Biden Administration and Congress Attempt to Secure Future of Medicare

As Medicare faces the risk of depleting its reserves by 2028, the Biden administration, Congress, and healthcare industry stakeholders are working to address healthcare affordability and Medicare Advantage payment issues.

Biden Administration Addresses Medicare Advantage Payment Concerns

One focus of the Biden administration targets “coding intensity,” which refers to the practice of choosing medical codes with higher reimbursements without proper justification.

MedPAC estimates this practice could mean as much as $23 billion in overpayments in 2023.

The new proposals also include making sure that Medicare Advantage plan providers use a higher percentage of premium dollars for actual medical care, rather than for administrative and overhead expenses.

Additionally, the administration has proposed covering mental health and substance abuse treatment sessions (up to three per year) without any out-of-pocket costs for patients starting in 2025. They also want Medicare to pay the same rates for services regardless of where the care is provided, such as a doctor’s office or hospital.

Addressing Healthcare Affordability Through Hospital Outpatient Billing Reform

Congress is also working on reforms that aim to reduce the higher prices hospitals charge for outpatient services that could be provided in less-expensive settings. These reforms could save Medicare over $100 billion within a decade, easing some of the financial pressure on the program.

Furthermore, several states have started implementing measures to help people understand when a hospital adds an extra charge, called a “facility fee,” for receiving care at a hospital outpatient department. These efforts aim to make healthcare costs more understandable and affordable for everyone.

Combined Efforts to Ensure Medicare’s Future

By reducing unnecessary spending, revising payment models, and increasing transparency, the Biden administration and Congress are working to ensure Medicare remains financially sustainable and continues to provide essential benefits to those who rely on it.

In this issue:

This Just In...Study Reveals Total Lifetime Medicare Costs

Use the 4% Rule to Secure Your Financial Future

New DEA Rules Could Reduce Telehealth Access

Why You Should Buy Life and Disability Insurance Together

Biden Administration and Congress Attempt to Secure Future of Medicare

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