Latest news with #Medicare
3 hours ago
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Idaho doctor, patients sue over new law halting public benefits to immigrants in US unlawfully
BOISE, Idaho -- An Idaho doctor and four residents are challenging a new state law that halts some of the few public benefits available to people living in the U.S. unlawfully, including a program that provides access to life-saving HIV and AIDS medication for low income patients. The ACLU of Idaho filed the federal lawsuit Thursday night on behalf of Dr. Abby Davids and four people with HIV who are not named because they are immigrants without lawful permanent residency. The complaint says the new law is vague, contradicts federal law and makes it impossible for health care providers to determine exactly what kind of immigration status is excluded and how to verify that status for patients. They want a judge to grant them class-action status, expanding any ruling to other impacted people. Dozens of patients treated by one Boise-area clinic stand to lose access to HIV and AIDS medication under the law, according to the complaint, including several cared for by Davids. 'Withdrawing HIV treatment from her patients will not only have devastating consequences on their health, it raises the public health risk of increased HIV transmission,' the ACLU wrote in the lawsuit. 'When her patients are undetectable, they cannot transmit the virus. Without HIV treatment, however, they cannot maintain an undetectable viral level and therefore are able to transmit the virus to others.' The new Idaho law takes effect July 1, and appears to be the first limiting public health benefits since President Donald Trump ordered federal agencies to enhance eligibility verification and ensure that public benefits aren't going to ineligible immigrants. The law requires people to verify that they are legal U.S. residents to receive public benefits like communicable disease testing, vaccinations, prenatal and postnatal care for women, crisis counseling, some food assistance for children and even access to food banks or soup kitchens that rely on public funding. Federal law generally prohibits immigrants in the U.S. illegally from receiving taxpayer-funded benefits like Medicare, Medicaid, Temporary Assistance for Needy Families and Social Security. But there are some exceptions for things like emergency medical care and other emergency or public health services. Idaho's law still allows for emergency medical services. But in a June 18 letter to health care providers, Idaho Division of Public Health administrator Elke Shaw-Tulloch said HIV is a long-term condition and not an emergency — so people must verify their lawful presence in order to get benefits through the federal Ryan White HIV/AIDS Program. The HIV patients challenging the new law include a married couple from Columbia with pending asylum applications, a man who was brought to the U.S. when he was just 4 years old and has Deferred Action for Childhood Arrivals status until next year, and a man from Mexico who has been living and working in Idaho since 2020. One of the patients said she and her husband were diagnosed with HIV in 2019 and immediately started antiretroviral therapy, receiving the medications at no cost through the Ryan White HIV/AIDS Program. The medication has lowered the viral load in her body enough that it is now undetectable, she wrote in a court filing, ensuring that she won't transmit the virus to others. 'My medication protected my daughter while I was pregnant because it prevented me from transmitting HIV to her during pregnancy,' she wrote. The treatment allows her to be with her child, watching her grow, she said. Davids has been trying for weeks to get clarity from the Idaho Department of Health and Welfare about exactly what kind of verification her patients will have to show, and exactly which kinds of immigration status are considered 'lawful.' But the state has yet to provide clear direction, according to the complaint. 'I am really scared about what this means for many of our patients. Their lives will now be in jeopardy,' Davids wrote in a May 30 email to the Department of Health and Welfare.
Health Line
3 hours ago
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- Health Line
Does Medicare Cover Famotidine?
