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Taxes - filing married or separately: check your Medicare Rates and ask you CPA. Loss Ratio: Money received vs claim payouts. Medicare Part D.
In this Episode of the Secure Your Retirement Podcast, Radon and Murs discuss the important and often confusing world of Medicare Part D with Medicare expert Shawn Southard. With the implementation of the Inflation Reduction Act Medicare provisions in 2025, significant updates have changed the way Medicare drug coverage works, especially for those nearing or already in retirement. Whether you're currently working and covered by an employer plan or about to transition to Medicare, this episode breaks down exactly what you need to know to avoid unnecessary costs and lifelong penalties.Listen in to learn about how Medicare Part D changes affect your coverage decisions, how employer coverage and Medicare interact, and why understanding creditable drug coverage is now more crucial than ever. Shawn also discusses HSA and Medicare rules, key timelines for enrollment, and strategies to avoid the dreaded Medicare late enrollment penalty. This is a must-listen for anyone planning to retire comfortably while staying informed and protected when it comes to their Medicare Part D options.In this episode, find out:· What exactly Medicare Part D covers and how it works.· How the Inflation Reduction Act Medicare provisions lower out-of-pocket drug costs.· What "creditable" drug coverage means and how to know if your employer plan qualifies.· When and how to enroll in Part D to avoid Medicare penalties.· How HSA and Medicare rules impact your decision to delay enrollment.Tweetable Quotes:“With Medicare Part D changes, what used to be a no-brainer may now require a complete reevaluation.” – Murs Tariq“Missing a 63-day window could mean a lifetime of penalties—knowing your coverage status is critical.” – Radon StancilResources:If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!To access the course, simply visit POMWealth.net/podcast.
Wondering what the difference between Medicare and Medicaid is? Learn all about it in this episode! Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Resources: 4 Effective Techniques for Closing Insurance Sales: https://lnk.to/asg655 2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D: https://ritterim.com/blog/2025-maximum-broker-commissions-for-medicare-advantage-and-medicare-part-d/ FREE DOWNLOAD – The Guide to Earning a Living Selling Health Insurance: https://ritterim.com/earning-a-living-selling-insurance/ How Much Can Agents Make Selling Under-65 Insurance? https://lnk.to/TlGBGH Leveling Up: From Chill Mode to Growth Mode ft. Christian Brindle: https://lnk.to/brindle2025 Ritter Insurance Marketing: https://ritterim.com/ References: Alice Burns, Elizabeth Hinton. “10 Things to Know about Medicaid.” KFF, 10 Apr. 2025, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid/. Nall, Rachel. “Am I Eligible for Medicare Part D?” Medicalnewstoday.com, Medical News Today, 21 Apr. 2020, https://www.medicalnewstoday.com/articles/am-i-eligible-for-medicare-part-d. “Compare Original Medicare & Medicare Advantage.” Medicare.Gov, https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage. Accessed 15 May 2025. (DCD), Digital Communications Division. “What's the Difference between Medicare and Medicaid?” HHS.Gov, U.S. Department of Health and Human Services, 7 Dec. 2022, https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html. “Does Medicaid Cover Dental Care?” HHS.Gov, U.S. Department of Health and Human Services, 8 Dec. 2022, https://www.hhs.gov/answers/medicare-and-medicaid/does-medicaid-cover-dental-care/index.html. “Medicare Adult Dental Benefits Coverage by State.” Chcs.org, Center for Health Care Strategies, Inc., Sept. 2019, https://www.chcs.org/media/Medicaid-Adult-Dental-Benefits-Overview-Appendix_091519.pdf “What's the Difference between Medicare Part a and Part B?” Healthline, 25 Feb. 2020, https://www.healthline.com/health/medicare/medicare-part-a-vs-b. ”Understanding Medicare Advantage Plans.” Medicare.gov, Feb. 2025, https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency.
A Lancet study warns of consequences for HIV prevention if PEPFAR loses funding, potentially millions of new pediatric HIV cases and increased AIDS-related deaths. Medicare Part D is highlighted, with research linking subsidy loss to higher mortality rates. A report from BMJ notes a 3.1% decline in U.S. drug overdose deaths, signaling a possible peak in the fentanyl crisis.
In this standout episode, three healthcare leaders unpack how they're transforming regulatory pressure into real-world impact. Melissa Skelton Duke (Banner Health), Dina Homer (HealthTeam Advantage), and Bita Farrokhroo (MedWatchers) share practical strategies for driving medication adherence, optimizing Part D performance, and bridging digital and cultural gaps to better serve diverse member populations. Learn how Banner is reframing adherence through member empathy, how HealthTeam Advantage aligns every employee to Stars performance, and how MedWatchers is consolidating fragmented workflows for a 29% lift in gap closure. With an NPS of 93, this is one of our highest-rated episodes in over 11 years. Download the Episode Guide: We're piloting a brand-new Episode Guide summarizing key insights and speaker highlights. Download the Guide to follow along and deepen your understanding of today's discussion. Thank you to MedWatchers for supporting this episode. With 180 pharmacists on staff, they're a trusted clinical partner to more than 300 health plan contracts—delivering over 2.7 million pharmacist-led interventions annually across Medicare, Medicaid, and Commercial populations. Learn how they're helping plans improve adherence, reduce readmissions, and scale Stars-aligned strategies at www.medwatchers.com.
The Department of Health and Human Services is facing another legal challenge over its decision to cut funding for public health initiatives. More nurses say they plan to leave the field due to stress and burnout. And, a new study finds that Medicare Part D coverage of popular weight loss drugs could raise costs by billions of dollars. Those stories and more coming up on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.
The Friday Five for April 25, 2025: Dr. Oz shares MAHA vision as CMS admin CY 2026 Part D Coverage Cost Breakdown CY 2026 Selected Drug Subsidy Cost Breakdown Provisions Not Finalized in 2026 MA and Part D Final Rule Impact of Non-Finalized Provisions on Agents Dr. Oz shares MAHA vision as CMS admin: Simmons-Duffin, Selena. “5 Things to Know as Dr. Oz Prepares to Lead Medicare and Medicaid.” NPR.Org, NPR, 3 Apr. 2025, www.npr.org/sections/shots-health-news/2025/03/25/g-s1-55766/dr-mehmet-oz-medicare-medicaid-cms-trump. “Dr. Mehmet Oz Shares Vision for CMS.” CMS.Gov, Centers for Medicare & Medicaid Services, 25 Apr. 2025, www.cms.gov/newsroom/press-releases/dr-mehmet-oz-shares-vision-cms. Olsen, Emily. “Dr. Oz Sworn in as CMS Administrator.” Healthcaredive.Com, Healthcare Dive, 21 Apr. 2025, www.healthcaredive.com/news/dr-mehmet-oz-sworn-in-cms-administrator/745880/. CY 2026 Part D Coverage Cost Breakdown: “Final CY 2026 Part D Redesign Program Instructions.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions. Accessed 23 Apr. 2025. “Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.” Federalregister.Gov, Federal Register, 15 Apr. 2025, www.federalregister.gov/documents/2025/04/15/2025-06008/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare. CY 2026 Selected Drug Subsidy Cost Breakdown: John, Stephnie A., and Abdie Santiago. “The IRA in 2025: The Future of Medicare Part D.” Mintz.Com, Mintz, 13 Feb. 2025, www.mintz.com/insights-center/viewpoints/2146/2025-02-13-ira-2025-future-medicare-part-d. “Medicare Prescription Drug Benefit Manual – Chapter 5.” Cms.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/chapter-5-benefits-and-beneficiary-protection-v92011.pdf. Accessed 23 Apr. 2025. “Factsheet: Medicare Drug Price Negotiation Program.” Cms.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf. Accessed 23 Apr. 2025. Provisions Not Finalized in 2026 MA and Part D Final Rule: “Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F).” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final. Accessed 24 Apr. 2025. Tong, Noah. “Medicare Advantage Final Rule Excludes Anti-Obesity Drug Coverage under Medicare, Medicaid.” Fiercehealthcare.Com, Fierce Healthcare, 4 Apr. 2025, www.fiercehealthcare.com/payers/medicare-advantage-final-rule-excludes-anti-obesity-drug-coverage-under-medicare-medicaid. “Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.” Federalregister.Gov, Federal Register, www.federalregister.gov/documents/2025/04/15/2025-06008/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare. Accessed 24 Apr. 2025. “Medicare Coverage of Anti-Obesity Medications.” Aspe.Hhs.Gov, Assistant Secretary for Planning and Evaluation, 26 Nov. 2024, aspe.hhs.gov/sites/default/files/documents/127bd5b3347b34be31ac5c6b5ed30e6a/medicare-coverage-anti-obesity-meds.pdf. Resources: 2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D: https://ritterim.com/blog/2025-maximum-broker-commissions-for-medicare-advantage-and-medicare-part-d/ 3 Additional Effective Techniques for Closing Insurance Sales: https://lnk.to/asg656 4 Effective Techniques for Closing Insurance Sales: https://lnk.to/asg655 5 Things About the 2026 CMS MA and Part D Rate Announcement: https://lnk.to/asgf20250411 CMS Updates, Content Library, & More! https://lnk.to/asgf20250328 Recent ACA Coverage Changes Reversed with 2025 Marketplace Proposed Rule: https://ritterim.com/blog/recent-aca-changes-reversed-with-2026-marketplace-proposed-rule/ Subscribe to the Ritter Blog: https://ritterim.com/blog/ The Best Appointment Schedulers for Insurance Agents: https://lnk.to/asg657 Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.
Working past 65 with health benefits - and delaying Medicare - is the topic for today. CMS is the Center for Medicare and Medicaid Services. Toni explains the 63 day filing period - and how to avoid a Late Enrollment Penalty (LEP). Do you have a creditable prescription plan? Do you need an inexpensive Medicare Part D prescription plan? All of this and so much more on today's podcast. Toni's new Medicare Survival Guide Advanced Edition book is available now - pick up your copy at www.tonisays.com Want more information? Take advantage of Toni's brand new video series now a available at https://tonisays.com Remember - with Medicare it's what you don't know that will hurt you! There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and https://tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni now offers informative Medicare Webinars for all of your Medicare needs at https://tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguG Spotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null You can find Medicare Moments at: https://podcasts.seniorresource.com/medicare-moments/ Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind. Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments! Blessings! Toni KingSee omnystudio.com/listener for privacy information.
Pushback against the Trump administration's massive government cuts exploded this weekend across America—and biopharma is no exception. Taking a deep dive into the leadership cuts, we found that more than half of the senior FDA leaders from six months ago are no longer there, and that's just the leadership. Across the Department of Health and Human Services, some 20,000 people will be leaving—of their own accord or otherwise—amounting to a 25% reduction in headcount that would leave HHS with around 62,000 employees. With many of these people likely destined for biopharma, does this pose an ethical problem? Meanwhile, the escalating tariff war is beginning to ring alarm bells for the economy, with Goldman Sachs now predicting a 45% chance of a recession happening in the next 12 months. While pharma has historically been considered resistant to the challenges of a recession—people always need medicines—this time around could be different, in part because of the consumer-led obesity market. Thanks to the Trump administration's decision to nix a Biden era proposal to cover GLP-1s under Medicare Part D—at least for now—these drugs will continue to cost consumers a pretty penny. Even without a recession being declared, Eli Lilly's and Novo Nordisk's stocks are falling significantly with the rest of the market. Lilly has lost more than $95 billion in market value in one month. Novo's value has declined $72 billion. The drugmakers are also still battling makers of knockoff versions of their drugs. Most recently, Lilly filed a lawsuit against a med spa in Indianapolis for allegedly taking vials of tirzepatide and splitting them up into single doses that are sold to patients without the packaging inserts. Of course, Lilly and Novo aren't the only pharma drug rivalry out there. There's also Keytruda vs. Opdivo, Leqembi vs. Kisunla and more. Finally, we take a look at seven late-stage MASH candidates that could hit the market in the next few years, following the FDA's 2024 approval of Madrigal's Rezdiffra, the first treatment for the metabolic disorder.
