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Morning Briefing

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Tuesday, Jan 25 2022

Full Issue

HHS Urged To Plug Medicare Gap That Doesn't Pay For At-Home Covid Tests

Lawmakers and advocates want the Biden administration to find a way to cover the rapid antigen tests. The laws governing Medicare currently don鈥檛 reimburse for self-administered diagnostic tests.

President Joe Biden's administration is facing pressure from lawmakers and advocates to close a major gap in its COVID-19 strategy, which leaves Medicare beneficiaries without coverage of at-home tests. Medicaid and Children's Health Insurance Plan enrollees are eligible for no-cost at-home COVID-19 tests under the American Rescue Plan Act. Households with private health insurance now can be reimbursed for at-home tests under a Centers for Medicare and Medicaid Services policy that took effect this month. (Hellmann and Goldman, 1/24)

A group of Democratic senators is happy the Biden administration is requiring commercial insurers to cover at-home COVID-19 tests for customers but questions why Medicare isn鈥檛 doing the same thing for seniors. The group of 19 Democratic senators wrote to Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) leadership Monday seeking answers on the lack of testing reimbursement. (King, 1/24)

In Medicare news from Rhode Island 鈥

Leaked findings of a聽federal inspection of the state-run Eleanor Slater Hospital聽reveal a mountain of "deficiencies," including a "failure to ensure"聽infection control and surveillance and a failure to meet the requirements of Medicare dollars. The deficiencies cited within the report extend from聽infection control to patient safety to the condition of the facilities. They include hospital聽management's failure to start the process to renew its expired operating license聽until it was called out on the lapse. (Gregg, 1/24)

In other Medicare news 鈥

Startup health insurers grew their Medicare Advantage membership during the annual enrollment period, with some capturing market share from larger competitors like UnitedHealth Group, Humana and Cigna. Among the larger insurtechs, Devoted Health increased its membership the most, nearly doubling its beneficiary base to 63,046 from the start of December to beginning of January, according to federal data. The majority of the company's growth and members came from Florida and Texas, states where more than 80% of Devoted's members reside. Devoted is the last of the large insurtechs to remain private and, after raising a Series D round late last year, represents the most valuable of the health insurer upstarts with a valuation of $11.5 billion. (Tepper, 1/24)

Sometimes, retirement doesn鈥檛 end up sticking. If the workforce is luring you back after you retired and you鈥檙e already on Medicare, you may be able to choose whether to drop your coverage in favor of an employer health plan and then re-enroll down the road. However, there are a lot of rules and deadlines to know if you go this route. For starters, the size of the employer offering the health plan matters. While workers at companies with fewer than 20 employees generally need to be enrolled in Medicare once they reach age 65 to avoid paying extra later, people at larger companies may have choices. (O'Brien, 1/24)

Studio 17鈥檚 Ilyana Capellan talks to Ben Gomez from Romy & Associates about how finding the right Medicare agent can help alleviate headaches caused by the confusion that is Medicare. Gomez says it鈥檚 important to know the difference between a captive agent and a broker/independent agent. 鈥淐aptive agents work for one company and can offer products from that company only. A broker or independent agent can represent several different companies giving their customers more options,鈥 said Gomez. (Capellan, 1/24)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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