. The caller ID shows an 800 number. A calm, professional voice tells a retired schoolteacher in Florida that Medicare owes her…