Medicare

Chronology of Coverage

1. Nov. 13, 2014

   Congressional Republicans, now in control, have plans to overhaul Medicare, transform Medicaid, and cut highest tax rates through budget process, measures once out of reach with Democrats controlling Senate; new Senate GOP majority will decide how far to press small-government vision. MORE

2. Nov. 11, 2014

   Medicare will cover annual screenings for lung cancer for four million older Americans with long history of heavy smoking; draft decision by Centers for Medicare and Medicaid Services will extend coverage for CT scans to Medicare beneficiaries who smoked at least a pack a day for 30 years or the equivalent. MORE

3. Oct. 13, 2014

   Federal officials say they have repeatedly criticized Medicare health plans for serious deficiencies, including improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs; findings come as millions of older Americans prepare to sign up for private health plans and prescription drug plans in Medicare's annual open enrollment period. MORE

4. Oct. 4, 2014

   Editorial decries flaws in medical system, including Medicare and Medicaid, that make it difficult for patients to obtain quality end-of-life services; welcomes changes being rolled out by New York State and Institute of Medicine intended to help protect patient rights and improve access to community and home care. MORE

5. Oct. 4, 2014

   Tara Siegel Bernard Your Money column offers ideas on how to approach process of choosing from mind-boggling array of Medicare plans. MORE

6. Sep. 22, 2014

   Op-Ed article by oncology experts Andrea McKee and Andrew Salner observes growing consensus that annual CT screening for lung cancer could save thousands of lives each year among older people and current and former smokers; argues that such screening should be eligible for coverage by Medicare. MORE

7. Sep. 21, 2014

   Jennifer Conlin Reverse Parenting column says she was forced to order her mother's heart medication through pharmacies in Canada after Medicare stopped covering it. MORE

8. Sep. 4, 2014

   The Upshot; Medicare spending is falling on a per-person basis, and if the pattern continues, as the Congressional Budget Office forecasts, it will be a rarity in the program's history; factors for pattern include the baby boom generation entering the program and Medicare patients using fewer expensive medical services. MORE

9. Aug. 31, 2014

   Medicare may begin covering end-of-life care consultations by doctors, type of planning once derided as 'death panels,' if it approves recommendation from the American Medical Assn; interest in consultations has risen along with the number of aging Americans, and many private insurers have already begun reimbursing doctors for them. MORE

10. Aug. 30, 2014

    Medicare quietly announces that it will settle hundreds of thousands of hospital appeals over bills for short-term care by offering deals that could add up to several hundred million dollars; decision is effort by agency to end battle with thousands of hospitals over amount they should receive for treating patients who stay for just a day or two. MORE

11. Aug. 28, 2014

    The Upshot; Congressional Budget Office continues to reduce its estimate for Medicare spending in coming years; six years of consistent reductions mean federal government's long-term budget deficit is considerably less severe than commonly thought, and that health care may be starting to stabilize as a share of national spending. MORE

12. Aug. 26, 2014

    Editorial underscores major flaws in Medicare's rating system for nursing homes, particularly its overreliance on self-reporting by nursing homes; calls for improvements in rating system. MORE

13. Aug. 25, 2014

    Examination of Medicare's rating system of nursing homes by The New York Times has found that many top-ranked nursing homes have been given seal of approval that is based on incomplete information and can mislead consumers; Medicare ratings, which have become gold standard across the country, are based in large part on self-reported data by nursing homes that government does not verify. MORE

14. Aug. 17, 2014

    Obama administration is planning to pay monthly fees to doctors who manage care for Medicare beneficiaries with two or more chronic conditions; major policy change comes amid growing evidence that patients with chronic illnesses suffer from disjointed, fragmented care; new initiative will adopt techniques devised by health maintenance organizations. MORE

15. Aug. 16, 2014

    Obama administration's declared war on health care fraud is returning only meager results, despite escalation, recovering about $4.3 billion of an estimated $60 billion in 2013; interviews reveal that sprawling effort relies on an array of poorly-managed outside contractors, rife with conflicts of interest and vulnerable to political influence. MORE

16. Aug. 5, 2014

    The Upshot; experts question effectiveness of HP Acthar Gel, drug made from pigs’ pituitary glands, which cost Medicare more than $141 million in 2012, up from $7 million in 2008; explosive growth illustrates how Medicare's prescription drug program is struggling to contain taxpayer burden of expensive therapies aimed at rare conditions. MORE