Famotidine is a generic drug that doctors prescribe to treat conditions related to excess stomach acid production, such as stomach ulcers and gastroesophageal reflux disease (GERD). It's available in over-the-counter (OTC) and prescription strengths, and companies may sell it under the brand names Pepcid AC or Zantac 360. Medicare Part D drug plans generally cover prescription famotidine, though there may be some variation based on the specific plan. Original Medicare doesn't cover OTC famotidine. However, some Medicare Advantage (Part C) plans may include OTC benefits that members can use toward this medication. Part D coverage for famotidine Medicare-approved private insurance companies sell Part D prescription drug plans. If you have Original Medicare, you can buy a stand-alone Part D plan, whereas people with Medicare Advantage plans often have Part D plans in their coverage. Each plan has a formulary. This is a list of medications that the plan covers. Part D plans generally include prescription famotidine in their formularies. However, since specifics vary by insurance carrier, plan, and location, there's no guarantee that all plans include coverage for famotidine. To learn whether your Medicare drug plan includes coverage for famotidine, consult your plan details or a representative. Over-the-counter famotidine and Medicare Many Medicare Advantage plans include coverage for OTC products as part of their additional benefits. If your Medicare Advantage plan includes OTC benefits, you can likely use them to buy famotidine. Generally, with OTC benefits, members can get a benefits card that works like a debit card. The plan adds funds to the card at regular intervals, and you can use it at participating retailers to buy eligible products. The specific retailer and product lists may depend on the plan, but Walgreens, for example, offers various famotidine products in different strengths and quantities through its OTC benefits program. Famotidine cost with Medicare The cost of famotidine may depend on its strength, quantity, form, and whether it's a generic or brand-name product. Formularies place covered drugs into tiers. These tiers typically correspond with a drug's cost, with lower tier drugs often carrying lower copayments or coinsurance. A plan's formulary may cover multiple versions of famotidine. If so, the oral tablet form is likely to be a tier 1 drug, whereas the oral suspension may be a tier 4 drug. However, this may not be the case for all plans that cover famotidine.
Health Line
3 hours ago
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- Health Line
How to Identify and Report Medicare Fraud
Medicare fraud is when a person knowingly submits false information or misuses the Medicare system to achieve personal financial gain or to receive benefits for which they are ineligible. Medicare has numerous official channels for reporting suspected fraud. While estimates vary, the Senior Medicare Patrol reports that Medicare losses due to fraud could be as high as $60 billion annually. What's clear is that Medicare fraud and abuse are pervasive, put significant stress on the system, and have the ability to affect the care that older adults receive. Medicare fraud can be perpetrated by various people and organizations, including healthcare providers, such as doctors, clinics, or hospitals, as well as criminal groups and individuals. In this article, we'll discuss what Medicare fraud is, how to identify it, and where to report it. Common types of Medicare fraud Medicare fraud can take many forms and can affect both beneficiaries and providers. Common types of Medicare fraud include: Medical identity theft: This can take many forms. It could involve using another person's Medicare number to obtain healthcare services or benefits or using a physician's identifier to fill prescriptions. Billing for unnecessary services: Under Medicare regulations, many procedures only receive coverage if they're considered medically necessary. If a provider intentionally bills for unnecessary procedures, it is a form of fraud. Kickbacks: Kickbacks are when a provider receives some form of compensation in exchange for referrals or utilization of services. An example would be a doctor who receives personal payment from a lab facility for referring patients. Billing for services never rendered: This is when a provider bills Medicare for services or procedures it never actually administered. It may involve falsifying documentation to create the appearance of authenticity. Upcoding and unbundling of services: Upcoding involves billing for services at a higher complexity than those actually rendered. Unbundling involves submitting bills in a staggered fashion to maximize payment when Medicare requires that those bills be submitted together to reduce costs. Vigilance is important in matters related to Medicare and billing. Understanding what to look for can help you identify fraud in practice. As a consumer and Medicare beneficiary, be sure to regularly check your Medicare claims and keep an eye out for irregularities. Look for: unfamiliar charges on your Medicare summary notice line items for services you didn't receive bills from unfamiliar providers If you have regular contact with a healthcare professional, facility, or other provider, you may notice trends that could signal potential