Latest news with #CentersforMedicare
Health Line
10 hours ago
- Health
- Health Line
How much does Farxiga cost with Medicare?
Farxiga can cost up to $600 without insurance, with costs varying by pharmacy and whether you choose the brand or the generic. With Medicare coverage, your out-of-pocket costs depend on your plan. Farxiga (dapagliflozin) is a medication for helping lower blood sugar levels and reduce the risk of heart and kidney issues for those with type 2 diabetes, heart failure, or chronic kidney disease. With Medicare, drug overage usually comes through a Medicare Part D or a Medicare Advantage Prescription Drug (MAPD) plan. But whether your plan covers Farxiga and how much the drug will cost after coverage depends on your plan. How much does Farxiga cost per month with Medicare? Depending on where you get it, the cost of Farxiga without insurance can be over $600. The generic version, dapagliflozin, still costs more than $400. Farxiga can be covered by Medicare Part D or a MAPD plan. However, whether this medication or its generic version is covered by your Medicare drug plan and how much the plan will cover depends on its specific list of covered drugs, called a formulary. Private insurers manage Medicare drug plans and will have a different list depending on the plan. In addition, keep in mind that Medicare drug plans also have a deductible, premium, and copay that can vary depending on the plan. In 2025, the national base beneficiary premium for Part D is $36.78. According to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Medicare Advantage plans is $17. What tier is Farxiga on? Within your plan's formulary, the insurer will place Farxiga in a tier. Generally, the higher the tier, the more you'll pay as a copayment, with the generic version typically in a lower tier than the brand-name drug. Many Medicare drug plans should include Farxiga, though its tier will depend on your plan. If your plan doesn't include this drug, it may include an alternative and equally effective medication. Generally, Medicare drug plans must cover at least two drugs from the most commonly prescribed categories. If the plan includes it and classifies it in a higher tier, your insurer may require prior authorization for coverage, which could include Step Therapy. This means you'll be asked to try a different, equally effective, but more cost-effective medication first before Medicare will approve coverage for Farxiga. Takeaway Farxiga is a drug designed to help lower blood sugar levels and reduce the risk of heart and kidney issues for those with type 2 diabetes, heart failure, or chronic kidney disease. Without insurance, the cost of Farxiga can range from around $400 to $600, depending on the pharmacy and whether you choose the brand-name or generic version. Usually, Medicare drug coverage comes through a Medicare Part D plan. While your exact coverage and costs for Farxiga depend on the specifics of your plan, many Medicare plans should cover this medication. Plus, once Medicare's price negotiation agreement starts in 2026, the price with coverage should be more affordable. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
12-06-2025
- Health
- Health Line
A Guide to the Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is a federal agency that provides health coverage to millions of people. It oversees programs like Medicare, Medicaid, and CHIP. The CMS works closely with the entire healthcare community to improve the equity, quality, and outcomes within the healthcare system. What is CMS? CMS is the federal agency that helps provide health coverage for more than 160 million people across the United States. It oversees the following health insurance programs: Medicare Medicaid Children's Health Insurance Program (CHIP) Health Insurance Marketplace CMS aims to strengthen and modernize the United States healthcare system and provide access to high quality care and improved health at lower costs. About Medicare Medicare is a federal health insurance program for people 65 years old and over. Those under 65 years old who have an eligible illness or disability may also qualify for coverage through Medicare. Medicare has four parts that offer different coverage for your healthcare needs: Part A: This is also known as hospital insurance. It covers inpatient care in facilities like hospitals and skilled nursing facilities. Part A also covers some home healthcare and hospice care. Part B: This is also known as medical insurance. It covers outpatient care and services you might receive from a doctor, specialist, or other healthcare professional. Part B also covers durable medical equipment (DME) and some home healthcare. Part C (Medicare Advantage): This is an alternative to Original Medicare (parts A and B). It offers the same coverage but is provided by Medicare-approved private insurance companies. Medicare Advantage plans also typically include prescription drug coverage (Part D) and additional benefits, such as vision, hearing, and dental. Part D: This offers prescription drug