And here we are, at the Academy of Managed Care Pharmacy Annual for a 2nd year in row for a special “on the road” episode of Pharmacy Friends. This year, AMCP is in Houston with more than 6,000 managed care pharmacy and health care industry professionals in attendance. And thought leaders from Prime Therapeutics are also on hand to present 7 research posters and several education sessions based on our integrated medical and pharmacy claims data. This episode will help you gain clarity on the real-world impact of GLP-1 drugs, understand how predictive modeling can help identify members enrolled in Medicare Part D at risk of large increases in prescription drug spending, and other trends shaping the health care industry.We also have two up and coming researchers share their experience taking their first steps in the managed care space and their careers. (00:00) Introduction(01:05) 2024 JMCP “Article of the Year” Award for Excellence(06:46) Latest GLP-1 research(15:56) Accelerated Drug Approval Program (28:00) PBM and Medical Pharmacy Industry Trends(41:17) Medicare Member Drug Cost Predictive Model: Creation and Feature Engineering (50:32) Advancing Health Equity in Food Allergy Prevention and Treatment: Bridging Gaps in Care and Knowledge(55:22) Legislative Impacts on Site of Service: What is the Big Deal?(1:00:07) The next generation of managed care professionals
In this episode, Our guest is MARC RYAN, who has extensive leadership experience across the healthcare industry. Most recently, he was a founding executive and President of MedHOK (MHK, acquired by Hearst Health). He has launched and operated multiple health plans. Marc served in senior policy roles in state and federal government, including as state management secretary of Connecticut and helping build Medicare Part D's relationship with state drug assistance programs in 2006. He created Connecticut's Medicaid and children's health managed care programs and its long-term care continuum. Marc is the author of The Healthcare Labyrinth: A Guide To Navigating Health Plans and Fixing American Health Insurance and the host of the Healthcare Labyrinth Podcast.Topics covered:(1) What are the trends in drug spending and the impact on all types of insurance products -- Medicare, Medicaid, commercial/employer -- cost trends for medical and retail(2) What is driving the major increases in drug costs/spending?(3) How are GLP-1s treated across various products? And will coverage change?(4) American drug prices compared with others? Can you discuss how we compare vs. other developed countries and why (more than twice -- in many cases 3, 4, and 5 times more -- impacts on employer, Medicare, etc. -- rising percentage of healthcare as well as employer) (5) Medicare drug price negotiations -- what it is and what has happened so far? where do you stand?(6) A lot is occurring in plans on PA, formularies, benefit design, PBM reform -- a very hot topic -can you tell us more about this and what you predict? (7) Can you explain the traditional PBMs vs. transparent ones? FTC lawsuit against PBMs and drug supply channel issues(8) There have been major changes to Part D and it is impacting Medicare Advantage and Part D -- what is happening for 2025 benefits as well as can you tell us a little on a study that questioned the value of Part D?(9a) Medication Adherence in the Star program for MA and Part D plans -- key. Can you tell us more here? 9(b) How could pharmacists in the community support medication adherence etc -- Will discuss trends from health plans about recognizing the best way to ensure medication reconciliation and adherence is teaming up with pharmacists. Guest - Marc RyanHost - Hillary Blackburn, PharmD, MBAwww.hillaryblackburn.comhttps://www.linkedin.com/in/hillary-blackburn-67a92421/ @talktoyourpharmacist for Instagram and Facebook ★ Support this podcast on Patreon ★
In this episode of 'Retire with Style', hosts Alex Murguia and Wade Pfau discuss significant updates in retirement planning for 2025, including changes to Medicare Part D, Social Security benefits, required minimum distributions (RMDs), and new catch-up contribution limits. They also explore the implications of inflation adjustments on qualified charitable distributions, longevity annuities, and the impact of increased real interest rates on retirement funding. The episode concludes with an announcement of an upcoming webinar focused on retirement spending strategies. Listen now to learn more! Takeaways The new $2,000 cap on out-of-pocket spending under Medicare Part D simplifies healthcare cost planning. Elimination of the windfall elimination provision enhances Social Security benefits for certain retirees. Clarified RMD rules for inherited IRAs require annual distributions for non-spouse beneficiaries after the owner's required beginning date. Catch-up contributions for those aged 60-63 have increased, allowing for greater retirement savings. Qualified charitable distributions (QCDs) have increased to $108,000, providing tax benefits for charitable giving. Real interest rate assumptions have improved, making it easier to meet retirement funding goals. The funded status of retirement plans is positively impacted by higher interest rates, reducing future liabilities. The upcoming webinar will address how much retirees can spend based on updated financial planning strategies. Retirees should adjust their financial plans to incorporate these significant 2025 updates. Understanding these changes is crucial for effective retirement planning and maximizing benefits. Chapters 00:00 Introduction and Updates 03:37 Medicare Part D Changes 07:50 Social Security Updates 12:32 Required Minimum Distributions (RMDs) Clarification 17:46 Catch-Up Contributions for Retirement Plans 20:09 Qualified Charitable Distributions and Longevity Annuities 23:55 Interest Rate Assumptions and Retirement Planning 29:07 Webinar Announcement and Financial Planning Adjustments 34:08 Conclusion and Future Plans Links Want to know more about Wade's updated Retirement Planning Guidebook? Register to attend Retirement Researcher's FREE Webinar, "How Much Do I Need to Retire?" hosted by Wade Pfau on Feb. 4th, 2025 at 2PM ET. Click to register and reserve your spot today: risaprofile.com/podcast To celebrate the latest update of the Retirement Planning Guidebook, we are hosting a GIVEAWAY! Enter for your chance to win a signed copy of the 2025 Revised - Retirement Planning Guidebook and a Retirement Researcher T-Shirt! There will be 3 separate winners. The giveaway closes on February 4th. https://bit.ly/40VlPqp The Retirement Planning Guidebook: 2nd Edition has just been updated for 2025! Visit your preferred book retailer or simply click here to order your copy today: https://www.wadepfau.com/books/ This episode is sponsored by Retirement Researcher https://retirementresearcher.com/. Download their free eBook, 8 Tips to Becoming A Retirement Income Investor at retirementresearcher.com/8tips
An important episode where we discuss the complexities and common misconceptions surrounding Medicare. Joining Mark and me are Dan Mangus, Vice President of Growth and Development for Senior Benefit Specialists, and Luke Atchison, to provide expert insights on the various parts of Medicare - Part A, B, C, and D. Discussion covers important enrollment dates, the impact of the Inflation Reduction Act on Medicare Part D, and the necessity of obtaining appropriate Medicare plans based on individual needs. There is an emphasis on the importance of having a knowledgeable advisor, the pitfalls of choosing plans based on current health without foreseeing future needs, and the need for additional coverage like Medigap or other insurance plans to supplement Medicare. Various CMS resources and tools for better understanding Medicare are recommended (in the show notes below), and listeners are urged to start preparing for Medicare well before turning 65. Listen to the Alphabet Soup of Medicare with Dan Mangus.[00:00] Introduction to Medicare Misinformation[00:39] Meet the Hosts and Catching Up[01:39] Empathy and Civility in Everyday Life[02:49] Introducing the Medicare Experts[03:45] Medicare Basics: Parts A and B[05:27] Medicare Parts C and D Explained[06:32] Medigap and Recent Changes in Medicare[10:25] Key Dates and Enrollment Periods[15:23] Finding Reliable Medicare Information[19:39] Misinformation and Marketing Tactics[22:27] Mistakes and Key Questions in Medicare[26:45] Support for Low-Income Individuals[27:58] State-Specific Insurance Differences[28:59] Investigating Medicare Before 65[29:35] Common Medicare Mistakes[30:03] Understanding Zero Premium Programs[31:19] Supplementing Medicare Advantage[32:15] Leveraging Your Health for Insurance[34:46] Questions to Ask Your Medicare Specialist[37:17] Resources for Medicare Education[43:41] The Role of Advisors and Brokers[45:27] Holistic Healthcare DecisionsTakeaways: Medicare has different parts, each serving unique healthcare coverage needs, so understanding them is crucial. Open enrollment periods for Medicare are specific, running from October 15 to December 7 each year. The recent Inflation Reduction Act significantly alters Medicare Part D, lowering out-of-pocket costs. When choosing a Medicare plan, always consider your current and potential future healthcare needs. Consulting with local Medicare specialists can help you navigate the complex options available. Be wary of marketing claims promising too-good-to-be-true benefits; seek accurate information. 2025 Medicare CostsAbout Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans | Internal Revenue ServiceAppealing Income Related Monthly Adjustment Amount of Medicare Part D or Part B PremiumsThe Alphabet Soup of Medicare - Saint Louis In Tune with Dan MangusWelcome to Medicare | MedicareIntroduction to Medicare
Newly inaugurated President Trump has issued sweeping initial healthcare orders for his second term. The Department of Health and Human Services releases the next 15 Medicare Part D drugs chosen for negotiations with a blockbuster GLP-1 weight loss drug at the top of the list. And, a new report from a federal watchdog raises red flags over the Food and Drug Administration's accelerated approval process for experimental drugs. We'll get those stories—and more—coming up on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.
Scott Ladner, chief investment officer at Horizon Investments, says that the stock market will need earnings growth to generate returns in 2025, but that those gains should run roughly equal to the level of earnings growth, leaving the market set up for low double-digit gains in 2025. He says that technology continues to provide a tailwind to the market, though henotes that the artificial intelligence evolution makes for a moving target where investors might want to gravitate towards industries that are adjacent to AI, making money off of the companies and sectors that use AI to drive profit gains. Ladner — whose firm practices goals-based planning — noted that while the U.S. economy remains the world's strongest, it would be a mistake to ignore international markets now. Leigh Purvis, prescription drug policy principal at the AARP Public Policy Institute discusses her research into showing that prices on brand-name drugs have been rising much faster than the rate of general inflation for decades, creating challenges — particularly for Medicare Part D enrollees — that many people have addressed by not refilling prescriptions or by skipping doses to make prescriptions last longer. Plus Dan Crowley, partner at Nightview Capital — portfolio manager of the Nightview Fund — brings his concentrated growth approach to the Market Call.
Medicare's General Enrollment Period is January 1 - March 31's each year. Toni explains that this is the time for those who never enrolled in Medicare Part A or Medicare Part B but NOT for those who failed to enroll in Medicare Part D. Important website: https://ssa.gov/medicare/sign-up Want more information? Take advantage of Toni's brand new video series now a available at https://tonisays.com Remember - with Medicare it's what you don't know that will hurt you! There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and https://tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni now offers informative Medicare Webinars for all of your Medicare needs at https://tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguG Spotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind. Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments! Blessings! Toni KingSee omnystudio.com/listener for privacy information.
