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215-388-2158

Medicare can be confusing.
We can help.

Medicare can be confusing. We can help. Medicare can be confusing. We can help. Medicare can be confusing. We can help.
  • Home
  • New To Medicare?
    • Medicare FAQ's
    • What is Medicare?
    • Turning 65?
    • How to enroll in Medicare
    • Original Medicare
    • Part D RX Drug Plan
  • Medicare 2023
  • Medicare Supplement
    • About Us
    • What is a Medigap?
    • Free Medigap Guide
  • Medicare Advantage
  • Working Past 65
  • D-SNP Dual Special Needs
  • Book an appointment
  • Contact Us
  • Testimonials
  • Prescription Drug Plans
  • Healthcare News
  • Additional Resources
  • Medicare In The News
  • Social Security
  • Resource Center
  • Videos
  • Photo Gallery

medicare in the news

Most who lose Medicaid will shift to employer plans

An AHIP-funded study estimates that 54% of Medicaid beneficiaries who lose coverage during the redetermination process will likely transition to health coverage through an employer, 21% will lose coverage entirely, 15% will transition to the Children's Health Insurance Program and the rest will either join nongroup coverage or shift to coverage through a different public program. Delaware is expected to have the highest percentage of Medicaid beneficiaries transferring to employer-based coverage after disenrollment at 57.1%, while seven states are expected to see uninsured rates ranging from 23.1% to 26.2%, according to the research. Read the full story https://healthpayerintelligence.com/news/americans-who-lose-medicaid-may-choose-employer-sponsored-coverage

Tripathi: Agencies working to support electronic prior authorization

National Coordinator for Health IT Micky Tripathi said the Biden administration is considering new certification requirements for health care provider EHRs to help improve the electronic prior authorization process. Speaking at AHIP's Medicare, Medicaid, Duals & Commercial Markets Forum on Wednesday, Tripathi said the ONC and the CMS are working together to ensure any electronic prior authorization requirements are aligned and to improve interoperability between health care providers and health insurance providers.

Full Story: https://www.fiercehealthcare.com/payers/onc-cms-officials-plot-next-reforms-entice-adoption-electronic-prior-authorization

Research: Primary care is key to population health

Agency for Healthcare Research and Quality data show that 78% of US primary care physicians are practicing in urban regions, causing many patients in outlying areas to have trouble accessing care. Researchers said a higher density of primary care clinicians boosts detection and diagnosis of health conditions and narrows health disparities, while adding 10 primary care physicians per 100,000 residents correlates to a 51.5-day increase in patient life expectancy. US cities with the highest and lowest proportions of primary care clinicians are listed. Full story. https://www.beckershospitalreview.com/rankings-and-ratings/5-cities-with-the-most-fewest-primary-care-providers.html

United Concordia Dental Logo Gets Contemporary Look

United Concordia Dental’s logo is getting a more contemporary look in the coming weeks to signify its evolution and innovation as a company. Full story https://news.unitedconcordia.com/united-concordia-news-releases?item=122496

HHS: 27 Part B drugs subject to new Medicare rebates

HHS has released a list of Part B prescription drugs whose manufacturers will need to pay rebates to Medicare beginning April 1 because their price increases have exceeded the rate of inflation. The list of 27 drugs includes AbbVie's Humira, Pfizer's Fragmin and Kite Pharma's Tecartus. 

Full Story https://news.bloomberglaw.com/pharma-and-life-sciences/abbvie-pfizer-endo-among-drugmakers-tapped-to-repay-medicare

MEdicare in the news

How insurance companies use AI algorithms to cut health care for seniors on Medicare Advantage

 Insurance companies are using algorithms to cut off healthcare to vulnerable seniors subscribed to Medicare  Advantage, the taxpayer-funded alternative to traditional Medicare.

Here & Now's Robin Young hears more from Bob Herman, who covers the business of healthcare for STAT News, the health and medicine publication.

This segment aired on March 15, 2023..Listen to the Podcast https://www.wbur.org/hereandnow/2023/03/15/ai-algorithms-medicare-advantage

Why Medicare is suddenly under debate again

The White House released President Biden's $6.8 trillion proposed budget  last week, listing his priorities for the upcoming fiscal year. Among  other things, Biden singled out Medicare — the federal health insurance  program for people aged 65 or older. Republican leaders insist they  won't be threatening cuts to Medicare in upcoming budget negotiations,  but others in the party have floated the idea of making changes over  time to the program — including benefit cuts they say will be necessary to keep Medicare solvent. Listen to the podcast https://www.npr.org/sections/health-shots/2023/03/14/1163163234/why-medicare-is-suddenly-under-debate-again

