Medicare
Coverage of Medicare in the Nexus archive.
- Do you need travel insurance?
Travel insurance is advised as a backup plan against disruptions during vacations, such as medical emergencies or natural disasters. Although credit card coverage can provide some starting protection, consumers may need a separate policy to cover costs like canceled trips due to illness or extra hotel nights. When selecting a policy, one must check for primary coverage, verify medical evacuation benefits, and confirm the insurance company's strong ratings.
- Walmart sees the slowest pace in US comparable sales in 6 years and offers cautious guidance
Walmart experienced the slowest growth in U.S. comparable sales in six years, with sales rising 2.6% in the second quarter. Although quarterly net income reached $6.37 billion and adjusted per-share results surpassed expectations, the company offered cautious guidance for future quarters that fell below analyst projections.
- Walmart strong again in second quarter, but its outlook is reserved
Walmart reported a strong second quarter with comparable sales up 2.6% and adjusted per share earnings topping Wall Street expectations. However, its outlook remains reserved, partly influenced by federal legislation requiring pharmacies to adjust high-cost drug prices. The retailer noted that gains in market share were primarily coming from wealthy households.
- Walmart strong again in second quarter, but its outlook is reserved
Walmart reported a strong second quarter with comparable sales in U.S. stores rising 2.6% and adjusted per share results of 81 cents, exceeding Wall Street expectations. However, the company's shares slid 6%, overshadowed by a more cautious outlook. For the full year, Walmart expects sales to be up anywhere from 4% to 5%, falling short of analyst predictions.
- Lawsuit by more than 1,000 women against Chesapeake Regional comes to court
Over 1,040 plaintiffs filed a lawsuit against an authority connected to Chesapeake Regional Medical Center. The lawsuit alleges that the hospital was grossly negligent in granting operating privileges to OBGYN Javaid Perwaiz, who was convicted on federal charges.
- Drug prices have declined sharply, and Trump is taking credit. The reason behind the drop is complex
Federal data reports that U.S. prescription drug prices fell 3.1% from a year ago, marking the steepest year-over-year drop since 1963. Although the White House credits these price declines to Trump's drug deals, experts note that other factors are potentially more significant contributors. These complex factors include Medicare negotiations allowed by the Inflation Reduction Act and increased market competition from generic or biosimilar drugs.
- Drug prices have declined sharply, and Trump is taking credit. The reason behind the drop is complex
Recent federal data shows that U.S. prescription drug prices declined 3.1% from a year ago, the steepest drop since 1963. While Donald Trump has taken credit for these drops through “most favored nation” deals, experts suggest other factors are equally significant. These contributors include competition from generic and biosimilar products, as well as policy changes like the Inflation Reduction Act's allowance for Medicare to negotiate drug costs.
- Drug prices have declined sharply, and Trump is taking credit. The reason behind the drop is complex
U.S. prescription drug prices declined 3.1% from a year ago, marking the steepest drop since 1963. Although President Donald Trump claims credit via 'most favored nation' deals, experts note the price reduction is complex. Contributing factors include Medicare's ability to negotiate costs through policies like the Inflation Reduction Act, and market competition fueled by generic and biosimilar drugs.
- The influencing power of political labels, whether they are accurate or not
As midterm elections approach, various political labels are used to categorize candidates, with 'democratic socialist' gaining significant attention. The article defines democratic socialists as those who seek to regulate capitalism while maintaining democracy, contrasting them with socialists who favor sharing ownership of the means of production. Examples cited include Zohran Mamdani and Abdul El-Sayed.
- Where healthcare could sway voters, Democratic canvassers ramp up an old tactic: talking to people
Voters in Wisconsin are weighing candidates' stances regarding cuts or expansion of Medicare and Medicaid. Bill Hogseth canvassed door-to-door in western Wisconsin, speaking with strangers about his own seizures and their resulting impacts. He also asked voters to share stories about their experiences with ambulance rides or hospital bills.
- Why House GOP hopes of cracking down on fraud could flame out
House Republicans hope that efforts to crack down on alleged abuse in safety-net programs will revive talks of tackling fraud before year's end. However, skepticism remains about whether any such bill will reach the president’s desk due to impending midterms and lack of immediate success. The article notes that achieving legislative goals requires intervention from Vice President Vance or President Trump.
- New York seniors face higher drug premiums as subsidy ends in 2027
Governor Kathy Hochul condemned the end of a Medicare subsidy program designed to keep prescription drug premiums lower for seniors in New York. The Centers for Medicare and Medicaid Services announced the conclusion of this program, which had started in 2024 under the Biden Administration.
- Mark Sanford returns to spotlight in SC senate race
Mark Sanford, a former South Carolina governor, has entered the race to replace Senator Lindsey Graham. He emphasizes concerns about the national debt and government efficiency, citing his past experience in reducing DMV wait times. Sanford also reflects on lessons learned from a 2009 marital scandal and his subsequent return to public office.