As we transition into a new administration, our hosts reflect on President Biden’s legacy in healthcare policy, focusing on three major areas that impacted patients: the COVID-19 response, the opioid crisis, and the Inflation Reduction Act. They discuss key achievements such as vaccine rollouts, reduced overdose deaths, and efforts to lower prescription drug costs, while also examining ongoing challenges and concerns. With the health policy landscape set to shift in 2025, this episode breaks down what patients need to know and how to stay engaged in advocacy for better care. Among the highlights in this episode: 00:40: Steven Newmark, Chief of Policy at GHLF, outlines three key areas where the Biden administration made a significant impact in health care: COVID-19 response, the opioid crisis, and the Inflation Reduction Act (IRA) 01:28: Steven highlights the Biden administration’s mass vaccination campaign, which saved an estimated 3.2 million American lives, according to the Commonwealth Fund 01:49: Zoe Rothblatt, Director of Community Outreach at GHLF, gives credit to Operation Warp Speed under Trump for fast-tracking vaccine development but emphasizes that the bulk of vaccinations happened under Biden 02:43: Zoe reflects on how the pandemic's threat level has changed, largely due to vaccines and continued booster developments 02:58: Steven shifts the discussion to the opioid crisis, explaining that overdose deaths were rising at 31% per year when Biden took office 03:35: Steven discusses how the administration's overdose prevention efforts led to a 14.5% decrease in overdose deaths — the largest reduction in U.S. history 04:17: Zoe explains how removing barriers to Naloxone access reduces response time during an overdose emergency 04:50: Steven discusses how Biden removed an outdated waiver requirement that expanded opioid treatment access by 15 times 06:11: Steven shifts focus to the IRA, explaining that it was one of Biden’s most significant health care policies 06:27: Zoe highlights a major win: capping Medicare Part D out-of-pocket prescription costs at $2,000 per year, down from $3,500 07:29: Steven explains why this is life-changing for seniors and people with disabilities, as many rely on multiple expensive medications 08:48: Zoe discusses the $35 monthly cap on insulin prices for Medicare patients, ensuring those with diabetes have affordable access to life-saving medication 09:11: Steven explains the potential downside of IRA’s Medicare drug price negotiations, which could reduce incentives for drug companies to develop new treatments 10:32: Zoe reminds listeners that with the upcoming presidential transition, health policies could change significantly, and GHLF will continue advocating for patient needs 11:01: Steven encourages listeners to join GHLF’s 50-State Network, stay informed, and share their stories to help shape health policies. Join GHLF’s 50 State Network, share your story, and get involved in advocacy to make a difference, email us at advocacy@ghlf.org Contact Our Hosts Steven Newmark, Chief of Policy at GHLF: snewmark@ghlf.org Zoe Rothblatt, Director of Community Outreach at GHLF: zrothblatt@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments in the form of an email, video, or audio clip of yourself to podcasts@ghlf.org Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.
End of the year money saving advice for prescription medications from Toni King. Want more information? Take advantage of Toni's brand new video series now a available at https://tonisays.com Remember - with Medicare it's what you don't know that will hurt you! There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and https://tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni ow offers informative Medicare Webinars for all of your Medicare needs at https://tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguG Spotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind. Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments! Blessings! Toni KingSee omnystudio.com/listener for privacy information.
Toni helps as someone who is paying a penalty for Part D may have been billed incorrectly. Want more information? Take advantage of Toni's brand new video series now a available at https://tonisays.com Remember - with Medicare it's what you don't know that will hurt you! There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and https://tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni now offers informative Medicare Webinars for all of your Medicare needs at https://tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguG Spotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind. Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments! Blessings! Toni KingSee omnystudio.com/listener for privacy information.
Send us a textJoin your host Clifton Pope as he is back to kick off the 2025 Future Fortune Series as financial insight is provided on what is going on in the world of finances from the perspective of HFWB!In this edition of the Future Fortune Series, Clifton Pope provides the scoop on why FAANG stock companies are investing 1 million dollars into the Trump Inaguration Fund and why you should always invest FAANG!(Facebook, Amazon, Apple, Netflix, Google, Microsoft-honorable mention)Questions are posed on whether the interest rate cut by the Fed in December 2024 truly the last one for a while, if inflation woes will put a halt on cryptocurrency market, and why prices are rising once again of Medicare Part D drugs with behind the scene peek from experience as a former pharmacy technician!Disclaimer: Clifton Pope is not a financial advisor but providing his perspective based on experience, research, and what he practices!Hit that follow/subscribe button on Apple/Spotify Podcasts as well as Rumble via @CPHFWB to stay updated with the newest releases from the show!Download, stream, and share all episodes of the show so you don't miss information or resources provided!Leave a rating/review to help grow the show as The HFWB Podcast Series is for you, the people, so let your voice be heard!Join the HFWB community for $5/month to get access to exclusive content today via https://hfwbpodcastseries.buzzsprout.comThank you for the love and the support!Support the showhttps://atherocare.com/HEALTHFITNESSWEALTHBUSINESShttps://athleticism.com/HEALTHFWEALTHBhttps://vitamz.com/HEALTHFITNESSWEALTHBUSINESShttps://Athleticism.comhttps://atherocare.comhttps://vitamz.comofficial sponsors of the HFWB Podcast Series
In this essential episode of PennyWise, host Nat Cardona is joined by NerdWallet expert Elizabeth Ayoola to discuss the upcoming changes to Medicare in 2025. With new developments on the horizon, Elizabeth provides listeners with crucial insights into the evolving landscape of Medicare Part D, including the introduction of an out-of-pocket maximum for prescription drugs, which promises relief for many consumers. Explore the implications of declining plan ratings and the potential impact on premiums, as well as tips for ensuring your prescription drugs remain covered. Elizabeth also sheds light on the special enrollment period for those affected by plan changes and the rising costs associated with Medicare Parts A and B. Show notes created manually and by https://headliner.app
Today's episode is part rant, part answer to Mike's question about the high cost of prescription drugs under Medicare Part D. We dive into why these costs are so steep, explore alternatives like Canadian pharmacies, and discuss what you can do to manage healthcare expenses in retirement. If you're thinking, "I love the Big Picture Retirement podcast!” please consider rating and reviewing this show! This helps us support more people -- just like you -- move toward a confident retirement. Just scroll down to the “ratings and reviews” section, tap to rate with five stars, and select “Write a Review.” Then be sure to let us know what you loved most about the episode! Also, if you haven't done so already, follow the podcast. We add new content every week, and if you're not following, you'll likely miss out. Follow now! Don't miss the Big Picture Retirement Planning Cheat Sheet. We've distilled the essential brackets, thresholds, and rules of retirement into an easy-to-digest, three-page summary. https://www.carrolladvisory.com/pl/2148282517 Want to ask Devin or John your question? Just visit https://www.bigpictureretirement.com/ and click on the “Ask A Question” menu selection. Although this show does not provide specific tax, legal, or financial advice, you can engage Devin or John through their individual firms. Contact Devin's team at https://www.carrolladvisory.com/ Contact John's team at https://www.rossandshoalmire.com/
January 2, 2025 ~ Guy and Jamie talk with University of Michigan professor Mark Fendrick about Medicare Part D being capped at $2,000 for the year, how another Donald Trump administration will impact drug prices, and more!
Prescription Drugs, Medicare Part D is discussed by Toni King. Want more information? Take advantage of Toni's brand new video series now a available at https://tonisays.com Remember - with Medicare it's what you don't know that will hurt you! There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and https://tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni ow offers informative Medicare Webinars for all of your Medicare needs at https://tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguG Spotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind. Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments! Blessings! Toni KingSee omnystudio.com/listener for privacy information.
It is crucial that multidisciplinary cancer care teams stay informed about upcoming changes to Medicare Part D under the Inflation Reduction Act. To support this effort, the Association of Cancer Care Centers (ACCC) is committed to providing updated information on health care policy changes, ensuring that both providers and patients are aware of the financial benefits. In this episode, CANCER BUZZ speaks with Lindsey Greenleaf, JD, MBA, solution leader in federal and state policy at ADVI Health and Pam Traxel, senior vice president of alliance development and philanthropy at American Cancer Society, Cancer Action Network, to discuss the impact of these policy updates. Ms. Greenleaf sheds light on the $2,000 out-of-pocket cap that will take place for Part D patients in 2025 and how future pricing policy could have an effect on drug innovation. Ms. Traxel expands on benefits and challenges involved with providing updates to oncologists on the new Medicare Part D cap, with the goal of ensuring that all patients who could benefit are aware. “I think the most important thing that oncologists and their practices can do is to make sure that they are providing information to patients about the fact that there is a change that will hopefully allow patients to better afford their cancer care.” -Pam Traxel “The second key piece of the Inflation Reduction Act related to Part D has to do with Part D benefit redesign, and that is what kicks in January 1, 2025, and that is a very notable, very positive change to the law where we finally have a $2,000 out-of-pocket cap that will be in place for Part D patients. This is a huge win for cancer patients, specifically due to the historically very high out-of-pocket costs for oral cancer drugs.” -Lindsey Greenleaf Lindsey Greenleaf, JD, MBA Solution Leader, Federal & State Policy ADVI Health, LLC Austin, TX Pam Traxel Senior Vice President of Alliance Development and Philanthropy American Cancer Society, Cancer Action Network Silver Spring, MD This podcast was developed in connection with the Oncology State Society Policy Program and made possible with support by Johnson & Johnson. Resources: ACCC Access, Payment & Reimbursement CMS Medicare Part D Improvements
Nationally syndicated financial columnist and author Terry Savage joins John Williams to talk about what you need to know about Medicare Part D, how I-Bond rates have fluctuated since 2022, and how she feels the economy will perform under the next administration. And as always, Terry answers all of your financial questions.
