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Costco to Launch Store-Branded Medicare Plans in Partnership with SCAN Group

Costco to Launch Store-Branded Medicare Plans in Partnership with SCAN Group

Costco to Launch Store-Branded Medicare Plans in Partnership with SCAN Group
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Costco Partners with SCAN Health Plan to Offer Medicare Advantage Plans

Costco Partners with SCAN Health Plan to Offer Medicare Advantage Plans

Costco Partners with SCAN Health Plan to Offer Medicare Advantage Plans
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Costco to Launch Medicare Advantage Plan in Partnership with SCAN Group

Costco to Launch Medicare Advantage Plan in Partnership with SCAN Group

Costco to Launch Medicare Advantage Plan in Partnership with SCAN Group
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Costco Partners with SCAN to Enter $500 Billion Medicare Advantage Market

Costco Partners with SCAN to Enter $500 Billion Medicare Advantage Market

Costco Partners with SCAN to Enter $500 Billion Medicare Advantage Market
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Costco to Offer Store-Branded Medicare Plans in Partnership with SCAN Group

Costco to Offer Store-Branded Medicare Plans in Partnership with SCAN Group

Costco to Offer Store-Branded Medicare Plans in Partnership with SCAN Group
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Four States Offer Enhanced Medigap Protections Beyond Federal Standards

Four States Offer Enhanced Medigap Protections Beyond Federal Standards

Federal law provides a six-month protected enrollment period for Medigap policies when individuals turn 65 and enroll in Medicare Part B, during which insurers cannot deny coverage or charge more due to health conditions. However, outside this window, most states allow insurers to medically underwrite policies, potentially denying coverage or increasing costs for individuals with pre-existing conditions like diabetes. Only four states—Connecticut, New York, Massachusetts, and Maine—offer significant Medigap protections that extend beyond this federal window. Connecticut and New York provide continuous guaranteed access to Medigap. Massachusetts offers broad protections throughout the year, while Maine mandates insurers to offer at least Plan A during an annual guaranteed-issue period. Other states may offer narrower opportunities, such as 'birthday windows' for existing Medigap policyholders, but these generally do not provide unrestricted access for all Medicare Advantage members seeking to switch to a su...
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Diabetes Diagnosis Can Restrict Medicare Advantage Enrollees from Switching to Original Medicare in Most States

Diabetes Diagnosis Can Restrict Medicare Advantage Enrollees from Switching to Original Medicare in Most States

In most U.S. states, a diabetes diagnosis can effectively 'lock' individuals into their Medicare Advantage plans, making it difficult to switch to Original Medicare with a Medigap policy. This is due to medical underwriting requirements for Medigap plans outside of specific enrollment windows. While federal law provides a six-month open enrollment period for Medigap when a person first turns 65 and enrolls in Medicare Part B, and a 12-month trial right for new Medicare Advantage enrollees to return to Original Medicare, these protections are time-limited. Once these windows close, insurers in most states can deny Medigap coverage or charge higher premiums based on pre-existing conditions like diabetes, especially if insulin use or complications are present. Only four states—Connecticut, New York, Massachusetts, and Maine—offer significant Medigap protections beyond the federal windows.
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American Medical Association Applauds CMS for Strengthening Prior Authorization Transparency

American Medical Association Applauds CMS for Strengthening Prior Authorization Transparency

The American Medical Association (AMA) has expressed strong approval for updated guidance issued by the U.S. Centers for Medicare and Medicaid Services (CMS) aimed at enhancing federal transparency requirements for prior authorization. The AMA had previously raised concerns and recommended specific corrective actions to CMS in May, following its review of how 15 Medicare Advantage contracts were implementing transparency provisions of the 2024 CMS Interoperability and Prior Authorization final rule. This rule mandates payers to publicly disclose prior authorization requirements and outcomes, with specific deadlines of three days for urgent requests and seven days for standard requests. The updated guidance clarifies that posting metrics only through password-protected portals or locations not easily accessible from a public website does not meet the 'publicly accessible' requirement. It also specifies that plans must publicly identify all medical items and services requiring prior authorization, avoid omit...
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AMA Applauds CMS for Strengthening Prior Authorization Transparency Requirements

AMA Applauds CMS for Strengthening Prior Authorization Transparency Requirements

The American Medical Association (AMA) has expressed its approval of updated guidance from the U.S. Centers for Medicare and Medicaid Services (CMS) that aims to strengthen federal transparency requirements for prior authorization. This new guidance clarifies that health plans must make required metrics publicly accessible, not just through password-protected portals or hard-to-find locations. Additionally, CMS now mandates that plans publicly identify all medical items and services requiring prior authorization and ensure that disclosures are understandable, including turnaround-time metrics with a specified unit of time. The AMA had previously documented concerns and recommended specific corrective actions to CMS in May, following its review of how 15 Medicare Advantage contracts were implementing the transparency provisions of the 2024 final rule.
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Geriatric Emergency Departments Expand Across U.S., Including VA Medical Centers, Improving Elder Care Outcomes

Geriatric Emergency Departments Expand Across U.S., Including VA Medical Centers, Improving Elder Care Outcomes

Geriatric emergency departments (GEDs) are rapidly expanding across the United States, with 624 accredited units established since 2017, including 73 within Department of Veterans Affairs medical centers. These specialized ERs are designed to address the unique needs of older patients, incorporating senior-friendly practices and protocols to prevent disorientation, falls, and other hazards common in elderly individuals. Unlike traditional ERs that focus on a single ailment, GEDs take a holistic approach, considering multiple chronic conditions, medication reviews, and cognitive assessments. Studies indicate that patients treated in GEDs have a 39% lower likelihood of hospital admission and a 38% reduction in mortality over 30 days, potentially saving Medicare up to $3,000 per visit.
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Guillermo's Salsa Achieves Rapid Success with Celebrity Backing and Strategic Distribution

Guillermo's Salsa Achieves Rapid Success with Celebrity Backing and Strategic Distribution

Guillermo's Salsa Achieves Rapid Success with Celebrity Backing and Strategic Distribution
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Medicare Beneficiaries Face Critical One-Time Medigap Enrollment Window

Medicare Beneficiaries Face Critical One-Time Medigap Enrollment Window

Many Medicare beneficiaries are unaware of a crucial, one-time six-month window, known as the Medigap Open Enrollment Period, which significantly impacts their ability to secure supplemental health insurance. This period commences the first month an individual is aged 65 or older and has enrolled in Medicare Part B. During this specific timeframe, federal law mandates that Medigap insurers must sell any policy they offer without the ability to reject an applicant or charge higher premiums based on pre-existing health conditions. While coverage for pre-existing conditions might still be subject to a waiting period, the application itself cannot be denied on medical grounds. Crucially, this protected enrollment window does not recur annually, unlike Medicare's Annual Enrollment Period for Medicare Advantage and Part D prescription drug plans. A common pitfall occurs when individuals initially opt for a Medicare Advantage plan, assuming they can easily switch back to Original Medicare and add Medigap later. H...