Little Deal: Trump Signs Executive Orders On Drug Prices
This affects prescriptions covered by Part B, not Part D. So while this is something, the scope of this is limited. There are other complicated clauses, but there are conditions set, that are unlikely to be met, so therefore meaningless. (link)
Little Deal (for now): Pre-authorizations Begin for Certain Medicare Part B Services
This doesn’t sound great. There is a new process for a limited (for now) list of outpatient procedures. This is a limited list, it remains to be seen if it expands.
Medicare Advantage policyholders can face this now, for a much wider list of procedures. For Medigap, this would be new. This can easily become a very Big Deal.
The complete list of procedures that require Pre-Authorization is here. (link)
Big Deal: Medicare Advantage Will Be Available for End-Stage Renal Disease Patients (!)
This is a big deal. In the past, ESRD patients could not enroll in Medicare Advantage (there are exceptions for those who had grandfathered plans). That changes in 2021.
- result in a HUGE decline in out of pocket expenses for ESRD patients, and especially for those pre-65 Medicare beneficiaries, who qualify for Medicare due to SSDI.
- result in pressure at Medicare Advantage carriers, who are not going to be compensated by the full expected cost of new ESRD patients.
Number of those in the US: 500,000. (link)