Host Dr. Davide Soldato and Dr. Aaron Mitchell discuss the JCO article "Quality of Treatment Selection for Medicare Beneficiaries With Cancer" TRANSCRIPT Dr. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, medical oncologist at Hospital San Martino in Genoa, Italy. Today, we are joined by JCO author Dr. Aaron Mitchell. Dr. Mitchell is a medical oncologist working at Memorial Sloan Kettering Cancer Center where he is also part of the Department of Epidemiology and Biostatistics. Dr. Mitchell specializes in treating genitourinary malignancy and has a research focus on improving how the healthcare system helps people with these and other cancers. So today, Dr. Mitchell will be discussing the article titled, “Quality of Treatment Selection for Medicare Beneficiaries with Cancer.” Thank you for speaking with us, Dr. Mitchell. Dr. Aaron Mitchell: Well, thank you for inviting me. I'm very glad to be here. Dr. Davide Soldato: So I just wanted to introduce the topic by asking a couple of questions, very general, about the background of the article. So basically you reported the data using the SEER-Medicare to assist to assess the determinants of optimal systemic therapies delivery and selection. So, in particular, you focused on individuals that were diagnosed with cancer who were Medicare beneficiaries and in particular were part of the low income subsidy, which is also known as LIS. So I just wanted to ask you if you could briefly explain to our listeners how this program works, and what was the rationale of the study, and if there is any element of novelty in your study compared to what was done before the study was published. Dr. Aaron Mitchell: Yeah. So that's a lot to cover, but yeah, a lot of opportunity to introduce the low income subsidy program which is a very important part of the Medicare program for prescription drugs, but often one that flies under the radar a little bit in the policy discussion. So this subsidy was created synchronously back with the Medicare Part D Program, which was created in 2006. There was some anticipation that for some high cost drugs, not all patients would be able to afford them even with the Part D program insurance as it was being created. And so they created a pathway to give an additional subsidy to some patients who had low income, who were anticipated to being at need and needing that assistance to afford high cost drugs. As the number of high cost drugs has really risen since 2006, this program has played an important role in helping patients afford drugs, especially those who need very expensive cancer drugs. And what this program does is, once you meet the eligibility requirements, which require patients to have both quite a low income. So if you're single, that is at 135% of the federal poverty limit or below, and it also places some restrictions on assets. You also have to have low assets, so low income and low assets in order to qualify for the subsidy. But then once you do, the subsidy is really quite large. Patients who qualify for the LIS at the full subsidy level will pay about $10 per month per drug, even for specialty cancer drugs. So if you think about drugs such as those that we use to treat prostate cancer, my specialty, drugs like enzalutamide or XTANDI that run $15,000 to $20,000 per month, the out of pocket cost for a low income subsidy beneficiary is $10. So that is a huge discount. $10 isn't nothing, but even for someone with a low income, if they've got one or two cancer drugs that are at this rate, it's something that they can often afford. This program applies to Part D cancer drugs that are prescription drugs basically. By and large, these are oral pills that patients are taking on a daily basis at home. These are the drugs that the low income subsidy program applies to. So if a patient needs a drug like that to treat their cancer, then they are able to receive it at very low cost. And what you'll see is a patient- in the studies that have been done, when a patient has low income, low enough for them to be able to qualify for this program, they then have better access to these drugs. You see increased adherence rates, you see increased prescription fill rates. And then when someone, when their income is just high enough to no longer qualify for this program, and they go back to regular Medicare Part D coverage, that's when the problems arise. So it's like as your income moves up the scale, you actually get more problems affording your cancer drugs. So that's the state of the literature so far. And what we realize though, is that all these studies that have looked at the low income subsidy have really focused on just the Part D drugs themselves, the oral drugs. And that's certainly not all of cancer care. There is a growing number of oral drugs, but for many cancers, especially when you're talking about immunotherapy drugs or new systemic radioligand therapies, these are not Part D drugs, these are Part B drugs. And so even if you are low income and you're qualifying for this subsidy, it's not going to help you if you need a Part B drug. Yes, there are certainly a whole host of other programs and different avenues that we can get patients assistance, but some percentage of them, even though they're low income and high need, would not have assistance with a Part B drug. So now, in coming back, the long answer to your question, our rationale was, let's look at these Part D low income subsidy patients and let's see what their access looks like, not just to the oral drugs, but to cancer care writ large. And can we study where they're fitting into the system, not only when they need oral drugs, but when they need any kind of cancer care across the board? Dr. Davide Soldato: So basically, just to summarize, it was an extension of previous literature, but specifically evaluating whether novel regimens that use, for example intravenous drugs, they were covered at the same level and whether there were any inequities in access to cancer treatment under this specific program, which is the LIS. Dr. Aaron Mitchell: Yes, I'd say that's a fair summary. Dr. Davide Soldato: Okay. So more or less, you included 9,000 patients inside of the study and 25% of them were beneficiaries of the LIS program. And you specifically looked at factors that could be associated with not receiving therapies at all, and also whether the quality of care that these patients were receiving were any different compared to those who were not part of the LIS program. So I just wanted to see if you could guide us a little bit in the results, whether you see any kind of differences when we look at access to any type of systemic therapies and whether being a part of the LIS program modified access to the drugs. Dr. Aaron Mitchell: Let me take this opportunity also to highlight a feature of our study that differentiates us a little bit from previous work that's been done. And this is around the specific definition of quality that we use. I know quality is in the title of the manuscript, but I think it's important to emphasize exactly what we mean in this study when we say quality, and it's something very specific. So our measure of quality references back to the NCCN guidelines, which I don't think our audience needs much of an introduction to that. It's the most worldwide recognized standard of care guidelines for oncology practice. And we specifically looked not only at the NCCN guidelines, but at their evidence block scoring system. So what we did was we looked not only at one set of guidelines, but we looked at guidelines across time. We looked at guidelines across our full study period, which was, give or take, 2015-2018, depending on the cancer. And we looked at each point in time to see what was the treatment regimen that was recommended by the NCCN guidelines as being preferred. Some of them make that designation, some of them don't. If there was not a designation of preferred, then we turned to the evidence blocks. And the evidence blocks, we then apply several different measures to kind of rank treatments from those that get high scores for efficacy and safety to those that get low scores for efficacy, safety and the quality of evidence. So we basically come up with a kind of a rank list of the recommended treatments at each point in time. And then we look at the ones that are the highest, we say which are the most highly recommended treatments at any given point in time. That then becomes our definition of quality treatment. And I'm saying this with air quotes, we use the term “optimal treatment” in the study. Did they get that treatment? If there were ties, you could have gotten either of the two treatments that got the equally good score, did you get that treatment versus did you get anything else? So then getting back to our analysis, what we really did was kind of a two-stage study. First, we put all of our patients into our pool, into one big analytic model. And we looked to see what are the factors that predict or are associated with a patient either getting no systemic therapy or any systemic therapy. And then as a second question, we look at the patients who got some form of systemic therapy, and then we ask, again, what percentage of those got the optimal treatment or high quality treatment as opposed to one of the more lowly recommended treatment regimens? So that's how we asked it. We found that patients who were low income subsidy recipients, the low income ones, they were both less likely to receive any systemic therapy. And then even the ones that receive systemic therapy, the ones who made it in the door to see their doctor or their part of the system, they still were less likely to get the optimal treatment that was recommended for their cancer type at the time that they were diagnosed. Dr. Davide Soldato: So basically, even when you are a part of this subsidiary program, you still have a lower access to any type of treatment. And even if you get treatment, you kind of get the ones that were not the preferred according to the NCCN guidelines, or at least they were not scoring as well as those specific regimens. But I think that what our audience might be wondering about is that frequently there are also some other types of characteristics, for example, age or number of comorbidities, which can be associated with having a low socioeconomic status. So I was wondering whether in the analysis you kind of looked specifically also at patient factors, for example, income rather than age or comorbidities, and whether you found any significant association with those and whether it was something that you planned to do in your study. Dr. Aaron Mitchell: Yes. So we looked at many patient factors and those included age and they included the degree of comorbidity. And what we saw with respect to those characteristics was not too surprising. We saw that patients who were older were less likely to receive systemic therapy. We saw that patients who had more comorbidities were also less likely to get systemic therapy. And then across our different designations of treatments, we saw that those patients were also less likely to get the optimal treatment for their cancer. This result though, we would say it certainly needs more study in the future, but it's not immediately concerning. And that is because for patients who have more age, more comorbidity, those often correlate with frailty. And so it could be that these patients aren't getting optimally treated or it could be that their oncologists are just making clinically appropriate decisions about patient selection. We saw as we were doing this work that the treatment regimens that are often getting the highest recommendations from the NCCN, hence, it would become our definition of high quality optimal treatment, are often ones that are aggressive. They're often ones that are multi-drug combinations. They're often ones that it's not just your old antineoplastics, it's the antineoplastics plus an additional immunotherapy or plus a targeted drug. So it's the ones that are more aggressive by and large, and that might be in some cases more than a patient who is older, more frail, could be able to tolerate. And so the oncologist might be making inappropriate judgment to say I'm going to do something a little bit less aggressive here and make an appropriate trade off between anti cancer efficacy and safety. I think we've got kind of a bookmark there and we can look at those trends in the future. So we saw that kind of as expected, and then we turned and looked towards the low income subsidy. And our premise there is, well, your income shouldn't predict what you're getting clinically. In an ideal world, you'd be able to get the appropriate treatment for a patient, and not depend on whether their income is above or below 135% of the poverty limit. So that one seems more like on its face an immediate concern. Dr. Davide Soldato: Thank you very much for the explanation. I was just wondering, did you make some kind of selection when you were analyzing specific diseases or settings where you included just metastatic patients or you also included patients with early stage neoadjuvant treatments? Because I think that it is also very interesting from the perspective of the objectives that we have as oncologists when we are administering systemic treatments. Dr. Aaron Mitchell: Yeah, thank you for bringing that up. That was also one of the goals of our study was to be broad. And we wanted to look for factors, whether it be low income subsidy, whether it be age, socioeconomic background, etc., things that would be broad predictors of outcomes, and by which I mean care delivery outcomes across the board. So not just for, let's say, metastatic breast cancer, but also across any cancer that a patient might walk in the door with, what are the systemic predictors. And so when you mentioned before that our overall cohort is approximately 9,000 patients, that's 9,000 patients split over a variety of what we call clinical scenarios or clinical indications. And that includes multiple solid tumor as well as liquid tumor malignancies. It includes both patients who are initiating systemic therapy with palliative intent for metastatic disease. It also includes several groups of patients who are getting adjuvant therapy. So we want it to be as broad as possible. Our selection of those scenarios was really done with the goal of being as broad as possible and really bringing in everything that we could within the constraints of our data source. And that was really the only limitation that we applied in concept was tumor types that are common enough to have a meaningful sample of patients to analyze. So, one, are there enough patients? And then two, are you able to identify this specific group of patients within SEER-Medicare data? Because when the NCCN divides groups of patients by biomarkers that are not available in SEER-Medicare, we can't really say, “Oh, we're going to study this group of patients.” That would then be one that we have to leave on the side and not include. But everything else where one of those things didn't apply, we tried to include it as best we could. Dr. Davide Soldato: Thank you very much for the explanation. And among the scenarios that you included in the study, were there any striking differences in terms of access to treatment and access to quality treatment the way you define the study? Dr. Aaron Mitchell: Yes, there were differences between these different cancer types, these different cancer indications, but they're not differences that I want to over interpret or read too much into. Certainly, every cancer indication is going to be different, but when we start getting into the individual cancer types, the sample size does get smaller. And we've not done formal tests of comparison or heterogeneity among cancer types. So I don't want to say that the differences which we certainly do see, like numerically, there are differences in the proportion of patients who are getting optimal treatment versus no treatment. I don't want to say that it's because the low income subsidy status or patient age has a bigger impact, let's say for lung cancer than breast cancer. I want to say that is heterogeneity for potential future