Medicare finalizing coverage policy for coronavirus vaccine

Posted on November 16, 2020 by MedicareMall

A senior Trump administration official says Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced soon

Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced shortly, a senior Trump administration official said Tuesday.

The coming announcement from the Centers for Medicare and Medicaid Services aims to align the time-consuming process for securing Medicare coverage of a new vaccine, drug or treatment with the rapid campaign to have a coronavirus vaccine ready for initial distribution once it is ready, possibly as early as the end of the year.

It’s questionable under normal circumstances if Medicare can pay for a drug that receives emergency use authorization from the Food and Drug Administration, as expected for the eventual coronavirus vaccine. Emergency use designation is a step short of full approval.

Compare Medicare Plans Now

The administration official said Medicare’s announcement will try to resolve several legal technicalities that could conceivably get in the way of delivering free vaccines to millions of seniors, a high-risk group for COVID-19, the disease caused by the coronavirus. The officials spoke to The Associated Press on the condition of anonymity to discuss a pending regulation.

President Donald Trump and lawmakers of both parties in Congress have spelled out their intention that all Americans will be able to get the vaccine for free. But the official said a series of potential legal obstacles that could get in the way of Medicare payment never got unscrambled.

Earlier this month, Medicare administrator Seema Verma said her agency was close to resolving the issue.

“I think we’ve figured out a path forward,” Verma said at the HLTH conference, a forum for innovators. “It was very clear that Congress wants to make sure that Medicare beneficiaries have this vaccine and that there isn’t any cost-sharing.”

“Stay tuned,” she added.

The $1.8 trillion CARES Act passed by Congress in March called for free vaccination for all Americans, from seniors covered by Medicare to families with employer-sponsored health insurance.

A White House-backed initiative called “Operation Warp Speed” is pushing to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have committed that the program will not interfere with their own science-based decisions. Vaccines that don’t meet the test for approval would be discarded.

States have already begun submitting their plans for vaccine distribution to the federal government.

Initially, it’s expected vaccines will go to people in high-risk groups such as medical personnel, frontline workers and nursing home residents and staff. Older people are also high on the priority list because their risks of serious illness and death from the coronavirus– which has killed more than 225,000 people in the United States– are much higher. It could be well into next year before a vaccine is widely available.

Medicare’s impending announcement was first reported by Politico.

Compare Medicare Plans Now

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

Posted on November 16, 2020 by MedicareMall

Trump administration set to announce Medicare and Medicaid will cover Covid vaccine

The Trump administration is set to announce as early as this week that Medicare and Medicaid will cover out-of-pocket costs for a potential coronavirus vaccine that is granted emergency use authorization, according to a person familiar with the matter.

Coming days before the election, the move could help President Donald Trump among seniors and lower-income Americans even though top medical experts don’t expect a vaccine to be approved until well after Election Day. In the run-up to the election, Trump had applied intense pressure on agencies to deliver policy wins that might help his reelection, aides said.

Officials have been working for several weeks on changing regulations to allow for Medicare and Medicaid recipients to receive free vaccines.

Compare Medicare Plans Now

View Entire Post ›

It’s not clear whether Trump himself will make the announcement of the rule change, though he is working to appeal seniors during stops in Florida later this week.

Politico first reported the coming changes.

There are currently four US Phase 3 trials of coronavirus vaccines as part of the federal government’s Covid-19 vaccine program, Operation Warp Speed.

Dr. Anthony Fauci, the nation’s top infectious disease expert, said Sunday that experts will know by early December whether a potential coronavirus vaccine is safe and effective, but widespread availability will likely not occur until several months into 2021.

Operation Warp Speed aims to have Covid-19 vaccines moved to administration sites within 24 hours of emergency use authorization or Food and Drug Administration license– with the goal of providing the vaccine free of charge.

“In terms of a principle and an aspiration, it’ll be that no American has to pay for a single dime out of pocket to get a vaccine,” Paul Mango, deputy chief of staff for policy at the US Department of Health Human Services, said back in September.

The federal government already struck a deal earlier this month with retail pharmacies CVS and Walgreens to help distribute the coronavirus vaccine– once one or more gets authorized– to long-term care facilities like nursing homes, with no out-of-pocket costs.

Compare Medicare Plans Now

View Entire Post ›

Inaccurate Census count could affect $1.5 trillion in federal funding

Posted on November 9, 2020 by MedicareMall

A census taker knocks on the door of a residence in August in Winter Park, Fla. Census workers visited households that hadn’t yet responded to the 2020 census.

The consequences of an inaccurate census

Highway construction. Food stamps. Rural education. Medicare.

