Pre-existing conditions have been prominent in the news lately and much of the discussion includes some misunderstandings about what it actually means to protect coverage of pre-existing conditions and why it matters. While Medicare and Medicaid cover pre-existing conditions and that coverage is not under threat, there are changes in laws and regulations, and even a pending court case, that do put coverage at-risk for millions of people in the United States who are covered by employer or individual insurance. Polling consistently finds that Americans want protections for pre-existing conditions, with 75% of the public saying it’s “very important” such protections remain law. But there is a lot of confusion about what this means.

Certain threats to health care seem to arise from the dead regularly, and this Halloween season features an assortment of such zombie threats to Medicare, Medicaid, and the Affordable Care Act (ACA). As 2018 winds down, we must remain vigilant about attempts to cut or eliminate these vital programs that help older adults, people with disabilities, and their families and caregivers.

In late September, the Centers for Medicare & Medicaid Services (CMS)—the federal agency that oversees the Medicare program—released an overview of the upcoming year in Medicare Advantage (MA) and the Part D prescription drug program. Among the notable inclusions, CMS expects more people to join MA plans than ever before, shows a sharp increase in the number of plans available, and reveals the number of plans that will offer expanded supplemental benefits.

This week, Congress passed two bipartisan bills aimed at removing barriers that may prevent people from paying the lowest possible price for their prescription drugs. The legislation will prohibit contractual limitations that can stop pharmacists from volunteering information about how consumers may be able to save money on their needed medications.

The Patient Right to Know Drug Prices Act (S.2554) bars insurers and Pharmacy Benefit Managers (PBMs) from restricting a pharmacy’s ability to tell consumers when here is a difference between how much they would pay for a drug using their insurance and how much they would pay without it. This bill applies to plans offered through the Affordable Care Act’s exchanges and by private employers. The Know the Lowest Price Act (S. 2553) provides this same protection for individuals who are covered by Medicare Advantage and Medicare Part D plans.

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.