- Changing how Medicare pays for hospice care could save the U.S. $7.6 billion a year — but at what cost to patients?
Changing how Medicare pays for hospice care could save the U.S. $7.6 billion annually, but concerns remain about potential impacts on patient care. The hospice industry argues the current payment system enables providers to create individualized care plans tailored to patients’ specific needs.
- STAT+: Exemption of rare disease therapies in drug-pricing pilots would wipe out huge savings, analysis finds
Excluding rare disease treatments from Medicare drug-pricing pilots would eliminate significant savings, according to a Harvard University researcher. Biotech companies are lobbying the Trump administration to exclude these treatments from the Global Benchmark for Efficient Drug Pricing (GLOBE) and Guarding U.S. Medicare Against Rising Drug Costs (GUARD) pilots, which aim to lower drug prices to levels in other wealthy nations.
- How would Spectrum or Medicare actually contact their customers?
The article discusses common scams targeting elderly individuals, including fraudulent calls from purported representatives of Medicare and Spectrum. Scammers often request personal information or access to devices, exploiting victims' lack of technical knowledge. The author expresses confusion about the legitimate process for receiving Medicare benefits.
- Abdul El-Sayed wants to find out whether a progressive can win in Michigan.
Abdul El-Sayed is running a campaign in Michigan with a platform opposing Israel, advocating for ICE abolition, increasing taxes on the wealthy, and expanding Medicare to all Americans.
- Vance to host Congress at White House to discuss legislative action on fraud
Vice President JD Vance will host a meeting with members of Congress at the White House to discuss legislative action on fraud. The task force, led by Vance, is targeting healthcare fraud schemes and has suspended over $1.4 billion in federal funding for suspected providers. The Justice Department recently expanded its Northeast Health Care Fraud Strike Force to Philadelphia.
- 19 alleged Philadelphia scammers charged with $4M in Medicare, Medicaid fraud: DOJ
The DOJ has charged 19 individuals in Philadelphia with $4 million in Medicare and Medicaid fraud. Federal and state authorities are expanding the Northeast Health Care Fraud Strike Force to the area to target such fraud.
- STAT+: The latest orphan drug exemptions may not be warranted, analysis finds
A new analysis questions the justification for expanded exemptions of orphan drugs from Medicare pricing negotiations under the Orphan Cures Act, which broadened protections for drugs with multiple rare disease indications. The law delays price negotiation timelines for these drugs, despite concerns they may not warrant such exemptions.
- STAT+: Medicare eliminates key pathways used by ‘breakthrough’ devices for extra payments
Medicare is eliminating alternative pathways that allowed FDA-designated 'breakthrough' medical devices to qualify for supplemental payments without proving clinical improvement. The Centers for Medicare and Medicaid Services finalized a rule requiring such devices to demonstrate substantial clinical improvement starting in fiscal year 2028.
- ‘My head hit the driver’s window’: A teenager T-boned our car. Will Medicare pay my hospital bills?
A teenager caused a T-bone collision, leaving the author injured. The author's car lacked collision coverage, raising concerns about whether Medicare will cover hospital expenses.
- Stein, DHHS urge federal health officials to reverse course decision affecting most vulnerable people using Medicaid, Medicare
Stein and DHHS are urging federal health officials to reverse a CMS rule that conflicts with Congress' intent to protect healthcare for vulnerable populations, risking health care loss for North Carolinians using Medicaid and Medicare.
- Medicare to end prescription subsidy program
Medicare will end a subsidy program that reduced prescription drug plan premiums, as insurers can now price plans accurately without it. The Centers for Medicare & Medicaid Services (CMS) claims premiums will rise by less than $10 for most recipients, with some seeing lower costs. The subsidy, which averaged a $16 reduction, supported Medicare Part D plans offered through private insurers like UnitedHealth Group, Humana, and Aetna.
- Teva CEO on Drug Pipeline, Direct Listing on NYSE
Teva Pharmaceuticals CEO Richard Francis discussed the company's positive Q2 earnings, the impact of changing Medicare rules on patients, and the new direct listing on the NYSE with Bloomberg reporter Romaine Bostick.
- NYC sues Brooklyn dentists for driving patients into medical debt, ‘appalling violations’ of law
New York City sued two Brooklyn dental providers for allegedly exploiting patients by misrepresenting costs, pressuring them into unnecessary procedures, and enrolling them in high-interest loans without consent. The lawsuit targets New York Family Dentistry and Canarsie Family Dentistry, accusing them of violating consumer protection laws and preying on vulnerable communities, including elderly and low-income individuals.
- Humana slashed its annual profit forecast as lower Medicare ratings squeezed bonuses
Humana, a health insurer, reduced its annual profit forecast to at least $6.52 per share from $8.36 due to lower Medicare ratings affecting bonuses.