coverage. Part D plans are offered through Medicare-approved private insurance companies. If you have Original Medicare, you can purchase a stand-alone Part D plan from one of these companies. The CMS oversees and manages the Medicare program. The Social Security Administration (SSA) manages Medicare enrollment and income-related monthly adjustment amounts (IRMAA) for Part B and Part D. About Medicaid Medicaid is a health insurance program that is run by individual states according to federal requirements. It is funded by both the state and federal governments. Medicaid provides health coverage to around 71.1 million people, including: adults with lower incomes pregnant individuals children older adults people with disabilities It is possible for you to qualify for coverage from both Medicaid and Medicare at the same time. This can help reduce or eliminate your out-of-pocket costs. About Children's Health Insurance Program (CHIP) CHIP helps provide comprehensive health insurance benefits to children. Each state runs its own CHIP program, which means that the exact coverage and benefits may vary. While states can choose what benefits to offer in their CHIP program, there are certain healthcare services they must include: dental vaccines behavioral health well-baby and well-child visits About the Health Insurance Marketplace The Health Insurance Marketplace can help you find health coverage if you don't already have it through Medicare, Medicaid, or employment. It can also help you: find answers to questions about health insurance compare health insurance plans for affordability and coverage find out if you are eligible for tax credits for private insurance or health programs like Medicare and Medicaid enroll in a health insurance plan that meets your needs Summary The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees health coverage programs like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). It has a mission to strengthen the United States health system and provide access to high quality care and improved health at lower costs. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Wall Street Journal
10-06-2025
- Health
- Wall Street Journal
Agency Overreach Leaves Patients Untreated
President Trump is pursuing deregulation to boost economic growth, but he could also use it to encourage medical innovation. As a first step, he could end the Coverage and Evidence Development program at the Centers for Medicare and Medicaid Services. CMS established the program two decades ago to speed Medicare coverage of new treatments that had been approved by the Food and Drug Administration. Instead, CED has slowed it down. In 2005 advances in medical devices were solving major medical problems, but CMS bureaucrats worried about taxpayer costs and demanded more data before covering them.
Health Line
02-06-2025
- Business
- Health Line
5 Things To Do When You Turn 65
By age 65, you may wish to take some important medical and financial steps. These involve Medicare, preventive health screenings, Social Security, taxes, and other legal considerations. Usually, if you're 65 years or older or younger and living with specific disabilities or conditions, you qualify for Medicare. If you're living with a qualifying disability, you'll be automatically enrolled in Original Medicare. However, if you're eligible because of your age, you'll need to sign up yourself. In addition, if you haven't already, you may wish to take this time to consider various social security and other legal decisions. Follow this guide for five things to do about Medicare, Social Security, and more when you reach 65. 1. Understand and enroll in Medicare To know which part or plan to enroll in, you'll need to understand the various benefits and costs. Generally, your Medicare enrollment options are: Original Medicare (parts A and B) Medicare Advantage (Part C) stand-alone Medicare Part D Medigap Both Healthline and this guide from the Centers for Medicare & Medicaid Services (CMS) go into detail about the benefits of each part of Medicare. In most cases, you won't pay a premium for Part A, but you must meet a deductible. Part B does have a premium and covers 80% of eligible expenses after you meet the deductible. Note that Original Medicare costs will change in 2026. Medigap can help you with your remaining out-of-pocket costs, but this requires paying an additional premium, and you can't use the plan with Part C. Private insurers manage Parts C and D, which means their costs vary by plan. Your out-of-pocket drug costs also depend on the specific plan's formulary. To cut your costs further, consider looking into whether you might be dually eligible for Medicaid or if you're eligible for Medicare Savings Program (MSP) or Extra Help. After enrollment, be aware that Medicare Part B covers a one‐time ' Welcome to Medicare ' preventive visit if you schedule it within 12 months of enrolling. You're also eligible for an annual wellness visit every 12 months. It's a good idea to take advantage of both of these visits and schedule any other preventive tests your doctor recommends. Long-term care insurance Long-term care insurance can help you manage your daily routines if you can no longer do so yourself at home, in a nursing home, or in an assisted living facility. But Medicare usually doesn't cover this. If you need this now or think you or a spouse may need this in the future, you may consult with a broker, look into State Partnership Programs, or check out your employer benefits if you're still working. 