fraud. These include: unusual billing patterns geographic anomalies suspicious documentation patient complaints How to report Medicare fraud If you suspect fraud may be occurring with a given provider, it's important to notify the Centers for Medicare & Medicaid Services (CMS). Reporting suspected fraud, waste, or abuse in Medicare programs is key to protecting both the integrity of the Medicare system and the individuals it serves. You can do this in various ways: Contact Medicare by phone at 800-MEDICARE (800-633-4227). Submit a complaint online with the Office of Inspector General of the Department of Health and Human Services (HSS-OIG). Contact the HSS-OIG by phone at 800-HHS-TIPS (800-447-8477). Individuals with a private Medicare plan, such as a Medicare Advantage (Part C) or Part D plan, can also reach out to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) with fraud complaints. You can reach I-MEDIC by phone at 877-772-3379. Before filing a complaint, it's important to collect all relevant documentation to back up your claim. This includes: your Medicare number the subject of your complaint, including information that can identify them the service in question and the date of receipt the cost of the service Summary Fraud and abuse cost Medicare billions of dollars each year. Reporting Medicare fraud is important for protecting individuals and maintaining the integrity of the Medicare system. Always guard your Medicare card, number, and other personal medical information. Additionally, review your Medicare summary notices routinely for irregularities that suggest inappropriate billing. If you think you were billed incorrectly, consider contacting Medicare for clarification. While errors happen, and not all errors are due to fraud, it's best to be safe and report your concerns. 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
3 hours ago
- Health
- Health Line
The Cost Breztri of with Medicare
Breztri can cost $400 or more without insurance, but Medicare may cover inhaler drugs for COPD, including Breztri. That said, the specific coverage and costs vary based on your exact plan. Breztri Aerosphere (budesonide, glycopyrrolate, and formoterol fumarate) is a metered-dose inhaler designed for adults living with chronic obstructive pulmonary disease (COPD). Medicare might help cover the cost of Breztri for COPD, but it's important to check the specifics of your plan, as there's no nationwide rule for inhaler coverage. Each Medicare Part D or Medicare Advantage Prescription Drug (MAPD) plan may cover different drugs. However, note that if you need a nebulizer rather than an inhaler, you would typically be covered under Medicare Part B. How much does Breztri cost with Medicare? If you don't have insurance, a 5.9-gram (g) Breztri inhaler costs around $400, while a larger 10.7-g inhaler can cost about $700. Whether your Medicare drug plan covers a Breztri inhaler depends on its formulary, which is a list of covered medications that varies with each plan. If your plan's formulary doesn't include this inhaler, it might offer coverage for a different one instead. If your plan covers Breztri, the amount you need to pay depends on its tier within the formulary. Higher tiers usually mean a higher cost. However, starting in 2025, you'll pay no more than $2,000 annually out of pocket for drugs through Medicare plans. Remember, Part D and MAPD plans are managed by private insurance companies, meaning your deductibles, premiums, and copays will depend on your plan. In 2025, the national base beneficiary premium for Part D is $36.78, and according to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Medicare Advantage plans is about $17. If you use a nebulizer and have coverage under Part B, you'll pay 20% of the cost after meeting your annual deductible of $257, as long as you keep up with your monthly premium of $185. How can I get cheaper Breztri with Medicare? Typically, you can get cheaper drugs through your Medicare plan by getting a prescription for a generic version. These tend to feature in lower formulary tiers, making them more affordable. There's no generic version of Breztri, but other medications may be just as effective and more budget-friendly. Your Medicare plan may cover these. In fact, since Breztri can be expensive, your plan might require prior authorization before they approve coverage. This could involve step therapy, where you're asked to try a different, equally effective but cheaper medication first. In addition, AstraZeneca, the company that produces Breztri, offers a cost assistance program that may make this drug more affordable for Medicare enrollees. You'll need to visit the manufacturer's website to check your eligibility. Takeaway Breztri is a brand-name inhaler designed for long-term management of chronic obstructive pulmonary disease (COPD) in adults. Although Medicare drug plans may cover COPD inhalers like Breztri, coverage is not uniformly required. This means your coverage and cost depend on the specific medication and your specific plan. Generally, Medicare Part D or a Medicare Advantage Prescription Drug (MAPD) plan provides drug coverage for Medicare, including for covered inhalers. However, if you need to use the drug with a nebulizer, your coverage would fall under Part B.
Health Line
3 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.