17. Jul. 29, 2014

    Federal government’s annual report on the financial health of Medicare and Social Security projects that Medicare trust fund will remain solvent for 16 more years, until 2030, four years later than Obama administration predicted in May 2013; estimates that Social Security trust fund will be depleted by 2033, same as expected in 2013. MORE

18. Jul. 21, 2014

    Paul Krugman Op-Ed column contends worries about budget deficits and national debt have faded from news after years of warnings due to fact that the panic surrounding them turned out to be false alarm; maintains debt panic was promoted only because it served political purpose as offering means to attack Social Security and Medicare. MORE

19. Jul. 1, 2014

    Executive Health Resources, little-known consultant owned by health insurance giant UnitedHealth Group, is flourishing by helping hospitals exploit what they describe as gray area in Medicare payments for hospital stays; consultant is often at center of battles between hospitals and Medicare over how facilities bill. MORE

20. Jun. 10, 2014

    Editorial welcomes progress on transgender rights in health care; praises Obama administration's decision to reverse 1981 policy that excluded gender reassignment surgery from coverage under Medicare; also notes Defense Department's new willingness to review ban on transgender military service and updated policy concerning gender designation on birth certificates in New York State. MORE

21. Jun. 3, 2014

    New York Times analysis of Medicare data shows that hospitals charged more for every single one of 98 common ailments in 2012, and the increase for all but seven exceeded the nation’s 2 percent inflation rate for that year. MORE

22. May. 31, 2014

    Department of Health and Human Services appeals board rules that Medicare may no longer exclude sex-reassignment surgery from coverage; decision, which applies to beneficiaries of the health plan for older Americans and people with disabilities, covers only surgery, not other treatments like hormones. MORE

23. May. 16, 2014

    Medicare pilot program aims to use vast volumes of government data mined from personal health records to direct assistance to potentially vulnerable people in emergencies and disasters; effort, however well-intentioned, raises privacy concerns. MORE

24. May. 14, 2014

    Ninety people, including doctors, pharmacy owners and elderly patients, are arrested in six cities, mostly in Florida, and charged with submitting fake billings to Medicare worth nearly $260 million. MORE

25. Apr. 28, 2014

    Government data indicates that of the 10 physical therapists nationwide who were paid most by Medicare in 2012, four lived in Brooklyn, NY; practice operated by Dr Wael Bakry, the top biller, received some $4.1 million from Medicare for astounding 183,000 treatments within year; high rate has raised eyebrows among analysts who say physical therapy is far more vulnerable to fraud than other types of medicine. MORE

26. Apr. 24, 2014

    Amedisys, one of the nation's largest home health providers, will pay $150 million to resolve accusations that it inflated Medicare billings and had improper financial relationships with referring physicians. MORE

27. Apr. 11, 2014

    Editorial on data showing that doctors who are top recipients of Medicare reimbursement dollars have donated heavily to 'super PACs' in the hopes of getting Medicare investigators off their backs; maintains it is undeniable there is a quid pro quo in the donations, and that it underscores the need for campaign finance reform. MORE

28. Apr. 10, 2014

    Health and Human Services Dept report shows that Florida doctors Salomon Melgen and Asad Qamar, who received the nation's highest Medicare reimbursements in 2012, are both major contributors to Democratic Party causes; Melgen and Qamar, subjects of investigations for fraudulent billing, defend their payments, citing unique conditions at their practices. MORE

29. Apr. 10, 2014

    Newly released data reveals that ophthalmologists were the biggest recipients of Medicare money in 2012; reasons say volumes about an aging population and specialty that does many procedures, all well-reimbursed by Medicare; findings also reveal the difficulty of interpreting the Medicare data; ophthalmologists say their high representation among the list of big recipients is misleading, since bulk of Medicare money goes to costs of drugs they administer. MORE

30. Apr. 10, 2014

    Release of Medicare payment data is getting mixed reviews from doctors, who say they favor sharing information but worry that data presented omits important details and may paint an unfairly negative picture of individual doctors. MORE

31. Apr. 9, 2014

    Centers for Medicare and Medicaid Services is making available to the public the most detailed data about Medicare ever released in the program's nearly 50-year history; data provides an unprecedented look at the practice of medicine across the country, and will provide consumers with an ability to compare doctors and treatments in a way they have never before had. MORE

32. Apr. 3, 2014

    Democrats are evincing some confidence about 2014 midterm elections for the first time this year after Pres Obama's announcement that the new health care plan has enrolled 7.1 million Americans, coinciding with the release by Rep Paul D Ryan of new Republican budget that proposes changes to Medicare and deep spending cuts. MORE