study when we are able to do a similar follow up analysis with say a larger sample size. I don't want to over interpret those differences at the moment. Dr. Davide Soldato: I was just wondering in case there was anything in particular that you wanted to highlight. But in the end, I think that we also have to acknowledge that the data are based on claims data, observational data. So maybe you're right when you say we should not over interpret this type of difference. And this is just to speculate a little bit, do you think that if you would look at this same specific question in a more contemporary diagnosis frame, like for example, you refer to the fact that most of the diagnoses were between 2016 and 2018. Now that we have more and more of these drugs that would qualify as Part B in the adjuvant or new adjuvant setting, do you think that you would see more differences compared to what you observed in the current study or do you think that it would be more or less the same? Of course this was not part of the analysis that you did, but it's just to have your opinion on the topic in general. Dr. Aaron Mitchell: My expectation would be that since not much has changed with respect to the low income subsidy program from the time period of our study until now, my baseline expectation would be that those results would hold. On the other hand, it is the case that there have been improvements to the standard Medicare Part D benefit since the time of our study. So the low income subsidy patients would be paying the same low out of pocket costs that I mentioned before, about $10 a month give or take, for a specialty cancer drug. But what has started to happen is that for everyone else, their coverage has improved. Because in the US we're in the process of closing, or I think now we finally finished, but you know, a few years lag in claims data, we've closed what used to be called the donut hole, where there was this big coverage gap where patients had to pay a large amount out of pocket for drugs. So there might therefore be a narrowing of the difference, let's say between our low income subsidy participants, the lowest income patients, and then everyone else. But not so much because the low income subsidy status improved or changed, but just because the baseline level of coverage for everyone else may have improved, narrowing that gap. So I'd say that would be very possible. And if your question is more geared towards not so much policy changes, but treatment landscape changes, I would say the big thing that I would maybe guess, and again, this is very much speculation, but you introduce the speculation in TBD on follow up. I think the big change in the landscape has been the broadening indication and uptake of immunotherapy drugs, our PD-1, PD-L1 inhibitors, for a variety of cancer types. And I think the way that that would manifest in our data, were we to repeat it in a more contemporary data set, would be, I think that the access for, let's say, that any systemic therapy among older patients might change. And that is because rather than just having your cytotoxics in hand, the clinical oncologists now know that for many cases there's if not first line therapy, then second line therapy for patients who don't qualify, you can go straight to it, to someone who's not a chemo candidate, you've got a much more tolerable treatment in your back pocket. And so I think that for patients who are more old or more comorbid, we might start to see that a greater proportion of them receive some systemic therapy, it just might not be the cytotoxic agent that is still most highly recommended. It might be, say a single agent, PD-L1 inhibitor, because their oncologist wants to be able to give them something. So I wouldn't be surprised if that gap starts to narrow as well if you're measuring no systemic therapy versus any systemic therapy. Dr. Davide Soldato: And going back to the policy part of the study that you did, do you think that the results of the study that you published in the JCO can better inform policy makers on how to make these treatments more available and be sure that the largest possible proportion of patients gets a systemic treatment and gets the optimal systemic treatment? Dr. Aaron Mitchell: Yes, I do think that this study has some direct and indirect policy implications. I think that our finding is one to highlight the low income subsidy program and maybe help it not to fly under the radar so much anymore. I think all the work that has been done on how much it has helped patients who need oral cancer medications is great, and it shows how beneficial this program can be. We're now shining the light kind of everywhere else and saying, “Okay. That's great. Here's how well it can work when it covers an oral drug, but we've got this group of low income patients who are still at need and they're still very clearly not able to access everything else. When it's not axitinib that they need, it's a pembrolizumab, they're still very much behind the curve and they need some help.” So I think that's one thing just to call attention to this as an ongoing problem. Low income patients, it's not a solved problem yet. It's something that needs further attention. And then for direct policy implications that are on the table, I think we're about to see the Medicare program be able to start negotiating not just Part D drugs, but also in future years, Part B covered drugs and try to lower the price for everyone, both for insurance, both for Medicare itself. And then to the extent that that boils over to the patient's out of pocket responsibility, it'll start to reduce the patient out of pocket costs as well. So I think we can look forward to hopefully an aggressive negotiation program by Medicare to start to directly lower the prices of Part B cancer drugs that these patients are unable to afford. Dr. Davide Soldato: Thank you very much. You did the research you published in the JCO, but you really seem very passionate about the topic of care delivery and quality of care and policy. So I just wanted to ask on a personal note, how did you come to this area of research which is frequently not one that is very cared for by oncologists? It's more frequently something that biostatisticians or public health scientists put their attention to. I just had this curiosity and I wanted to ask you if you could explain a little bit how you came to this area of research. Dr. Aaron Mitchell: Thank you for asking. That's a great question. I'll tell my favorite story about my journey there. I entered medical school planning to be a clinical investigator or maybe even a basic science researcher, and I had some background in that. I went to medical school at NYU where the teaching hospital is Bellevue, which is a large, well known public hospital within New York City. And my eyes started to open regarding the inequities in the system. You always hear about it, you read about the problems in the US healthcare system, but then when you see it on a day to day basis and you can walk four blocks from a private, very well resourced hospital to see a patient with a similar condition four blocks down the road at a under resourced public hospital getting very different treatments and receiving very different outcomes, the injustice in the system really hits you on a visceral level. And it was really, I would say, as soon as I started my clinical rotations in medical school that I realized maybe that's where I can make the most impact with my career and just really fell into it. By the time I was done with medical school, I then knew that I wanted to do something that was in the health policy space. And then by the time I was done with residency, I was like, “Oh, someone had mentioned the words health services research” and the light went on. It's like, “Oh, that's me. That's what I want to do.” Dr. Davide Soldato: Thank you very much. That was a nice story. And I really think that we should all work towards trying to make sure that the inequities inside of the system are eliminated as much as possible. So I think that this concludes our interview for today. So thank you again, Dr. Mitchell, for joining us. Dr. Aaron Mitchell: You're very welcome and thank you so much for your interest. Dr. Davide Soldato: We appreciate you sharing more on your JCO article titled, “Quality of Treatment Selection for Medicare Beneficiaries with Cancer.” If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinion, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
Mark Miller, Morningstar contributor, talks about the new $2,000 out-of-pocket cap for Medicare Part D coming in 2025. Plus, learn what you should know before switching between Medicare Advantage and traditional Medicare during open enrollment.Traditional Medicare vs. Medicare AdvantageWhy Seniors Shouldn't Just Roll Over Their Plans in 20252025 Medicare Part D ChangesMedicare's New Prescription Payment PlanWhat Should Seniors Do If Their Medicare Advantage Plan is Being Eliminated?What You Need to Know About Switching Between Traditional Medicare and Medicare Advantage Where You Can Go to Get Help Choosing a New Medicare Plan Read about topics from this episode. Medicare Open Enrollment: What to Know as You Enroll for 2025I'm 65 and Still Working. Should I Enroll in Medicare?Are Consumers Better Off With Medicare Plus a Medigap Plan? What to watch from Morningstar.A Better Way to Use Leverage in Your ETF PortfolioApple Earnings Are on Deck. Will Apple Intelligence Help Drive iPhone Sales?Is Your Portfolio Built to Withstand a Market Rotation?Inherited IRA Rules: What You Need to Know Before 2025 Read what our team is writing:Mark MillerIvanna Hampton Follow us on social media.Facebook: https://www.facebook.com/MorningstarInc/X: https://x.com/MorningstarIncInstagram: https://www.instagram.com/morningstar... LinkedIn: https://www.linkedin.com/company/5161/
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Jim Sullivan from Pay4Care.org discusses significant changes to Medicare's prescription drug coverage in 2025, particularly regarding the Medicare Part D plans and Medicare Advantage plans with drug coverage. Jim discusses key 2025 changes to Medicare Part D, including a new $2,000 out-of-pocket maximum for prescription drug costs. Beneficiaries can now opt for the Medicare Prescription Payment Plan, allowing them to spread out deductible payments monthly to ease early-year costs. The Open Enrollment Period (Oct 15 - Dec 7) is a vital time for beneficiaries to review their plans, as many premiums, copays, and formularies will change, and some plans will be discontinued. Clients should be proactive since plans may automatically transfer them to a different plan if theirs is terminated, potentially impacting drug coverage and costs. Jim urges advisors to support clients in ensuring their coverage meets their healthcare needs, prioritizing both affordability and the quality of care provided. Access resources related to this podcast: Note: If you're using a podcast app that does not hyperlink to the resources, visit Libsyn (PFP) to access show notes with direct links. Learn more on the latest proposals and regulations by accessing The Medicare & You Handbook. You can also access Jim Sullivan's Guide to Retirement & Elder Planning: Healthcare Coverage Planning-6th Ed on the AICPA website. A deep dive for advisors can be found in the Health Transitions Guide: Vol. 3 .
Nationally syndicated financial columnist and author Terry Savage joins John Williams to talk about what you need to know about Medicare Part D, her thoughts on Vice President Kamala Harris’ proposal for Medicare to cover long-term-care services at home, why gold is at an all-time high, and to answer all of your financial questions.
Send us a textQuestions about robotics and tax planning? Don't miss this episode of The Bottom Line Pharmacy Podcast!Join Scotty Sykes, CPA, CFP and Bonnie Bond, CPA as they sit down with Darin Gleason, National Sales Director for Retail Pharmacies at ScriptPro to discuss:Impact of tax changes on pharmacies and bonus depreciationManaging costs and improving efficiency in your pharmacyMaximizing tax savings by implementing roboticsStay up to date on new episodes by liking and subscribing!Read and follow along with this episode at the show transcript:More about our guest:Darin Gleason is the National Sales Director for Retail and Chains with ScriptPro. He has 17 years of experience working with independent pharmacies and automation. In his 17 years of work with independent pharmacies, Darin has seen many changes including changes in Medicare Part D reimbursements, COVID, and DIR fees.ScriptPro is a pharmacy automation system that is built and installed to the custom specs of the pharmacy.Follow Darin Gleason and ScriptPro: Darin Gleason LinkedIn ScriptPro Website ScriptPro Facebook ScriptPro Twitter (X) ScriptPro LinkedIn ScriptPro YouTube Check out all of our social media: Sykes & Company, P.A. FacebookSykes & Company, P.A. TwitterSykes & Company, P.A. LinkedInSykes & Company, P.A. InstagramScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP Twitter Bonnie Bond – CPA LinkedIn Bonnie Bond – CPA Twitter More resources about this topic: Podcast – The Hidden Cost of Not Automating Blog - Improving Profitability and Customer Service Levels Through AI Blog – Three Tips to Manage Payroll Expenses Blog – 5 Ways to Diversify Services in Your Pharmacy
