Medicare Advantage Company Pays $342M to Government in Midst of Billing Probe
The payment by Elevance Health to the Centers for Medicare & Medicaid Services comes as the agency threatened to bar new enrollments in the company’s plans.
Medicare
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Democrats To Propose Bill Capping Out-of-Pocket Medicare Costs for Enrollees
Some Senate Democrats want to cap the amount beneficiaries in traditional Medicare have to pay toward care, but the move is expected to draw GOP opposition for potentially adding billions to Medicare costs.
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Medicare’s AI Push Snarls Patients and Doctors in Errors and Delays
Medicare is testing the use of artificial intelligence to preapprove several healthcare services. Federal health officials say prior authorization can help reduce fraud and contain costs. But doctors and patients describe the trial as “horrendous” and full of red tape so far.
By Darius Tahir -
Indiana Takes On Powerful Hospitals by Capping Prices They Charge Employers
“Government has to intervene, because healthcare is run like an unregulated utility,” Indiana’s GOP governor says of the state’s effort to regulate hospital prices.
By Phil Galewitz and Samantha Liss The Drip, Drip, Drip of Declining Coverage
Episode 450As predicted, the expiration of enhanced tax subsidies for Affordable Care Act health plans is causing many people to lose coverage for failing to make premium payments. Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. responded angrily to a New York Times article suggesting he’s not actively engaged in the work of his sprawling department. Lauren Weber of The Washington Post, Lizzy Lawrence of Stat, and Sandhya Raman of Bloomberg Law join Ńîąóĺú´«Ă˝Ň•îl Health News’ Julie Rovner to discuss these stories and more. Also this week, Rovner interviews KFF’s Tricia Neuman, who is retiring this month as a senior vice president and the executive director of the Program on Medicare Policy.
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That Discount at the Pharmacy Counter May Pack Hidden Costs
The new TrumpRx program relies partly on connecting consumers with discount coupons offered by drugmakers. For insured patients, though, using a coupon can prove dicey.
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Trump Promised Cheaper Drugs. Some Prices Dropped. Many Others Shot Up.
For all of President Donald Trump’s showmanship, the share of Americans his policies will likely help remains slim, even if some patients do come out ahead.
By Elisabeth Rosenthal and Arthur Allen -
A New Medicare Option for Weight Loss Drugs: What Older Americans Should Know
It may soon get easier for millions of people with Medicare to get discounted GLP-1 drugs for weight loss.
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HHS’ Healthy Food Agenda Puts Hospitals on Notice About Patients’ Meals
The backlash was immediate after the Trump administration served notice that hospitals and nursing homes should limit sugary drinks and dietary supplements in favor of what the Department of Health and Human Services terms “real food.”
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The Help That Many Older Americans Need Most
With shortages of medical professionals and an aging population, thousands of community healthcare workers prevent older adults from falling through the cracks.
By Paula Span -
Medigap Premiums Leap, and Consumers Have Few Alternatives
Millions of people rely on the supplemental insurance to offset the deductibles, copayments, and other costs faced by enrollees in the traditional Medicare program.
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Real Estate Investors Profit From Long-Term Care While Residents Languish
Real estate investment trusts are landlords for thousands of nursing homes, assisted living facilities, and hospitals. Some select the managers and keep close watch over their performance but deny responsibility for bad care.
By Jordan Rau -
Watch: As AI Makes More Health Coverage Decisions, the Risks to Patients Grow
Major health insurers and even Medicare are using artificial intelligence to make coverage decisions. But class action lawsuits have accused insurers of using AI to wrongfully withhold treatment, and new research illuminates the risks.
By Darius Tahir and Hannah Norman Abortion Pills, the Budget, and RFK Jr.
Episode 441This week, the Trump administration won a court battle to delay a ruling on access to the abortion pill mifepristone, angering its own anti-abortion allies. Meanwhile, the president’s budget arrived on Capitol Hill, where lawmakers are unlikely to agree to its proposed cuts to Health and Human Services programs. Lauren Weber of The Washington Post, Alice Miranda Ollstein of Politico, and Maya Goldman of Axios join Ńîąóĺú´«Ă˝Ň•îl Health News’ Julie Rovner to discuss these stories and more.
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States Face Another Challenge With Medicaid Work Rules: Staffing Shortages
Some states already don’t have enough staff to quickly process Medicaid applications and answer enrollees’ phone calls. Researchers say they may not be prepared to handle new Medicaid work rules, predicting people will lose coverage as a result.
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Immigrant Seniors Lose Medicare Coverage Despite Paying for It
Rosa MarĂa Carranza has worked and paid taxes for more than two decades, but a provision in the GOP's One Big Beautiful Bill Act will make her and an estimated 100,000 other lawfully present immigrant seniors ineligible for Medicare. Now Carranza’s once secure retirement is in question.
GOP Mulls More Health Cuts
Episode 440Despite public opposition to the cuts they made to federal health programs in 2025, Republicans reportedly are considering more cuts to help pay for the war in Iran. Meanwhile, the Supreme Court ruled that Colorado cannot ban “conversion therapy” for LGBTQ+ minors. Jessie Hellmann of CQ Roll Call, Alice Miranda Ollstein of Politico, and Sandhya Raman of Bloomberg Law join Ńîąóĺú´«Ă˝Ň•îl Health News’ Julie Rovner to discuss these stories and more. Also this week, Rovner interviews Ńîąóĺú´«Ă˝Ň•îl Health News’ Elisabeth Rosenthal, who wrote the last two “Bill of the Month” stories.
A Headless CDC
Episode 439The Trump administration faces the challenge of naming a new director of the Centers for Disease Control and Prevention who can both satisfy the Make America Healthy Again movement and get confirmed by the Senate. Meanwhile, a new Senate bill to rescind the approval of the abortion pill mifepristone is again elevating the abortion debate, which some Republicans would prefer to stay on the back burner until after the midterms. Shefali Luthra of The 19th, Lizzy Lawrence of Stat, and Rachel Cohrs Zhang of Bloomberg News join Ńîąóĺú´«Ă˝Ň•îl Health News’ Julie Rovner to discuss the news. Also this week, Rovner interviews Georgetown University Law Center’s Katie Keith about the state of the Affordable Care Act on its 16th anniversary.
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Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare
Adults ages 50 through 64 faced some of the steepest increases in out-of-pocket costs for Obamacare plans after a set of federal subsidies expired at the end of December. Some say they are putting off care or considering dropping health insurance coverage until Medicare picks up the bill.
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Oz Says California’s Not Fighting Health Care Fraud, but Data Shows It’s Part of a Larger Battle
Trump administration officials say the state allows rampant fraud and have promised to investigate, blaming the “Russian, Armenian mafia” in the hospice and home health care industry. But data shows hotbeds of health care fraud throughout the country, with California outperforming most other states in recovering fraud dollars.
By Don Thompson