33. Apr. 3, 2014

    Medicare says that it plans to make available to consumers and others detailed information on what it pays individual physicians, despite the long-term resistance by the American Medical Assn and other groups. MORE

34. Apr. 2, 2014

    Editorial Keeping Track column offers updates on Arizona's abortion law, the need for stronger labor-law enforcement with the introduction of $10.10 per hour minimum wage for federal contractors, and Congress's reluctance to fix flawed payment formula for Medicare doctors' fees. MORE

35. Mar. 15, 2014

    Retiring column; while the seniors rights movement remains relatively muted, intensifying fear about retirement security could spur elderly agitators into the streets. MORE

36. Mar. 13, 2014

    Changes to payments made by the federal government to Medicare Advantage insurers contained within the health care reform law have set some Medicare Advantage subscribers scrambling. MORE

37. Mar. 11, 2014

    Obama administration, under pressure from patients, pharmaceutical companies and members of Congress from both parties, withdraws proposal that would have allowed insurers to limit Medicare coverage for certain classes of drugs; limitations would have included drugs used to treat depression and schizophrenia. MORE

38. Mar. 4, 2014

    Pres Obama's 2015 budget will include proposal to remove illegal immigrants from Medicare rolls and require citizenship or lawful presence in country as condition of getting benefits. MORE

39. Mar. 2, 2014

    Editorial contends Obama administration's proposed cuts to Medicare Advantage plans are fair, reasonable and mandated by law; criticizes Republicans for making misleading claims about the cuts. MORE

40. Feb. 22, 2014

    Obama administration proposes cuts in Medicare payment rates for managed-care plans serving more than one-fourth of all beneficiaries; Republicans immediately pounce on the proposal, which appears likely to become a significant issue in this year’s midterm elections. MORE

41. Feb. 22, 2014

    Alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing Obama administration proposal that would allow insurers to limit Medicare coverage for three classes of drugs, including those used to treat depression and schizophrenia; White House says plan will lower costs and reduce overuse of drugs, but opponents warn it will adversely affect disabled and older Americans. MORE

42. Jan. 26, 2014

    Obama administration is cracking down on doctors who repeatedly over-charge Medicare patients; under new directive doctors, termed recalcitrant providers, would face civil fines and could be expelled from Medicare and other federal health programs; government may also for first time disclose how much individual physicians are paid for treating Medicare patients. MORE

43. Jan. 24, 2014

    Justice Department joins eight separate whistle-blower suits claiming for-profit hospital chain Health Management Associates tried to inflate Medicare and Medicaid payments by admitting more patients regardless of whether hospital care was needed, and pressuring doctors at hospitals in six states to increase admissions; similar accusations are being raised at other hospital and medical groups as health care undergoes sweeping changes. MORE

44. Nov. 18, 2013

    Congressional Memo; public uproar over the 1989 Medicare Catastrophic Coverage Act, intended to protect older Americans from bankruptcy due to medical bills, offers parallel to current turmoil of insurance exchanges under the Affordable Care Act; series of missteps caused law to be stricken from the books only seventeen months after it was signed by Pres Ronald Reagan, amounting to political catastrophe for lawmakers. MORE

45. Nov. 17, 2013

    Ezekiel J Emanuel Op-Ed article supports Medicare's decision to only pay for a test that determines whether a person is likely to suffer from Alzheimer's if the patient is part of a randomized, controlled trial; says test is important for research on the disease, but does not yet accurately predict the possibility that someone will get it. MORE

46. Oct. 15, 2013

    Government officials, and insurance companies, are scrambling to reassure Medicare beneficiaries that they are unaffected by the rollout of the federal health exchange. MORE

47. Oct. 15, 2013

    Ann Carrns Your Money Adviser column advises Medicare patients to play close attention for annual changes to supplemental coverage like the Medicare Part D prescription drug program; notes that premiums can go up, drugs can be dropped from coverage, and doctors can leave the network. MORE

48. Sep. 15, 2013

    Sunday Dialogue on changes to how Medicare reimburses doctors. MORE

49. Sep. 1, 2013

    Editorial highlights an analysis by experts at the Department of Health and Human Services that shows that the percentage of doctors accepting new Medicare patients has actually risen from 2005 to 2012; contends the finding should demolish claims made by those who call for radical changes to Medicare, who have made exaggerated claims to the contrary. MORE

50. Aug. 29, 2013

    Many members of Congress who voted to eliminate over $500 million a year in excessive drug payments being sent to kidney dialysis clinics nationwide now want to reverse that move, demonstrating lobbyists’ muscle; industry lobbyists aligned with nonprofit groups that in many cases helped set up or finance campaign to protect Medicare payments, which critics argue is stark example of federal government waste. MORE

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ARTICLES ABOUT MEDICARE

In Control, Republican Lawmakers See Budget as Way to Push Agenda

By JONATHAN WEISMAN

Congressional Republicans have plans to transform Medicare and Medicaid and to cut taxes for high earners, measures once out of reach with Democrats controlling the Senate.