Learn more about how you can prepare for retirement by downloading the complimentary Retire Your Way Toolkit - https://bit.ly/4gXJY5o Register for our next Journey to Retirement Online Workshop to learn more about building a comprehensive retirement plan. - https://bit.ly/4aeNR1B In this episode of Retiring Today, Molly Nelson and Loren Merkle, along with AnnaMarie Morrow, Director of Medicare at Merkle Retirement Planning, dive into the critical Medicare changes coming in 2025. - Understand Medicare Part D and its significance. - Important updates for 2025 Medicare Part D plans. - Key Medicare legislation changes from 2022 to 2029. - Strategies to avoid unexpected prescription drug costs. - How to account for health care as part of your overall retirement plan. Loren Merkle, CERTIFIED FINANCIAL PLANNER™, RETIREMENT INCOME CERTIFIED PROFESSIONAL®, CERTIFIED FINANCIAL FIDUCIARY® https://merkleretirementplanning.com/staff-members/loren-merkle/ AnnaMarie Morrow, Director of Medicare https://merkleretirementplanning.com/staff-members/annamarie-morrow/ Molly Nelson, Host of Retiring Today https://merkleretirementplanning.com/staff-members/molly-nelson/ -- This video does not constitute an offer to sell, a solicitation of an offer to buy, or a recommendation of any security or any other product or service by Merkle Retirement Planning LLC, Elite Retirement Planning LLC, MRP Insurance LLC, or any other third party regardless of whether such security, product or service is referenced in this episode. Furthermore, nothing in this episode is intended to provide tax, legal, or investment advice and nothing in this episode should be construed as a recommendation to buy, sell, or hold any investment or security or to engage in any investment strategy or transaction. Merkle Retirement Planning, LLC does not represent that the securities, products, or services discussed in this episode are suitable for any particular investor. You are solely responsible for determining whether any investment, investment strategy, security or related transaction is appropriate for you based on your personal investment objectives, financial circumstances and risk tolerance. You should consult your business advisor, attorney, or tax and accounting advisor regarding your specific business, legal or tax situation. Medicare services provided through MRP Insurance, LLC. Any and all other services related to insurance are an outside business activity and are not offered through or supervised by Elite Retirement Planning, LLC. MRP Insurance, LLC, is not affiliated with or endorsed by any government agency. This is an advertisement for insurance. By responding to the ad, you will be put in contact with a licensed insurance agent offering Medicare Advantage Plans, Medicare Supplement Plans, and Prescription Drug Plans. We do not offer every plan available in your area. Currently we represent [5] organizations which offer [22] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
The Friday Five for October 18, 2024: Elevance to Require Paper Apps for 2025 MAPD PPO Plans in Most States Federal Trade Commission Announces “Click to Cancel” Rule New Apple iPad Mini & Amazon Kindle ColorSoft Impact of Medicare Part D Changes by State KFF 2025 Medicare Part D Snapshot Report Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Elevance Requires Paper Apps for 2025 MAPD PPO Plans in Most States: Elevance to Require Paper Apps for 2025 MAPD PPO Plans in Most States: https://ritterim.com/blog/elevance-to-require-paper-apps-for-2025-mapd-ppo-plans-in-most-states/ Federal Trade Commission Announces “Click to Cancel” Rule: Selyukh, Alina. “Canceling Subscriptions Has to Be as Easy as Signing up, FTC Says in a New Rule.” NPR, NPR, 16 Oct. 2024, www.npr.org/2024/10/16/nx-s1-5154814/click-to-cancel-subscriptions-memberships-ftc-rule. Solomon Ensor, Julia. “Click to Cancel: The FTC's Amended Negative Option Rule and What It Means for Your Business.” FTC.Gov, Federal Trade Commission, 16 Oct. 2024, www.ftc.gov/business-guidance/blog/2024/10/click-cancel-ftcs-amended-negative-option-rule-what-it-means-your-business. “Federal Trade Commission Announces Final ‘Click-to-Cancel' Rule Making It Easier for Consumers to End Recurring Subscriptions and Memberships.” FTC.Gov, Federal Trade Commission, 16 Oct. 2024, www.ftc.gov/news-events/news/press-releases/2024/10/federal-trade-commission-announces-final-click-cancel-rule-making-it-easier-consumers-end-recurring. “Rule Concerning Recurring Subscriptions and Other Negative Option Programs.” FTC.Gov, Federal Trade Commission, www.ftc.gov/system/files/ftc_gov/pdf/p064202_negative_option_rule.pdf. Accessed 16 Oct. 2024. “The FTC's ‘Click to Cancel' Rule.” FTC.Gov, Federal Trade Commission, 16 Oct. 2024, www.ftc.gov/system/files/ftc_gov/pdf/NegOptions-1page.pdf. Roth, Emma. “The FTC Is Finally Making It Easier to Cancel Your Gym Membership.” Theverge.Com, The Verge, 16 Oct. 2024, www.theverge.com/2024/10/16/24271649/ftc-click-to-cancel-subscriptions-final-rule. da Silva, João. “US ‘click to Cancel' Rule to Tackle Subscription Traps.” BBC News, BBC, 17 Oct. 2024, www.bbc.com/news/articles/c07nlvmyl05o. Apple iPad Mini & Amazon Kindle ColorSoft: “Apple Introduces Powerful New iPad Mini Built for Apple Intelligence.” Apple.Com, Apple, 15 Oct. 2024, www.apple.com/newsroom/2024/10/apple-introduces-powerful-new-ipad-mini-built-for-apple-intelligence/. Fried, Ina. “Amazon Debuts Color Screen Kindle, Updates Other e-Readers.” Axios.Com, Axios, 17 Oct. 2024, www.axios.com/2024/10/17/amazon-color-screen-kindle-e-reader-updates. Staff, Amazon. “Amazon Reveals First Color Kindle, New Kindle Scribe, and More.” Aboutamazon.Com, Amazon, 16 Oct. 2024, www.aboutamazon.com/news/devices/new-kindle-color-scribe-paperwhite-entry. “Amazon Reveals Its First Color Kindle E-Reader after Years of Development | Reuters.” Reuters.Com, Reuters, 16 Oct. 2024, www.reuters.com/technology/amazon-reveals-its-first-color-kindle-e-reader-after-years-development-2024-10-16/. LeClair, Dave. “IPad Mini 7 Unveiled with A17 Pro Chip - Release Date, Specs, Price and More.” Tomsguide.Com, Tom's Guide, 15 Oct. 2024, www.tomsguide.com/tablets/ipads/ipad-mini-7-unveiled-with-a17-pro-chip-release-date-specs-price-and-more. Kennemer, Quentyn. “You Can Now Preorder the New iPad Mini.” Verge.Com, The Verge, 15 Oct. 2024, www.theverge.com/2024/10/15/24268182/ipad-mini-2024-preorder-how-to-buy-price-release-date. Impact of Medicare Part D Changes by State: Bell, Allison. “11 Worst States for Medicare Drug Plan Menu Cuts.” Thinkadvisor.Com, ThinkAdvisor, 9 Oct. 2024, www.thinkadvisor.com/2024/10/09/11-worst-states-for-medicare-drug-plan-menu-cuts/. 2025 Medicare Part D Snapshot Report: Cubanski, Juliette. “A Current Snapshot of the Medicare Part D Prescription Drug Benefit.” KFF.Org, KFF, 9 Oct. 2024, www.kff.org/medicare/issue-brief/a-current-snapshot-of-the-medicare-part-d-prescription-drug-benefit/. Cubanski, Juliette. “Medicare Part D Premiums Are Increasing for Many but Not All Stand-Alone Plans in 2025, Reflecting Effects of New Premium Stabilization Demonstration.” KFF.Org, KFF, 7 Oct. 2024, www.kff.org/policy-watch/medicare-part-d-premiums-are-increasing-for-many-but-not-all-stand-alone-plans-in-2025-reflecting-effects-of-new-premium-stabilization-demonstration/. Resources: A Review of Integrity's Top Medicare Quoting Tools: https://ritterim.com/blog/a-review-of-the-integrity-offered-medicare-quoting-software/ CMS Announces Medicare $2 Drug List Model RFI: https://link.chtbl.com/ASGF20241011 Changes to Medicare in 2025 Affect Dual Eligible Special Needs Plans: https://link.chtbl.com/ASGB20241012 Cigna to Sell Medicare Business to HCSC: https://ritterim.com/blog/cigna-to-sell-medicare-business-to-hcsc/ How to Ask Your Current Clients for Referrals: https://link.chtbl.com/ASG623 Meet Your Sales Team: https://ritterim.com/meet-your-sales-team/ The 2025 COLA Increase & How It Affects Your Clients: https://link.chtbl.com/ASGN20241015 The Value of Plan N for Medicare Shoppers ft. Ted Sims: https://link.chtbl.com/ASGTedSims2024 What CMS Requires Medicare Agents to Discuss Prior to Enrollments: https://ritterim.com/blog/what-cms-requires-medicare-agents-to-discuss-prior-to-enrollments/ When Do Med Supp Plans K, L, M, & N Make Sense? https://ritterim.com/blog/when-do-med-supp-plans-k-l-m-and-n-make-sense/ Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/
In this conversation, Joe Grogan and Ge Bai discuss the complexities of healthcare finance, focusing on the Inflation Reduction Act (IRA) and its implications for drug pricing and Medicare. They delve into the role of the Congressional Budget Office (CBO) in estimating the financial impacts of healthcare policies, highlighting the discrepancies between projected savings and actual costs. The discussion also touches on the challenges faced by seniors under Medicare Part D, the potential consequences for drug innovation, and the need for bipartisan solutions in healthcare reform. Additionally, they explore the implications of proposed long-term care policies and the financial burdens they may impose.
Open enrollment is underway! And if you're one of the 25% of people living with MS who get their coverage through Medicare, there are some major changes coming in 2025. So, it's especially important that you review your prescription drug coverage to make sure you're enrolled in the Medicare Part D plan that's best for you. Sarah Anderson, pharmacist and senior director of clinical resources and programming at the National MS Society, joins me to help us decipher those changes and navigate the sometimes confusing world of health insurance. We'll also tell you about a research team that's editing human DNA to promote myelin repair. We'll share the results of a study that offers some surprising evidence about the quality of MS care for women in France. We'll explain why a study that shows people with MS are at a higher risk for being diagnosed with cancer may not be as scary as it sounds. In my conversation with Dawn Schottlandt, you'll hear the story of In My Running Shoes and learn how people with MS and other disabilities can benefit from their work. And we'll give you all the details about artist Elizabeth Jameson's exhibition, An Intimate Journey, which opens in New York on Saturday, October 19th. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: Open Enrollment has begun :22 Researchers succeed in editing human DNA to promote myelin repair 1:14 Research reveals women with MS are often undertreated in France 3:38 Are people with MS more likely to develop cancer? 6:18 Dawn Schottlandt explains why she founded In My Running Shoes and how you might benefit 9:12 Elizabeth Jameson's art exhibition, An Intimate Journey, opens in New York on Saturday 16:01 Sarah Anderson explains the changes to Medicare in 2025 18:04 Share this episode 27:56 Have you downloaded the free RealTalk MS app? 28:16 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/372 ADD YOUR VOICE TO THE CONVERSATION I've always considered the RealTalk MS podcast a conversation. This is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com STUDY: CRISPR-Edited ES-Derived Oligodendrocyte Progenitor Cells Improve Remyelination in Rodents https://www.nature.com/articles/s41467-024-52444-w STUDY: Cancer Risk Among Patients with Multiple Sclerosis https://www.neurology.org/doi/10.1212/WNL.0000000000209885 In My Running Shoes https://inmyrunninigshoes.org Elizabeth Jameson exhibition at the Positive Exposure Gallery https://positiveexposure.org/event/41014 Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 372 Guests: Dawn Schottlandt and Sarah Anderson Privacy Policy
CMS recently announced changes that will affect Dual Eligible Special Needs Plans. Press play to learn how this affects you and your D-SNP clients for the upcoming plan year! Read the text version Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Resources: 4 Ways PlanEnroll Will Make This Your Best AEP Yet: https://link.chtbl.com/ASG617R5 2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D: https://link.chtbl.com/ASGN20240808 2025 Medicare Market Disruption Means Opportunity for Agents: https://ritterim.com/follow-medicare-changes/ 2025 Medicare Part D Redesign Updates: https://ritterim.com/blog/2025-medicare-part-d-redesign-updates/ CMS Announces Part D Savings & 2025 Maximum Fair Prices for First 10 Medicare-Negotiated Drugs: https://link.chtbl.com/ASG619R5 Get Your Portfolio Reviewed by Ritter: https://ritterim.com/portfolio/ Learn more about PlanEnroll: https://ritterim.com/planenroll/ The Beginner's Guide to D-SNPs: https://ritterim.com/blog/the-beginners-guide-to-dsnps/ Register with Ritter Insurance Marketing: https://app.ritterim.com/public/registration/ Ritter Fact Finder Free PDF Download: https://ritterim.com/documents/ritter-fact-finder.pdf References: Barnette, Lindsay P. “Guidance for States Seeking to Leverage New ...” CMS, Centers for Medicare & Medicaid Services, 25 Aug. 2022, www.cms.gov/files/document/stateoppsintegratedcareprogs.pdf. Freed, Salama, et al. “10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs).” KFF, KFF, 9 Feb. 2024, www.kff.org/medicare/issue-brief/10-things-to-know-about-medicare-advantage-dual-eligible-special-needs-plans-d-snps/. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X (fka) Twitter, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/
On this episode of the Astonishing Healthcare podcast, Capital Rx's Samantha Custer, Director of Member Experience, and Jake Mulkey, Product Manager, join host Justin Venneri to discuss a niche, important aspect of Medicare Part D plans: Transition Benefits. What goes on behind the scenes to enable a plan member to receive uninterrupted care? What role does modern software - i.e., JUDI® - play in providing members with a temporary supply of their medication and meeting notification requirements? What makes for a great relationship between product teams and other business units?To answer these questions and more, Sam and Jake explain everything from how processes can be built into the adjudication process in JUDI in real time to the exchange of data and reporting surrounding the notifications that must be sent to plan members, per CMS requirements. Sam also explains how flexible JUDI is and that if CMS issues changes to any one part of the process, they can be adhered to "quickly and easily," or if commercial clients want to leverage the setup, it's no problem. Jake shares his views on building products in a modern platform and some things he's learned over the years that make for a good working relationship between product and other teams.Related ContentAH005 - Star Ratings, MTM, & CMS Translation Requirements with Jay Tran, PharmDPharmacy Benefits 101: Medicare Star RatingsHow Our Favorite New JUDI® Features Aid Pharmacy Benefit AdministrationHow Our Favorite New JUDI® Features Aid Government ProgramsFor more information about Capital Rx and this episode, please visit Capital Rx Insights.
Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372. … It opened a doorway to a whole group of very relentless people.” For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I want to start there because it's a nice comment, but it's also a call to action. Think about this and think about it not in the context of being a “stakeholder” and not in the context of being an organization but in the context of humans who work at these various organizations who, combined, comprise the bucket of companies that we lumped together using the old stakeholder word. All of these individuals are making choices every day, and all of these choices, they could be made with integrity and with the patient or member in mind … or not. In real life, right now, the overwhelming majority of members/patients in this country get their clinical care and the pleasure of paying for that care or drugs within the current ecosystem we have here in the USA. For any of us, or all of us who work within that traditional ecosystem, it is up to us to choose our own legacy here. It's probably why you listen to this show in the first place, actually. There are so many RHV (Relentless Health Value) listeners who are pushing for patients against the riptide that is the profit motives of the organization that they work for. It's hard. But yeah, it's all about finding our people and supporting each other. Okay, so let's get to the “between a rock and a hard place” portion of this discussion. Hospitals and ASOs (administrative services organizations)/carriers/TPAs (third-party administrators) often enter into or sometimes enter into what amounts to anticompetitive contracts with each other. Listen to episode 395 with Brennan Bilberry for the rundown on that one. But meanwhile, the CAA, the Consolidated Appropriations Act from 2021, holds employer plan sponsors accountable and responsible to ensure that plan assets are spent prudently, that costs paid are reasonable, and that there's no conflict of interest (COI). This is the definition of what a fiduciary is supposed to do, by the way—prudent, reasonable, and no COI. Anticompetitive contracts between a carrier and a hospital are the very definition of COI. And when that COI results in higher, maybe unreasonable, prices and non-prudent spend, well, plan sponsors are put between a rock and a hard place if they stick with their existing vendors. Rosa Novo from Miami-Dade County Public Schools put this really succinctly on a panel at a 32BJ event recently. She said what amounts to, I have no choice but to actually do the right thing here, for many reasons, but one of them is I do not look good in orange. She said, my personal butt is on the line here. And furthermore, who do class action lawsuits make look bad when their company or CEO or CFO are personally sued over conflicted benefits? See the Wells Fargo lawsuit, J&J lawsuit, etc. It sucks that employers or plan sponsors get put into this pickle by their own vendors. And that's what we're talking about today. This is a conversation that starts out talking about rates (ie, prices), edges into rights (ie, plan sponsor rights), and ends up all about power. And by the way, if you're a plan sponsor, especially in New York City, maybe doing the right thing here means hatching a plan to steer and tier in your benefit design, figuring out how to, for reals, help support the efforts of 32BJ to advantage pretty much every patient near and far. The pushback I often hear to doing something like this often involves the perception that plan members are too rich to care about reasonable prices, prudent plan spending, and COI. And yeah, to state the obvious, these same people are also sophisticated enough to smell a fine opportunity for a class action lawsuit; and also, they probably do care, as more and more studies suggest. Sorry if I just stumbled onto a sacred cow. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. And yeah, it's a freakin' tangled web we weave; and this tale is a perfect case study of it. It makes me even more invested in remembering my own manifesto (that was episode 400) to ensure that I can feel good about what I personally have accomplished and what I have been a part of and the net impact of my own personal actions, since I, too, very often work in the belly of the beast. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available. More on that in the show that follows. Also mentioned in this episode are 32BJ Benefit Funds; Michelle Bernabe, RN, KAT; Brennan Bilberry; Rosa Novo; Marilyn Bartlett; Cynthia Fisher; Zack Cooper, PhD; Claire Brockbank; Andreas Mang; Chris Deacon; Elizabeth Mitchell; and Purchaser Business Group on Health. You can learn more at health.32bjfunds.org and by following Cora on LinkedIn. Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of Service Employees International Union 32BJ have easy and sustained access to affordable, high-quality healthcare. Since becoming director of the Health Fund in 2021, Cora has prioritized a data-driven approach to healthcare, focusing on reducing trend; solving the affordability challenge on behalf of union members; and most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. Most recently, Cora conducted an innovative medical request for proposal (RFP), stipulating that all finalists must have a signature-ready contract drafted by the Health Fund prior to award. By including the Health Fund–drafted contract in the RFP process, the Fund was able to negotiate an agreement that brought unprecedented visibility and increased accountability to the 32BJ Health Fund benefit. Cora is regarded as an expert in pharmacy benefit management and previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations to strategy and acquisitions. She earned an MBA from Saint Louis University. 06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors? 09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design. 12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design? 14:12 How do these anticompetitive rights have quality implications as well as cost implications? 18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year? 19:46 What did the healthcare savings allow the unions and employers to do? 20:46 Study by Zack Cooper, PhD. 21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend. 24:15 Why 32BJ Health Fund wants to control the contracting process. 26:00 EP419 with Andreas Mang. 27:18 What are 32BJ Health Fund's four non-negotiables? 33:17 Wall Street Journal article on health insurance contract. 35:30 Upcoming episode with Claire Brockbank. 36:14 What is the challenge that exists in our current healthcare environment? 37:43 Cora's advice on how to get high-quality healthcare at an affordable price. You can learn more at health.32bjfunds.org and by following Cora on LinkedIn. @CoraOpsahl discusses #fiduciaryresponsibility in #healthcare on our #healthcarepodcast. #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn (EP446)
As we approach Medicare's Open Enrollment period, NP Pulse welcomes AANP's president elect Valerie Fuller to discuss the big changes that have happened — and will happen starting Jan. 1 of 2025— to Medicare Part D. Learn how seniors can opt in to the program and what changes will be taking place with regard to costs for medications, vaccines and more. This podcast is made possible by PhRMA.
Looking to drive meaningful change in the health care ecosystem? Look to the Deloitte Health Equity Institute.Health Affairs' Editor-in-Chief Alan Weil interviews Pragya Kakani of Cornell University about her recent paper exploring the association between Medicare Part D protected-class policy and lower drug rebates.Order the October 2024 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
On this week's episode of THE FINANCIAL COMMUTE, host Chris Galeski welcomes Brian McArthur, President of Design My Medicare to discuss upcoming changes to Medicare.Here are some key takeaways from their discussion:- Starting in 2025, Medicare Part D will see significant changes, including a $2,000 annual out-of-pocket cap on drug costs, aiming to provide relief for beneficiaries with high prescription costs.- Insulin users will benefit from a $35 monthly cap, which began in 2023, and this will continue under the new changes to reduce financial burdens on those with diabetes.- The confusing coverage gap in Part D, known as the "donut hole," is being eliminated, simplifying the cost structure for enrollees.- Adjustments to how premium subsidies are calculated mean that those with lower incomes might qualify for more assistance in paying their Part D premiums.- Pharmaceutical companies will now cover a portion of costs in the catastrophic phase, which previously required the federal government and beneficiaries to bear the bulk of these expenses.- Those enrolled in Medicare or planning to enroll should review their options during the annual election period, as the changes may significantly alter their cost-sharing responsibilities.- Chris and Brian recommend listeners to consult with a Medicare advisor to navigate these changes and select the most appropriate plan for individual health and financial needs.
Carriers not paying commissions on PDP business? We understand the frustration! Listen for ideas on how to move forward while still serving the best interests of your clients. Read the text version Claim your free portfolio review with Ritter! Resources: 2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D: https://ritterim.com/blog/2025-maximum-broker-commissions-for-medicare-advantage-and-medicare-part-d/ 2025 Medicare Market Disruption Means Opportunity for Agents: https://ritterim.com/follow-medicare-changes/ 4 Ways PlanEnroll Will Make This Your Best AEP Yet: https://link.chtbl.com/ASG617R5 A Quick Guide to Cross-Selling Ancillary Insurance with Medicare Products: https://ritterim.com/selling-ancillary-with-medicare/ Find and contact your dedicated sales specialist here at Ritter: https://ritterim.com/meet-your-sales-team/ How to Ask Your Current Clients for Referrals: https://ritterim.com/blog/how-to-ask-your-current-clients-for-referrals/ How Much Money Can Agents Make Selling Ancillary Health Insurance? https://ritterim.com/blog/how-much-money-can-agents-make-selling-ancillary-health-insurance/ Register with Ritter Insurance Marketing: https://app.ritterim.com/public/registration/ Signs It's Time to Expand Your Insurance Portfolio & Make the Move! https://link.chtbl.com/ASG605 The Advisor Approach: Cross-Selling by Fact-Finding: https://link.chtbl.com/ASG587 The Complete Guide on How to Sell Medicare Advantage Plans: https://ritterim.com/medicare-advantage-ebook/ The Insurance Agent's Guide to Generating Referrals: https://ritterim.com/insurance-referral-generation/ Why Being a Likable Agent Is Good for Your Business: https://ritterim.com/blog/why-being-a-likable-agent-is-good-for-your-business/ References: Simone, Christine. “How Medicare Agent Commissions Work for Medicare Advantage, Part D, and Medigap Insurance.” CaribouWealth.Com, Carinbou, 7 Feb. 2024, www.caribouwealth.com/post/how-medicare-agent-commissions-work-for-medicare-advantage-part-d-and-medigap-insurance. Freed, Meredith, et al. “Medicare Advantage in 2024: Enrollment Update and Key Trends.” KFF, KFF, 8 Aug. 2024, www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-enrollment-update-and-key-trends/. Kelly, Susan. “Most Medicare Advantage Enrollees like Their Plans, Survey Finds.” Healthcaredive.Com, Healthcare Dive, 14 June 2022, www.healthcaredive.com/news/most-medicare-advantage-enrollees-like-plans-ehealth/625429/. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.
The Friday Five for October 4, 2024: KFF Study on Medicare Beneficiaries' Tendency to Shop Ritter's First Annual ACA Summit Agent Reaction to MedicareCENTER & Upcoming Webinar Instagram Best Practices & New Pro Dashboard Features 2025 Medicare Advantage and Medicare Part D Premiums KFF Study on Medicare Beneficiaries' Tendency to Shop: Ochieng, Nancy, et al. “Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans during Medicare's Open Enrollment Period.” KFF, KFF, 27 Sept. 2024, www.kff.org/medicare/issue-brief/nearly-7-in-10-medicare-beneficiaries-did-not-compare-plans-during-medicares-open-enrollment-period/. Ritter's First Annual ACA Summit: Register to Attend the Inaugural ACA Summit Agent Reaction to MedicareCENTER & Upcoming Webinar: Learn more about MedicareCENTER: https://integrity.com/medicarecenter/ Register to Attend: Sales Tech Train & Talk - Understanding MedicareCENTER Instagram Best Practices & New Pro Dashboard Features: “About the Instagram Professional Dashboard.” Help.Instagram.Com, Instagram, help.instagram.com/257516379077270. Accessed 3 Oct. 2024. “How Can I Check My Account Type on Instagram?” SocialBu Help, SocialBu, help.socialbu.com/article/331-how-can-i-check-my-account-type-on-instagram. Accessed 3 Oct. 2024. Sato, Mia. “Instagram's ‘Best Practices' Tell Creators How They Should Post.” The Verge, The Verge, 1 Oct. 2024, www.theverge.com/2024/10/1/24259462/instagram-best-practices-business-profiles-tips-reach. “Introducing Best Practices, an Education Hub for Creators on Instagram.” Abaout.Fb.Com, Meta, 30 Sept. 2024, about.fb.com/news/2024/10/best-practices-education-hub-creators-instagram/. “Instagram Creator Education: Best Practices.” Instagram for Creators, Instagram, creators.instagram.com/best-practices#instagram. Accessed 3 Oct. 2024. Instagram Creators Account, Meta, www.instagram.com/creators/. Accessed 3 Oct. 2024. 2025 Medicare Advantage and Medicare Part D Premiums: “Medicare Advantage and Medicare Prescription Drug Programs to Remain Stable as CMS Implements Improvements to the Programs in 2025.” CMS.Gov, Centers for Medicare & Medicaid Services, 27 Sept. 2024, www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-cms-implements-improvements. Freed, Meredith, et al. “Medicare Advantage in 2024: Enrollment Update and Key Trends.” KFF, KFF, 8 Aug. 2024, www.kff.org/medicare/issue-brief/medicare-advantage-in-2024-enrollment-update-and-key-trends/. “Medicare Enrollment for June 2024.” Data.CMS.Gov, Centers for Medicare & Medicaid Services Data, data.cms.gov/tools/medicare-enrollment-dashboard. Accessed 2 Oct. 2024. “Medicare Monthly Enrollment.” Data.CMS.Gov, Centers for Medicare & Medicaid Services Data, data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment. Accessed 2 Oct. 2024. Resources: 4 Ways PlanEnroll Will Make This Your Best AEP Yet: https://link.chtbl.com/ASG617R5 Best Video Editing Apps for Social Media: https://link.chtbl.com/ASGA69 Get Your Medicare Advantage Sales Contracts Here — Recommendations for 2025: https://ritterim.com/blog/get-your-medicare-advantage-sales-contracts-here-recommendations-for-2025/ Prescription Drugs Your Medicare Clients Could See Lower Coinsurances for in 2024: https://ritterim.com/blog/prescription-drugs-your-medicare-clients-could-see-lower-coinsurances-for-in-2024/ Tech News Roundup: https://link.chtbl.com/ASGF20240927 Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/
On this episode of Ask Michelle, Michelle is joined by KC Rippstein, Employee Benefits Compliance Practice Lead at IMA. They provided updates on hospital indemnity notices, Medicare Part D notices, and the projected 2025 FSA limit. Michelle answers questions about exempt status of licensed childcare teachers, non-discrimination testing for employee benefits, and disability and paid family leave for remote out-of-state employees. Curious about a compliance issue? Submit your questions to AskMichelle@imacorp.com and Michelle will answer them on the next episode.