2. Set up a healthcare proxy If you haven't already, you might want to consider setting up a healthcare proxy. This will allow someone you trust to make medical decisions for you if you're ever unable to do so yourself. In addition, you can fill out a form to give the person access to your Medicare records and allow them to speak with providers on your behalf. Both of these can be really important if you have significant health issues that might affect your ability to make decisions or you're concerned that you might in the future. If you're married, it's a good idea to designate one another as proxies. Alternatively, or in addition, it may be a good idea to create or refresh your estate plan or issue a power of attorney to someone on your behalf. Depending on your goals, these legal moves could also replace designating a healthcare proxy while allowing the person you choose to manage your financial affairs. To decide on the best path for you, you may wish to consult with an attorney. 3. Make your home safer As you age, your physical needs may increase, and mobility around your home can become more challenging. You may prefer to stay in your home for as long as possible, but you may also have concerns about your safety. That said, there are things you can do to help make your home safer and protect yourself from injury in your home. These include: Adding grab bars or handrails on stairs, in bathrooms and showers, or anywhere you might need more support. Making sure your lighting is good and up to date in every room. Putting nonslip strips on stairs or fitting carpet on other slippery surfaces. Durable Medicare Equipment (DME) If you need it, you may be able to get mobility devices like walkers, wheelchairs, or scooters for use at home through Medicare Part B. 3. Understand retirement benefits You can begin receiving Social Security benefits as early as age 62, although you'll only get the full benefits once you reach the designated full retirement age. You can check when you're eligible for full benefits on Note that if you wait to get full benefits past full eligibility, your payments could increase by up to 8%. In addition, if you've been married for at least 10 years, you might be eligible for spousal benefits, which can also boost your payments. That said, depending on your situation, you may need your retirement benefits sooner. That's why it's important to know when you're eligible and how much you'll be able to get. 4. Review retirement savings Whether you're retiring this year or not, it's wise to review your retirement accounts to ensure your portfolio aligns with your retirement objectives. If you're currently still working and your employer provides a retirement savings option like a 401(k), make sure you're making the maximum possible contributions. Additionally, you can invest up to $7,000 annually into an Individual Retirement Account (IRA). Each of these retirement account types has its own benefits and drawbacks, and you might have one or both. There are also different rules on when and how you can withdraw money from these accounts. For this reason, consulting a financial advisor can be beneficial to ensure you're managing these correctly and contributing the right amounts. 5. Check your taxes Filing tax returns can be complex. When you're working on your tax return, it's important to pay extra attention to avoid losing out on deductions that you're owed due to errors. Be especially aware that once you turn 65 years old, you can get a larger deduction on your federal tax returns. If you or your spouse has a visual impairment, you may qualify for a bigger standard deduction. In addition, you might be able to get additional state deductions based on the specific rules in your state. If you need to, consider speaking with a tax consultant to make sure you're filing your taxes correctly and getting the right deductions. Takeaway Generally, people who are 65 years or older, as well as younger individuals with certain disabilities, qualify for Medicare. If you live with an eligible disability, you'll be automatically enrolled in Original Medicare, but if you qualify by age, you need to enroll on your own. Before you enroll in Medicare, consider the program's structure, the plans that best suit your needs and their associated costs, and the key enrollment periods. Other things to consider around age 64 are your plans for your future healthcare needs, your Social Security benefits, the status of your retirement benefits, changes in tax exemptions, home safety, essential legal documents, and more.
