Nearly 1 million new customers have enrolled in the Affordable Care Act's exchanges since the open enrollment period began on Nov. 1, with a total of over 5.3 million sign-ups so far. The Centers for Medicare & Medicaid Services (CMS) reported that 4.4 million individuals have returned to marketplace plans for 2025, indicating a strong demand for affordable healthcare. The enrollment period continues until Jan. 15, with many eligible for premium tax credits, allowing 80% of enrollees to secure plans for $10 or less per month.
The Centers for Medicare & Medicaid Services (CMS) has finalized a six-year mandatory model aimed at increasing kidney transplant access, set to begin on July 1. The Increasing Organ Transplant Access (IOTA) Model will incentivize 103 participating hospitals to perform more transplants while addressing social determinants of health. Following stakeholder feedback, the CMS has adjusted performance incentives and eliminated certain quality measures, with the model running concurrently with an overhaul of the Organ Procurement and Transplantation Network.
The Centers for Medicare & Medicaid Services (CMS) is proposing to cover anti-obesity medications under Medicare Part D and Medicaid, recognizing obesity as a disease. This move could make 7% of the Part D population eligible for coverage, with projected costs of $24.8 billion for Part D and $14.8 billion for Medicaid. However, critics warn that widespread use of GLP-1 drugs could strain the healthcare system, and the rule's finalization may face challenges if a new administration takes office.
The Biden administration has proposed a rule to allow Medicare and Medicaid to cover weight loss drugs, potentially benefiting millions of Americans with obesity. This move, aimed at recognizing obesity as a chronic disease, could cost taxpayers around $36 billion over a decade, raising concerns about financial strain on these programs. The proposal's fate hinges on the incoming Trump administration's decision, amid mixed opinions from its appointed health officials.
President-elect Donald Trump has nominated Dr. Mehmet Oz to lead Medicare and Medicaid as the CMS administrator, emphasizing his qualifications amid a healthcare crisis. Oz's appointment follows Trump's selection of vaccine skeptic Robert F. Kennedy Jr. to head HHS, with both facing scrutiny over their controversial views and qualifications. Critics, including Sen. Patty Murray, express concern over Oz's lack of experience and extreme positions on reproductive health.
The Centers for Medicare and Medicaid Services (CMS) has finalized a 2.9% Medicare pay increase for outpatient facilities and ambulatory surgical centers for 2025, alongside new maternal health mandates aimed at improving care standards. The rule introduces the first-ever maternal health and safety standards for hospitals, requiring enhanced staffing and equipment protocols, while also addressing health disparities and expanding access to behavioral health services. However, the American Hospital Association criticized the payment increases as inadequate, warning that they could hinder patient access to care, particularly in rural areas.
Humana has filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) over the 2025 Medicare Advantage and Part D Star Ratings, claiming the agency did not adhere to its own rules and failed to provide necessary data. The complaint highlights significant changes in cut points that drastically reduced Humana's star ratings, impacting the quality bonus payments essential for lowering costs or enhancing benefits for enrollees. Humana seeks the retraction and recalculation of the ratings, emphasizing the critical importance of these ratings in the half-trillion-dollar Medicare program.
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