Learn more about the new Medicare prescription payment plan program ahead of the 2025 Annual Enrollment Period. Get the information you need now so you can answer client questions this AEP! Read the text version Resources: 5 Things About the Medicare Prescription Payment Plan: https://link.chtbl.com/ASGF20240726 Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Register with Ritter Insurance Marketing: https://app.ritterim.com/public/registration/ The Complete Guide on How to Sell Prescription Drug Plans: https://ritterim.com/pdp-ebook/ What the Inflation Reduction Act Means for Your Medicare & ACA Clients: https://ritterim.com/blog/what-the-inflation-reduction-act-means-for-your-medicare-aca-clients/ References: “Fact Sheet: Medicare Prescription Payment Plan.” CMS.Gov, Centers for Medicare and Medicaid Services, www.cms.gov/files/document/medicare-prescription-payment-plan-fact-sheet.pdf Accessed 23 August 2024. “Fact Sheet: Medicare Prescription Payment Plan Final Part One Guidance.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/fact-sheet-medicare-prescription-payment-plan-final-part-one-guidance.pdf Accessed 23 August 2024. “Fact Sheet: Medicare Prescription Payment Plan Final Part Two Guidance.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/fact-sheet-medicare-prescription-payment-plan-final-part-two-guidance.pdf. Accessed 23 August 2024. Cottrill, Alex, et al. “Income and Assets of Medicare Beneficiaries in 2023.” KFF, KFF, 9 Feb. 2024, www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-in-2023/. “Inflation Reduction Act and Medicare.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/inflation-reduction-act-and-medicare Accessed 23 August 2024. Cubanski, Juliette, and Anthony Damico. “Medicare Part D in 2024: A First Look at Prescription Drug Plan Availability, Premiums, and Cost Sharing.” KFF, KFF, 8 Nov. 2023, www.kff.org/medicare/issue-brief/medicare-part-d-in-2024-a-first-look-at-prescription-drug-plan-availability-premiums-and-cost-sharing/. “Medicare Prescription Payment Plan Implementation Timeline.” CMS.Gov, Centers for Medicare & Medicaid Services, 1 July 2024, www.cms.gov/files/document/medicare-prescription-payment-plan-timeline.pdf Seshamani, Meena. “Medicare Prescription Payment Plan Draft Part Two Guidance” CMS.Gov, Centers for Medicare & Medicaid Services, 15 Feb. 2024, www.cms.gov/files/document/medicare-prescription-payment-plan-draft-part-two-guidance.pdf Seshamani, Meena. “Medicare Prescription Payment Plan Part 1 Guidance.” CMS.Gov, Centers for Medicare & Medicaid Services, 21 Aug. 2023, www.cms.gov/files/document/medicare-prescription-payment-plan-part-1-guidance.pdf “Welcome to Medicare.” Medicare, Centers for Medicare & Medicaid Services, www.medicare.gov/. Accessed 23 Aug. 2024. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/
Understanding Medicare Part D and the Inflation Reduction Act Kathe Kline is joined by Andrew Saul, Sales Director at Physicians Mutual, to delve into the complexities surrounding Medicare Part D and the changes ushered in by the Inflation Reduction Act. Key points of discussion included the new $2,000 out-of-pocket cap and its impact on seniors, along with price negotiation for prescription drugs. One of the major hurdles discussed was the inability of Medicare to negotiate drug prices, which has historically driven up costs for seniors. Andrew Saul illustrated this disparity with the example of Eliquis, a popular blood thinner. Non-Medicare recipients might pay $10 a month, while those on Medicare face costs upwards of $500 monthly without manufacturer coupons. Kathe shared her firsthand experience with prescription costs during her recent COVID-19 quarantine. The difficulty in navigating prescriptions, particularly the high cost and obstacles to obtaining Paxlovid, highlighted a larger issue within the system. She emphasized the restrictions Medicare beneficiaries face with manufacturer coupons, which can drastically reduce prescription costs for others. Andrew and Kathe explored the balancing act between allowing pharmaceutical companies to profit while ensuring fair drug pricing. Even with laws like the Insulin Savers Act capping prices, the lack of generic options keeps costs high. Andrew noted that new regulations will enable Medicare to negotiate prices for 10 high-cost drugs starting in 2026, but the scale of change is limited. The Inflation Reduction Act, passed in August 2022, is poised to bring changes such as Medicare's newfound ability to negotiate drug prices. Despite this advancement, critics argue for a more comprehensive and expedited implementation. Kathe contrasted the U.S. healthcare system with Europe's, noting Europe's more effective cost management due to direct government negotiations with drug manufacturers. Andrew offered insights into upcoming changes and the importance of well-informed agents in guiding clients through Medicare's intricacies. He emphasized that periodic drug plan reviews are crucial for cost savings. As we await further changes prompted by the Inflation Reduction Act, staying informed and proactive remains essential for Medicare beneficiaries and advisors alike. This episode is sponsored by CertifiedMedicareAgents.com
On Thursday, the Biden administration announced an agreement with drugmakers to reduce the prices of 10 of the most common prescription drugs covered under Medicare Part D. The agreement marks the first time the federal government has negotiated with pharmaceutical companies on drug prices, and the administration estimates the lower prices will save Medicare $6 billion when the deal goes into effect in 2026.You can read today's podcast here, our “Under the Radar” story here and today's “Have a nice day” story here.You can watch the entire Tangle Live event at City Winery NYC on our YouTube Channel!Check out Episode 5 of our podcast series, The Undecideds. Please give us a 5-star rating and leave a comment!Today's clickables: Quick hits (1:57), Today's story (3:05) Right's take (6:04), Left's take (10:12), Isaac's take (13:56), Questions Answered (19:21), Under the Radar (22:14), Numbers (23:13), Have a nice day (23:51)You can subscribe to Tangle by clicking here or drop something in our tip jar by clicking here. Help share Tangle.I'm a firm believer that our politics would be a little bit better if everyone were reading balanced news that allows room for debate, disagreement, and multiple perspectives. If you can take 15 seconds to share Tangle with a few friends I'd really appreciate it. Email Tangle to a friend here, share Tangle on X/Twitter here, or share Tangle on Facebook here.Take the survey: What do you think of the Medicare negotiations? Let us know!Our podcast is written by Isaac Saul and edited and engineered by Dewey Thomas. Music for the podcast was produced by Diet 75. Our newsletter is edited by Managing Editor Ari Weitzman, Will Kaback, Bailey Saul, Sean Brady, and produced in conjunction with Tangle's social media manager Magdalena Bokowa, who also created our logo. Hosted on Acast. See acast.com/privacy for more information.
What happens when you combine the insights of a seasoned healthcare executive with pressing issues in U.S. healthcare policy? Join us as Brian Peters, CEO of the Michigan Hospital Association, breaks down the complexities of the Affordable Care Act, the impact of Medicaid provider taxes, and the evolving landscape of healthcare as we approach a crucial election season. Discover how Michigan's innovative policies, like allowing Certified Registered Nurse Anesthetists (CRNAs) to work independently, are transforming access to care, particularly in rural areas.Curious about the future of telemedicine and hospital-at-home programs post-COVID? We explore their rapid expansion and the critical public policies needed to support them. Brian shines a light on the importance of adequate reimbursement and the necessity of widespread broadband access to make telehealth viable. We also delve into the often-overlooked role of grassroots advocacy, highlighting tools like the Michigan Health and Hospital Association's MyCareChampion page to keep you informed and engaged in healthcare priorities.Dive into a discussion on Medicare and private insurance, where we tackle the growing influence of Medicare Advantage plans and the need for policies that prioritize patient care. Brian shares his thoughts on the effectiveness of the Medicare Part D program and the vital 340B prescription drug program. We wrap up with a look at recent policy changes, including capping insulin prices and allowing Medicare to negotiate drug prices, emphasizing the importance of accessible, high-quality healthcare for all. Don't miss this episode packed with actionable insights and policy analysis from one of healthcare's leading voices.Support the Show.Engage the conversation on Substack at The Common Bridge!
In this episode of the Secure Your Retirement Podcast, Radon and Murs discuss the upcoming changes to Medicare Part D in 2025, bringing on their in-house healthcare specialist, Shawn Southard. The discussion highlights significant updates to prescription drug coverage that will impact beneficiaries, especially concerning cost reductions and structural changes due to the Inflation Reduction Act of 2022. Listen in to learn about the details of these changes, including the lowering of out-of-pocket maximums and the elimination of the infamous "donut hole" coverage gap. The conversation also touches on the broader implications for Medicare beneficiaries, such as potential increases in plan premiums and the necessity for careful review of one's Medicare coverage in light of these changes. In this episode, find out: Key changes to Medicare Part D starting in 2025. The impact of the Inflation Reduction Act on Medicare beneficiaries. The reduction of out-of-pocket maximums for prescription drugs. The elimination of the Medicare "donut hole." Strategies for navigating these changes and optimizing Medicare coverage. Tweetable Quotes: "Potentially, the most that people are going to have to pay now in Medicare prescription drug plans is $2,000 out of pocket." - Shawn Southard "This is the year you need to take a hard stop and review your Medicare situation." - Shawn Southard Resources: If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement! To access the course, simply visit POMWealth.net/podcast.
Watch The X22 Report On Video No videos found Click On Picture To See Larger PictureThe blue states are pushing the green new scam which is destroying the economy and the peoples way of life, it is backfiring on the Ds. Biden's economy is imploding. Stock market glitch or is it a test for the crash? Narrative for rate cuts picks up speed. The [DS] is now pushing the narrative that the Trump supporters are going to push riots and bring the country to a civil war. This is what the [DS] wants, and they might be pushing this narrative to stay in control and to stay in the WH. What if the WH is breached, they tried to do this during the time Trump is in the WH. Is Trump going to turn the table on them so they are the one that won't leave the WH and they need to be dragged out? (function(w,d,s,i){w.ldAdInit=w.ldAdInit||[];w.ldAdInit.push({slot:13499335648425062,size:[0, 0],id:"ld-7164-1323"});if(!d.getElementById(i)){var j=d.createElement(s),p=d.getElementsByTagName(s)[0];j.async=true;j.src="//cdn2.customads.co/_js/ajs.js";j.id=i;p.parentNode.insertBefore(j,p);}})(window,document,"script","ld-ajs"); Economy Blue States Find Yet Another Climate Racket To Penalize American Businesses Vermont enacted a law Friday that will require energy companies to pay huge sums to cover costs purportedly driven by climate change — and several other states may be following suit. Republican Vermont Gov. Phil Scott allowed his state's climate “superfund” bill to become law Friday without his signature, obligating energy producers that emitted more than one billion tons of greenhouse gases since 1995 to pay into a “superfund” that would be tapped to pay for disasters purportedly caused or exacerbated by climate change, according to NBC News. The new law is likely to become the subject of a legal battle with the energy industry, and some blue states — including New York and Massachusetts — are looking to pass similar bills in the near future. “What these states are basically saying is, ‘if you make things we don't like, we're going to fine you into oblivion for what you've done anywhere in the world. And we're going to use all that money to pay for products and projects favored by progressives,'” OH Skinner, executive director of the Alliance for Consumers, told the Daily Caller News Foundation. Source: dailycaller.com Biden's Inflation Reduction Act Screws Seniors with the Biggest Medicare Premium Increase Ever One of the classic strategies in the Obama/Biden playbook is policy that sounds good in the short-term, but whose long-term consequences won't be felt until after an election. That way if Democrats win, they're insulated from voters holding them accountable; but if they lose, they can blame Republicans when things go south. This was undoubtedly one of the plays the Biden administration had in mind for the gallingly misnamed Inflation Reduction Act (IRA). But this disastrous legislation hasn't just sabotaged Americans' wallets, it's sabotaged their health as well. Snuck into the IRA was a poorly drafted provision that attempted to lower out-of-pocket expenses on prescription drugs. The IRA lowers the out-of-pocket maximum for seniors from about $3,300 to $2,000 by shifting the responsibility for the $1,300 difference to insurance companies. To no one's surprise, the insurance companies pass that cost to consumers in the form of higher premiums and restricted access to prescription drugs. This year, premiums for Medicare Part D are up more than 20 percent for the more than 50 million Americans enrolled. In 2025, they could increase again by more than 50 percent! We hope people are paying close enough attention during open enrollment in October to compare this price spike as President Biden campaigns on how he “fought Big Pharma to lower drug costs!” The brilliant design of the Medicare Part D program 20 years ago was harnessing competition.
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