November 13, 2014, Thursday

MORE ON MEDICARE AND: United States , Federal Budget (US) , Medicaid , Medicare , United States Politics and Government , Income Tax , Midterm Elections (2014) , House of Representatives , Senate

1964: Medicare Foe Says He'll Act

By INTERNATIONAL HERALD TRIBUNE

From the International Herald Tribune archives: A Republican opponent agreed to usher through the Medicare bill in 1964.

November 12, 2014, Wednesday

MORE ON MEDICARE AND: Johnson, Lyndon Baines, Presidential Library , Health Insurance and Managed Care , Medicare , Medicine and Health

Medicare Proposes Paying for Lung Cancer Screenings for Older Longtime Smokers

By SABRINA TAVERNISE

A draft decision by the Centers for Medicare and Medicaid Services would extend coverage for CT scans to Medicare beneficiaries who smoked at least a pack a day for 30 years or the equivalent.

November 11, 2014, Tuesday

MORE ON MEDICARE AND: Medicare , Smoking and Tobacco , Lung Cancer , Tests (Medical) , Centers for Medicare and Medicaid Services , Health Insurance and Managed Care

U.S. Finds Many Failures in Medicare Health Plans

By ROBERT PEAR

Federal audits found many coverage denials for medical services and prescription drugs are poorly explained or unjustified. Insurers usually do not deny it, but pay a penalty and carry on.

October 13, 2014, Monday

MORE ON MEDICARE AND: Medicare , Health Insurance and Managed Care , Drugs (Pharmaceuticals) , Elderly , Centers for Medicare and Medicaid Services

Chain to Pay $38 Million Over Claims of Poor Care

By KATIE THOMAS

The company settled after it was accused of inappropriate billing and of providing care to nursing home residents that was effectively worthless.

October 11, 2014, Saturday

MORE ON MEDICARE AND: Extendicare Inc , Nursing Homes , Elder Care , Health Insurance and Managed Care , Justice Department , Suits and Litigation (Civil) , Medicare , Medicaid

Easier Time in Health Marketplace Is Promised

By ROBERT PEAR

Officials said that the revamped HealthCare.gov would not crash, and that most signing up for the first time would visit much fewer screens.

October 9, 2014, Thursday

MORE ON MEDICARE AND: Health Insurance and Managed Care , Patient Protection and Affordable Care Act (2010) , Medicare , HealthCare.gov , United States Politics and Government , Health and Human Services Department , Obama, Barack , Slavitt, Andrew M , Counihan, Kevin J , United States

Care at the End of Life

By THE EDITORIAL BOARD

All too often, such care for Americans is shoddy or contrary to a patient’s wishes.

October 4, 2014, Saturday

MORE ON MEDICARE AND: Elder Care , Hospice Care , Death and Dying , Medicaid , Medicare , Editorials , Institute of Medicine

Beware of Shifting Options Within Medicare Plans

By TARA SIEGEL BERNARD

Open enrollment for Medicare starts Oct. 15, and offers older Americans a dizzying array of health care options.

October 4, 2014, Saturday

MORE ON MEDICARE AND: Medicare , Personal Finances , Health Insurance and Managed Care , Drugs (Pharmaceuticals)

Screening Smokers for Lung Cancer

Readers discuss the benefits and drawbacks of expanded screenings.

September 30, 2014, Tuesday

MORE ON MEDICARE AND: Lung Cancer , Smoking and Tobacco , Preventive Medicine , Tests (Medical) , Medicare , Health Insurance and Managed Care

Fighting to Honor a Father’s Last Wish: To Die at Home

By NINA BERNSTEIN

Maureen Stefanides wanted to fulfill her father’s request after long nursing home stays left him weak and unhappy, but the forces of the health care system seemed stacked against her.

September 26, 2014, Friday

MORE ON MEDICARE AND: Death and Dying , Elder Care , Hospice Care , Health Insurance and Managed Care , Nursing Homes , Home Health Care , Medicaid , Medicare , Elderly