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Medicare

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don't need to sign up because they have purchased insurance on the Affordable Care Act's marketplaces. That failure to enroll on time can leave them facing a lifetime of penalties.

Almost 100 hospitals reported suspicious data on dangerous infections to Centers for Medicare & Medicaid Services officials, but the agency did not follow up or examine any of the cases in depth, according to a report by the Health and Human Services inspector general's office.

Most hospitals report how many infections strike patients during treatment, meaning the infections are likely contracted inside the facility. Each year, Medicare is supposed to review up to 200 cases in which hospitals report suspicious infection-tracking results.

Marketplace officials calculate a customer's subsidy, so why is the customer held responsible for repayments? Why are so many of my prescriptions held up for authorization by my Medicare drug plan? Here are answers to some recent questions from readers.

Andrew Harnik / AP Photo

Congresswoman Cathy McMorris Rodgers expects the Trump administration and Congress to act soon to deal with the Affordable Care Act and possibly change Medicare.

Now that Republicans will actually have the numbers to do away with Obamacare, McMorris Rodgers says some provisions of the landmark law will likely be spared.

The federal government will pay more than $100,000 to give someone a kidney transplant, but after three years, the government will often stop paying for the drugs needed to keep that transplanted kidney alive.

Constance Creasey is one of the thousands of people who find themselves caught up by this peculiar feature of the federal kidney program.

Social Security alone consumes nearly a quarter of the federal budget.

At this week's vice presidential debate, Democrat Tim Kaine and Republican Mike Pence spoke about how the administrations they hope to join would deal with the challenges facing safety net programs like it.

Social Security

The Challenge

More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.

The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation's best-known hospitals while awarding top scores to many unheralded ones.

The Justice Department calls it the largest criminal health care fraud case ever brought against individual suspects: Three people are accused of orchestrating a massive fraud involving a number of Miami-based health care providers.

The three facing charges are all from Florida's Miami-Dade County; they include Philip Esformes, 47, owner of more than 30 Miami-area nursing and assisted living facilities; hospital administrator Odette Barcha, 49; and physician assistant Arnaldo Carmouze, 56, the Justice Department says.

Prescription drug prices continue to climb, putting the pinch on consumers. Some older Americans appear to be seeking an alternative to mainstream medicines that has become easier to get legally in many parts of the country. Just ask Cheech and Chong.

The Department of Health and Human Services Tuesday proposed key changes in the Medicare appeals process to help reduce the backlog of more than 700,000 cases involving denied claims.

The measures "will help us get a leg up on this problem," said Nancy Griswold, chief law judge of the Office of Medicare Hearing and Appeals.

If there weren't a single additional appeal filed and no changes in the system, it would take 11 years to eliminate the backlog, Griswold said in an interview.

A program that has helped seniors understand the many intricacies of Medicare, as well as save them millions of dollars, would be eliminated by a budget bill overwhelmingly approved last week by the powerful Senate Appropriations Committee.

Congress should move to slow spending in Medicare's drug benefit by adopting a package of changes that could save billions of dollars, but that would also add costs for insurers and have mixed effects on enrollees, an independent advisory commission said Wednesday.

Private Medicare Advantage plans treating the elderly have overbilled the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a congressional audit released Monday.

Updated April 20 at 1:50 ET with a statement from the American Hospital Association.

Bowing to pressure from the hospital industry and Congress, the Obama administration on Wednesday delayed releasing its new hospital quality rating measure just a day before its planned launch.

Eliza Catchings has been seeing doctors at the Christie Clinic in central Illinois since 1957. But just after receiving this year's WellCare Medicare Advantage member card, the insurer told her the clinic was leaving WellCare's provider network and she would have to choose new doctors.

"I was terrified," said Catchings, 79, who gets care for diabetes and heart problems. But she was helped by a little-noticed change in federal policy.

A diabetes prevention program being tested by the YMCA of the USA has proved successful at reducing the risk of developing the disease, according to the Department of Health and Human Services.

So the Obama administration wants Medicare to pay for the services for beneficiaries at high risk of developing diabetes.

Aetna and Cigna inked deals last month with drug maker Novartis that offer the insurers rebates tied to how well a pricey new heart failure drug works to cut hospitalizations and deaths. If the $4,500-a-year drug meets targets, the rebate goes down. Doesn't work so well? The insurers get a bigger payment.

In another approach, pharmacy benefit firm Express Scripts this year began paying drug makers a special negotiated rate for some cancer drugs. The goal is to reward the use of medicines that are most effective for certain cancers.

Medicare is going to test new ways to reimburse doctors for medications, in hopes they'll choose less expensive drugs.

The plan would alter Medicare Part B, which pays for medicines administered in doctors offices or outpatient hospital clinics — to eliminate incentives for doctors to use the most expensive drugs.

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We’ve been hearing a lot about the politics of health care lately.  In the meantime, many employers are in open enrollment season, making for a confusing month when it comes to health insurance.  And for seniors on Medicare,  November brings the annual dilemma about prescription drugs.