The hottest Medicare Substack posts right now

And their main takeaways

Biden is continuing Trump's privatization of Medicare. Here's what you need to know.

HEALTH CARE un-covered • 259 implied HN points • 29 Jun 22

Biden is following Trump's lead by continuing a program that privatizes Medicare. This shift is concerning because it can affect seniors' healthcare options.
Many seniors might be moved into profit-driven Medicare plans without realizing it. This could limit their access to care and services.
Critics argue that allowing private equity and insurance companies into Medicare will make them more focused on profits than on providing quality healthcare to seniors.

Here is what you need to know in healthcare this week.

HEALTH CARE un-covered • 279 implied HN points • 20 May 22

🏥 Health Politics Healthcare Costs Insurance Issues Medicare Policy Impact Public Health

Insulin prices have skyrocketed, and many diabetics are struggling to afford it. In fact, out-of-pocket spending for insulin doubled from 2007 to 2019 for those on Medicare.
High-deductible health plans are making it harder for low-income workers to get preventative care. People earning less than $75,000 a year often avoid necessary medical check-ups due to high costs.
Private insurers are paying much more for healthcare services than Medicare, which leads to higher premiums for consumers. This shows that privatizing healthcare isn't necessarily better for controlling costs.

A CLOSER LOOK: The Mid Year Earnings of 7 Big For-Profit Insurance Companies

HEALTH CARE un-covered • 219 implied HN points • 16 Aug 22

🏥 Health Politics Insurance Medicare Medicaid Profitability Government funding

The largest for-profit insurance companies made $43.8 billion in profits and had $620.6 billion in revenue, mostly from taxpayer money. This shows how much they benefit financially from government programs.
Three major insurers control 80% of the pharmacy benefit market. This means they have a huge influence over how prescription medications are managed and priced.
A large number of Americans are underinsured, with 43.4% lacking sufficient coverage. This highlights a growing issue in healthcare, where many people struggle to afford medical care despite having insurance.

Interested in the U.S. health care system? Here's what you need to know going into 2023.

HEALTH CARE un-covered • 139 implied HN points • 12 Jan 23

🏥 Health Politics Health care Insurance Policy Advocacy Medicare

Pharmacy Benefit Managers (PBMs) are under scrutiny in Congress, with both political parties examining their roles in rising healthcare costs. It's important for patient advocates to educate lawmakers on the real impacts of PBMs.
Health insurance benefits have been decreasing over the years, making care less affordable for many Americans, especially women. People are paying higher premiums but getting less coverage now than in the past.
Rural areas face significant challenges in accessing healthcare, especially with transportation. Lack of options for medical transport can make it hard for patients in these regions to attend necessary appointments.

What I’m reading in health care this week.

HEALTH CARE un-covered • 119 implied HN points • 19 Jan 23

🏥 Health Politics Health care Medicare Insurance Legislation Public Policy

Restaurant workers' money is being used for lobbying instead of improving their wages and healthcare. This is hurting low-wage workers who really need better support.
More seniors are signing up for Medicare Advantage plans, which may not be as beneficial as they seem. It's important for legislators and the public to be cautious about these private plans.
The process for getting medical approvals is becoming a huge hassle for doctors and patients. There are calls for reforms to make it easier and less burdensome to access necessary healthcare services.

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Big insurer Anthem took in $38 billion in the first 3 months of 2022. Most of it by far came from taxpayers.

HEALTH CARE un-covered • 199 implied HN points • 28 Apr 22

🏥 Health Politics Health Insurance Public funding Medicare Medicaid

Anthem's revenue has shifted significantly, with most of its income now coming from taxpayer-funded programs like Medicare and Medicaid rather than private-paying customers.
The employer-based health insurance system is declining rapidly as many employers can no longer afford to provide coverage, affecting the number of private-paying customers.
Despite growing profits largely from private-paying clients, many of Anthem's customers are struggling to afford out-of-pocket costs, leading to increased financial hardships.

