The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, is seeking comments on a proposed rule that would completely restructure how Medicare providers are paid. This new proposal could have significant, negative implications for people with Medicare. We encourage those who are interested in Medicare policy to let CMS know about your concerns before the comment period closes on Monday, September 10. Learn what’s in the proposal and what you can do to respond before the deadline!

This week, the Kaiser Family Foundation (KFF) released a data note on the Medicare Part D coverage gap, commonly referred to as the “donut hole.” The KFF data note breaks down the number of people with Part D who reach the various levels of coverage, what their average spending is, and how beneficiaries, drug manufacturers, drug plans, and the federal government split up the responsibility for various charges. Importantly, the note discusses the implications some future policy decisions may have on people with Medicare, including calls from manufacturers to decrease the amount they pay or proposals from the Trump Administration that would sharply increase the money people with Part D must spend.

Last week, the Medicare Rights Center submitted comments on new federal marketing guidance that will apply to Medicare Advantage (MA) and Part D prescription drug plans in 2019.

The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, updates and releases marketing guidance every year so that MA and drug plans have current, uniform rules for marketing their products safely and accurately, without discriminating against people with Medicare. Some years see minor tweaks to the rules, but other years, like this one, see wholesale changes in how plans may be marketed.

This week, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced that premiums for Medicare Part D, an optional benefit that provides prescription drug coverage, will be slightly lower for 2019. The average 2018 premium for basic coverage is $33.59, and the projected average for 2019 will be $32.50.

CMS suggests that increased competition and changes in cost sharing are the main reasons for the reduction. However, the drop may more likely reflect changes that Congress made earlier this year that shifted some of the costs for medications in the “donut hole”—a coverage gap in the program where costs for beneficiaries historically increased sharply—away from drug plans and onto manufacturers.

Last week, the Medicare Rights Center submitted comments on a Request for Information (RFI) from the Department of Health and Human Services (HHS). This RFI asked for feedback on a host of potential changes that touted as ways to lower prescription drug costs for people with Medicare and Medicaid.

In May, the Trump Administration released a “blueprint” of various proposals in an attempt to bring down drug costs. Medicare Rights supports efforts to make prescription drugs more affordable. Many people with Medicare struggle to afford their medications, and Medicare affordability is one of the top issues on our national helpline every year. Something must be done to ensure the millions of people with Medicare have access to needed prescriptions.

To launch our new series, we begin with “Medicare: Strong and Built to Last.” This fact sheet gives some basic statistics about the Medicare program, including who uses it, why it’s important, and its financial footing.

In January, the Centers for Medicare & Medicaid Services (CMS) approved a Medicaid waiver in Kentucky that would allow the state to make participation in a work or “community engagement” program a condition for Medicaid eligibility. A group of advocates sued on behalf of Kentuckians who would be at risk of losing Medicaid coverage, and last month a federal judge put Kentucky’s Medicaid work requirement on hold. His decision called into question CMS’s attention to vital details about the Kentucky Medicaid waiver, including whether the waiver violates one of the primary purposes of the Medicaid statute—to provide health coverage.

This week, the Health Policy Consensus Group—a consortium of think tanks and former and current lawmakers—put forward a new plan to repeal the Affordable Care Act (ACA) that would end Medicaid expansion and eliminate the ACA’s robust consumer protections for individuals with preexisting conditions, adults over 50, and women. If this sounds familiar, it should. Last year saw several plans to end the ACA’s Medicaid funding and consumer protections, often couched in language promising states more “flexibility.” These proposals would have caused millions of Americans to lose access to critical services, pay more for care, or even lose health coverage entirely.

Last week, the Department of Justice (DOJ) asked a federal court in Texas to end the Affordable Care Act’s (ACA) protections for people with pre-existing conditions. The underlying legal challenge was filed earlier this year by 20 state attorneys general, who argue that without the individual mandate—which was eliminated in December’s Tax Cuts and Jobs Act—the entire is ACA unconstitutional. In an unexpected move, the DOJ declined to defend the ACA in this case, and instead asked the court to invalidate only the law’s provisions that prevent insurers from denying coverage or charging higher rates based on health status.

Last week, the Medicare Rights Center submitted comments to the Center for Medicare & Medicaid Innovation (CMMI) in response to a request for information on a potential new Medicare model. CMMI—an offshoot of the Centers for Medicare & Medicaid Services (CMS), which is the agency that oversees the Medicare program—was created to develop and test new ideas in health care delivery. Most of these ideas involve different ways of paying providers such as doctors or hospitals.

In this request for information, CMMI asked interested parties to provide input on ways to design and test a model for Direct Provider Contracting (DPC). In a DPC model, a beneficiary could choose to join a primary care or specialty provider’s practice and potentially gain certain benefits such as reduced cost sharing or increased services that Medicare does not generally pay for. While this idea may be intriguing, CMMI did not provide any detail on how such a model would work, which leaves some dangerous options on the table.