- Trump Administration Weighs Overhaul of Doctor Payments in Medicare
The Trump administration is exploring alternatives to the current Medicare physician payment system based on fee-for-service. The Centers for Medicare issued a request for information on July 14 to evaluate potential changes.
- [US] A zillion calls from numbers with the same "first six"
The article describes frequent unsolicited phone calls from numbers sharing the same first six digits, differing by one digit in the area code/exchange. Callers, likely several counties away, attempt to sell Medicare Advantage plans, with the recipient suspecting the calls are part of a telemarketing scheme during a Special Enrollment Period.
- ‘I’m in my peak earning years’: I’m working beyond 70. Will that help increase my Social Security?
An individual working beyond 70 plans to retire at the end of their 70th year and transition to Medicare. They question whether working past 70 will increase their Social Security benefits.
- CMS evaluates one year of health tech progress, announces eight new pledge categories
CMS evaluated one year of health tech progress and announced eight new pledge categories. A symbolic event at Health and Human Services headquarters featured a coffin labeled 'RIP CLIPBOARD' to signify the decline of traditional paper-based healthcare practices.
- Earlier lifeline for rural hospitals faces test under ‘Big Beautiful’ law
Sturgis Hospital in Michigan, which converted to a federal emergency-focused model to save rural hospitals, closed after three years, highlighting concerns about the model's effectiveness under the One Big Beautiful Bill Act. The law includes a $50 billion Rural Health Transformation Program but faces criticism for potentially disadvantaging rural hospitals amid expected Medicaid funding cuts.
- STAT+: Pharmalittle: We’re reading about Lilly obesity drug data, a push for FDA to ban DTC ads, and more
Eli Lilly's obesity drug retatrutide showed significant weight loss in a Phase 3 study but did not reduce cardiovascular risk. The U.S. Medicare program is offering injectable GLP-1 obesity medications like Wegovy, Foundayo, and Zepbound through a trial program for $50 monthly, with high patient demand for injectables despite expectations of pill preference.
- How Much Does Medicare Part D Cost?
Medicare Part D, which provides prescription drug coverage, has a 2026 average monthly premium of $34.50, a maximum annual deductible of $615, and an out-of-pocket cap of $2,100. The Inflation Reduction Act of 2022 limits insulin copays to $35 per month, and Part D covers 10 specific drugs with reduced costs. Coverage is structured through tiered pricing and stages, including deductible, initial coverage, and catastrophic phases.
- Health Committee advances Collins’ insulin price cap over GOP objections
The Senate Health Committee, led by Republicans, advanced legislation to cap insulin costs at $35/month despite GOP objections. Maine Republican Susan Collins sponsored the bill, which aims to lower costs for diabetes patients. The bill passed 17-5, with bipartisan support but opposition from Chair Bill Cassidy.
- Trump’s Personnel Agency Says It Will Remove Some Identifying Info as It Sweeps Up Medical Records
The Trump administration's Office of Personnel Management plans to collect medical records of millions of federal workers and retirees, pseudonymizing data by removing names and Social Security numbers to detect fraud in health programs. The initiative faces criticism from privacy advocates and Senator Mark Warner, who argue it lacks sufficient privacy protections.
- ER visits by uninsured patients in Virginia hospitals spiked by 8% last year
Virginia hospitals reported an 8% increase in ER visits by uninsured patients last year, attributed to federal healthcare shifts and reduced primary care access. State lawmakers allocated funding for free clinics and a new subsidy to address ACA subsidy expirations, while 13 rural hospitals face closure risks due to Medicare/Medicaid reimbursement cuts and expired subsidies.
- ‘Notorious’ fugitive arrested by federal agents accused of planning $547 million fraud scheme
Khalid Satary, a foreign national, was arrested for allegedly orchestrating a $547 million Medicare fraud scheme involving unnecessary genetic tests and kickbacks. He operated diagnostic labs from 2016 to 2019 and fled the U.S. in 2022 before being captured in the Middle East in 2026 with a fake Mexican passport.
- Metro Nashville retirees could access affordable GLP-1 drugs through new program. Here’s what to know
A federal CMS pilot program offers limited coverage of three GLP-1 weight-management medications for qualifying Metro Nashville retirees on Medicare or Medicare Advantage. The program, separate from Metro’s health plan, requires a $50 monthly copay and mandates prescriptions be processed through a CMS system, not Metro’s plan. Vanderbilt University is studying the drugs’ potential for asthma and obesity.
- Novo Nordisk sues Eli Lilly, alleging the company's GLP-1 ads are 'deliberately false'
Novo Nordisk sued Eli Lilly, alleging deceptive advertising claims about its weight-loss drug Zepbound compared to Novo Nordisk's Wegovy. The lawsuit claims Eli Lilly's ads use outdated clinical trials comparing different doses and mislead consumers into believing Zepbound is superior. Eli Lilly has defended its advertising and intends to contest the lawsuit.