The federal government relies on data derived from the decennial census to distribute roughly $1.5 trillion in funds for these programs, along with more than 300 others. The money goes to state and local governments, non-profits, businesses and households across the nation.

That’s why experts are so concerned that the US Census Bureau could end its 2020 count early, which they say will increase the chances of missing many Americans, particularly immigrants, people of color, low-income folks and rural residents. And that, in turn, could reduce federal funding for programs that support them and entire communities.

“The Census data are used to determine who gets what slice of each pie,” said Andrew Reamer, a research professor at George Washington University who specializes in Census-guided federal spending. “If you miss 10,000 people, they are gone for the decade.”

The Supreme Court on Tuesday granted a request for from the Trump administration to halt the process while an appeal plays out. A lower court order would have required the count to continue until October 31, but the administration argues that the shortened deadline is needed to give the agency time to deliver the results to the President by December 31, as required by law.

The decennial census serves as the foundation for three other sets of data the Census Bureau creates that are used in apportioning federal funding. An accurate population count is key and any undercount can translate into significant losses.

For instance, had Texas’ population been undercounted by 1% in 2010, the state would have lost nearly $292 million in federal reimbursements for Medicaid and the Children’s Health Insurance Program in fiscal 2015, Reamer’s research found. Pennsylvania would have received about $222 million less, while Florida would have been sent nearly $178 million less.

Compare Medicare Plans Now

Medicare uses geographic data based on the Census to determine how many pharmacies must be in Part D enrollees’ networks and how much to reimburse physicians.

And states utilize Census-based population data to allocate federal highway funding, while federal agencies determine support of disadvantaged youth employment efforts and nutrition programs for women, infants and children based on the share of kids in poverty in a specific area.

Some states and local communities incorporated the importance of the Census count into their outreach, reminding their residents that federal funding for their roads, schools and other programs depends on their filling out the survey.

“It’s a very critical piece of policy and planning and funding,” said Mallory Bateman, state data center coordinator at the University of Utah. “This is our way to show who lives in the state… and get them the funding that they need.”

The census has never been perfect. It typically overcounts White Americans and misses people of color and those living in rural areas, among others. But this year, the problem could be even more extensive, largely because of the shorter deadlines for following up with those who don’t respond and for processing the results, said John Thompson, a former Census Bureau director under the Obama administration.

Also, immigrants– both legal and undocumented– may be less likely to fill out the survey because of increased fears that the data will be used against the, after President Donald Trump issued a memorandum to exclude undocumented immigrants from the counts used to apportion the House of Representatives, Thompson said. The Supreme Court will hear a case this term seeking to block Trump’s move.

“Many communities will certainly receive less than their fair share of federal funds,” said Alex Tausanovitch, director, campaign finance and electoral reform at the left-leaning Center for American Progress.

Compare Medicare Plans Now

Uber Launches Medicine Delivery Service in South Africa

Posted on November 6, 2020 by MedicareMall

Uber launches medicines delivery service in South Africa

Uber Eats’ South African unit on Thursday expanded delivery offerings, launching an app-based over-the-counter medicines service as it seeks to claw market share in the fast-growing online shopping sector in Africa’s most industrialized economy.

Uber Eats, a unit of U.S. ride-hailing service Uber Technologies already has a lion’s share of South Africa’s $600 million food dispatching market.

The equally lucrative medicines delivery market is controlled by pharmacy chains Clicks and Dis-Chem, which offered delivery services long before Covid-19 spurred a shift to online shopping.

Analysts say such “first movers” including Naspers-owned Takealot, have a natural advantage over newcomers, especially with users increasingly seeking to use fewer smartphone applications to do more things.

But Uber Eats is banking on a “marketplace” strategy–combining ride-hailing and grocery deliveries and other services on a single mobile phone app that already has over 2 million users in the country, it said in a statement.

Its latest foray in the delivery sector is in partnership with local health group Medicare, which operates more than 50 clinics and pharmacies around the country, and will allow its app users to purchase over-the-counter medication.

Compare Medicare Plans Now

“The nationwide lockdown and restriction in movement created an immediate need to accelerate our business in increasing the accessibility to daily essentials,” general manager of the Uber Eats South Africa Shane Austin told Reuters.

“Which is part of the reason our focus has been towards on-boarding various other merchants onto the app, aside from just restaurants.”

In its latest Digital Market Outlook, information portal Statista predicted South Africa’s e-commerce market would see annual compound growth of 11% up to 2024, with the number of online shoppers growing to nearly 37 million from around 25 million currently.

What are your thoughts on having your medications delivered? Would you make the switch if this service is offered in your area? Leave your comments below!