Judge halts New York City's plan to redirect tax dollars to private health insurance companies

HEALTH CARE un-covered • 119 implied HN points • 29 Nov 22

🏥 Health Politics Healthcare policy Insurance Issues Medicare Public Health

A judge stopped New York City's plan to move municipal retirees into private Medicare Advantage plans. This decision allows them to stay in traditional Medicare without facing penalties.
The city's plan aimed to save $600 million by pushing retirees into private insurance options, but this would have burdened taxpayers across the country. The plan depended on federal subsidies to work.
There are concerns about Medicare Advantage plans, as they can limit access to necessary care and lead to higher out-of-pocket costs for retirees. Many believe that staying in traditional Medicare is safer and more reliable for their health needs.

What I'm reading in health care this week.

HEALTH CARE un-covered • 99 implied HN points • 30 Jan 23

🏥 Health Politics Healthcare policy Medicare Insurance Issues Patient Care

Doctors are facing a lot more claim denials this year, which is making their jobs harder and causing burnout. There's a push from healthcare providers for the government to change the rules around prior authorizations to help ease this burden.
Patients with diabetes are struggling when companies switch them to high-deductible health plans. These plans can increase the chances of serious health issues and financial troubles for patients who need regular care.
The government is looking closely at Medicare Advantage plans due to concerns about overpayments to insurers. Changes could be on the way that would affect how these plans operate and the money insurers can make from them.

Here is what you need to know in healthcare this week.

HEALTH CARE un-covered • 119 implied HN points • 27 May 22

🏥 Health Politics Healthcare policy Insurance Issues Pharmaceuticals Patient Advocacy Medicare

Big Insurance companies have gotten very powerful and can make it hard for patients to get the care they need. They create many barriers, like high costs and complex approvals.
Some healthcare organizations that once supported Big Insurance are now worried about its growing power and are asking the government to step in. They realize their previous choices contributed to the problem.
Legislation is being introduced to limit the influence of Pharmacy Benefit Managers (PBMs) and ensure patients have better access to medications. More people are speaking out about the negative impacts of PBMs on drug costs.

UnitedHealth Group has fewer private paying customers than in 2012, but its remaining customers are paying way more in premiums and deductibles

HEALTH CARE un-covered • 79 implied HN points • 18 Oct 22

🏥 Health Politics Health Policy Insurance Medicaid Medicare

UnitedHealth Group has fewer private customers than it did ten years ago, but the ones it has are paying significantly more in premiums and deductibles.
The average family plan has become much more expensive, and employees are shouldering more of the costs than they used to.
As insurance companies keep raising prices while offering less coverage, people are essentially paying more for fewer benefits over time.

Congress must cap increasingly lethal Medicare out-of-pocket requirements

HEALTH CARE un-covered • 39 implied HN points • 25 Oct 21

🏥 Health Politics Medicare Insurance Healthcare Costs Legislation

Medicare costs are rising, making it harder for seniors to pay for care. Many people with Medicare can face high out-of-pocket expenses that lead to debt or avoiding necessary treatment.
Congress should put a cap on out-of-pocket costs for Medicare. This could help seniors save money and get the care they need without falling deep into debt.
Medicare Advantage plans often seem attractive, but they can have hidden costs that can be very high. Seniors need to be careful in choosing their plans to avoid surprises.

Anthem, the USA’s second biggest insurer, has had spectacular growth over the past 10 years.

HEALTH CARE un-covered • 0 implied HN points • 23 Jul 21

🏥 Health Politics Healthcare Insurance Medicaid Medicare

Anthem, a major health insurer in the USA, has seen huge growth, mainly from government programs like Medicaid and Medicare. This means more taxpayers are funding their rise.
Over the past decade, most new members in Anthem's plans came from government programs instead of private insurance. This shift highlights how the Affordable Care Act helped many people gain health coverage.
Even with rising costs for their customers, Anthem continues to profit well by purchasing its own stocks. This move benefits investors more than it helps the people who need health insurance.

Why is Pharma Reducing Insulin Prices?

Discharge Summary • 0 implied HN points • 28 Mar 23

🏥 Health & Wellness Pharma Advocacy Legislation Medicare

Pharma companies like Eli Lilly, Novo Nordisk, and Sanofi are reducing insulin prices, capping payments, and making insulin more affordable.
Advocacy efforts from patients and community members played a significant role in influencing legislation that led to these pricing changes.
Legislation such as the Inflation Reduction Act and the American Rescue Plan impacted the insulin market, pushing pharma companies to lower prices to avoid significant financial penalties.