Compare Medicare Plans Now

View Entire Post ›

Walmart’s Next Health Foray Is Medicare Plan With Startup Clover

Posted on October 23, 2020 by MedicareMall

Could you be looking at Medicare Advantage plans offered by Walmart in the future?

Walmart is partnering with an insurance startup, Clover Health, to offer seniors in Georgia access to their new Medicare Advantage plans next year. Two products will be available and members of those plans will have access to the new Walmart Health Centers that Walmart is now testing in its stores outside of Atlanta. Those clinics and other providers in the plan will be able to use Clover’s technology to improve care and track patients’ health, the companies have stated.

Entering an already competitive and lucrative market

As Walmart develops its health-care strategy, its progress has been closely watched. The retail giant is seen as a potential threat to established providers and insurers. This new Georgia offering will make Walmart a player in the Medicare Advantage program, a market that is currently dominated by UnitedHealth Group Inc., Humana Inc., CVS Health Corp.’s Aetna unit, and BlueCross BlueShield branded plans, some of which are also expanding their offerings.

1/3 of Medicare beneficiaries opt for private Advantage plans

More than a third of Medicare beneficiaries opt to get their benefits through private Advantage plans that collect fees from the government in exchange for members’ care. The plans often combine traditional Medicare benefits with other services such as vision and dental care, gym memberships, and prescription drug coverage.

Compare Medicare Supplement Plans

Seniors often choose Advantage plans over traditional Medicare to get those benefits, though they may have to agree to use a limited network of doctors and hospitals. Clover’s new plans with Walmart will use a preferred-provider organization network, though Clover said members won’t face additional fees for going out-of-network.

Your plan options with Clover

One of the two plans won’t charge monthly premiums, and both will offer free primary care, the companies said. Members will get $400-a-year benefit for the over-the-counter health expenses that can be spent in Walmart stores or on its website, similar to the perk the retailer offered Anthem Medicare subscribers through a deal two years ago. Clover will underwrite the insurance plans, branded “LiveHealthy: Clover Powered, Walmart Enhanced.”

Other companies expanding offerings in response

Other companies are expanding as well. Cigna Corp. plans to sell Medicare Advantage plans in five new states, and UnitedHealth said its expansion in 2021 to almost 300 counties would be its largest in five years. Humana plans to launch dozens of new plans across hundreds of counties, the company said. Aetna is adding 115 new counties, and Anthem is expanding into more than 80.

The Clover difference

Clover said its product with Walmart will be distinguished by low costs and convenience. “Our vision is, we deliver care wherever our members want to get care,” said Andrew Toy, Clover’s president and chief technology officer. A Walmart spokeswoman said company officials weren’t available for interviews. In addition to Walmart’s health clinics, the network will include 31 hospitals and 8,000 providers in the region, which covers eight Georgia counties mostly outside of Atlanta.

Walmart began opening health clinics in Georgia stores in 2019 and now has six locations there and one in Arkansas, according to the company’s website. Cash prices are posted in price sheets online and in waiting rooms: $40 for basic office visit and $20 to test for strep throat, for example. The clinics offer primary care, vision, dental care, lab tests, and mental health visits.

Expanding footprint

Walmart will continue expanding its health centers, with seven more Georgia locations planned in the months ahead and additional centers coming in the Chicago area and some cities in Florida, according to a company blog post on September 17.

Compare Medicare Supplement Plans

“The demand definitely tells us that Americans are looking for access to quality care, and we think Walmart- its footprint- should be a part of that,” Walmart U.S. Chief Executive Officer John Furner said in an investor conference this month.

Other moves by Walmart into the sector include a collaboration with Oak Street Health, a Medicare-focused primary care company, to open clinics at three supercenters in the Dallas-Fort Worth area, according to a press release this month. The retailer recently formed an insurance agency to enroll customers in Medicare health plans, the Arkansas Democrat-Gazette reported in July, citing job ads and corporate filings. The company also sells monthly supplies of low-cost generic prescription drugs for $4.

New players on the field

Founded in 2014, Clover is among a handful of new entrants like Devoted Health and Oscar that are trying to use technology to improve health care. Backed by almost $1 billion from investors including GV, the venture capital arm of Alphabet Inc., the company has about 57,000 members in seven states and plans to triple the number of counties where it offers plans next year.

Clover’s software for medical professionals, known as Clover Assistant, will be deployed in the Walmart clinics and to other providers in the network. The program analyzes data from patient records, labs, socioeconomic data, and other sources to prompt clinicians to recommend actions like screening tests and adhere to evidence-based treatment guidelines, Toy said.

What do you think of Walmart and Clover’s new Medicare Advantage plans? Leave your thoughts in a comment below.