Biden budget would raise taxes for some to bolster Medicare

 

…NPR  chief economics correspondent Scott Horsley joins Here & Now‘s  Deepa Fernandes to discuss what’s in the budget that President Biden  releases Thursday, which includes a tax on incomes over $400,000 to fund  Medicare. This article was originally published on WBUR.org. …

Biden says his budget plan would extend Medicare to 2050 without adding to the deficit By Deepa Shi

 President Biden is proposing a tax increase for people who make more  than $400,000 to extend the life of Medicare for another 25 years,  highlighting a major element of his budget proposal which the White  House will release in full on Thursday.. Read the entire article https://www.npr.org/2023/03/07/1161582417/biden-budget-medicare

They could lose the house — to Medicaid

Read the entire article https://www.npr.org/sections/health-shots/2023/03/01/1159490515/they-could-lose-the-house-to-medicaid

How seniors could lose in the Medicare political wars

Read the article https://www.npr.org/sections/health-shots/2023/02/16/1157324177/medicare-political-wars-could-hurt-seniors

medicare in the news

Most with overdue medical bills carry hospital debt

A report from the Robert Wood Johnson Foundation and the Urban Institute found that 15.4% of Americans ages 18 to 64 live in families with past-due health care bills, and 72.9% of those cases involve money owed to a hospital. Researchers examined data from the Health Reform Monitoring Survey with 9,494 respondents, and they found that 60.9% of people who had past-due hospital bills had been contacted by a collections agency, 5.2% had been sued by a hospital, 3.9% said their salaries had been garnished, and 1.9% said their bank account funds had been seized. 

Read More. https://www.beckershospitalreview.com/finance/majority-of-adults-with-past-due-medical-debt-owe-money-to-hospitals.html

Health care staff shortages affecting more Americans

A HealthDay/Harris Poll survey conducted last month found 35% of US adults ages 18 and older have noticed or have been affected by the shortage in health care workers, up from 25% in November, and 52% are concerned that staffing shortages will prevent them from getting necessary health care services. The poll, which included 2,048 respondents, also found that 84% have attempted to get medical care in the last six months, and almost 73% of them said their medical care was delayed or they encountered challenges in getting health care. Read More https://consumer.healthday.com/poll-shows-more-americans-worried-about-health-care-understaffing-2659571765.html

Medicaid stakeholders prioritize continuity of coverage

Roughly 15 million Medicaid enrollees are expected to lose coverage after eligibility redetermination begins next month, and some state Medicaid officials are leaning on health insurance providers to avert a substantial jump in uninsured rates. Officials say insurers offering Medicaid plans have the marketing resources needed and better access to enrollees to reach them with information about finding other coverage, such as through Affordable Care Act exchanges. Read More. https://khn.org/news/article/medicaid-disenrollment-public-health-emergency-insurance-revenue-increase/

Poll: 37% of US adults skip Rx fills because of costs

A survey of 1,500 Americans conducted this month found 37% of US adults have not filled a prescription due to cost, and women and people with less than $50,000 in annual family income were more likely to report doing so. A majority of respondents said they favor government efforts to limit the cost of prescription drugs such as insulin, cancer treatments, antidepressants and blood thinners

Read More . https://thehill.com/changing-america/respect/poverty/3893811-more-than-one-third-of-americans-havent-filled-a-prescription-due-to-cost-survey/.

CDC: US adults should get hepatitis B test, vaccine

The CDC has issued a recommendation that all US adults should be tested for hepatitis B at least once during their lifetime, and all individuals between the ages of 19 and 59 years should get immunized against it. Officials wrote that up to 2.4 million US residents may have the infection, and it can cause "substantial morbidity and mortality," but two-thirds of those who are infected may be unaware of it. Read More. https://www.healio.com/news/infectious-disease/20230309/cdc-recommends-hepatitis-b-testing-for-all-adults

Some prostate cancer may not need treatment

A study of more than 1,600 UK men with localized prostate cancer found their risk of death was low regardless of whether they had surgery or were treated with radiation or actively monitored for up to 21 years after diagnosis. More aggressive treatment did not lower patients' mortality risk from prostate cancer, but it slowed the progression of the disease, researchers reported in the New England Journal of Medicine. Read More https://apnews.com/article/prostate-cancer-treatment-surgery-radiation-study-508ac3025e164ff629b180ebb6113df0

medicare in the news

Women face high out-of-pocket costs for breast cancer treatment

 Women with high deductible health plans or consumer driven health plans experienced higher out-of-pocket costs for breast cancer treatment than those with PPO or EPO plans.

Read More https://healthpayerintelligence.com/news/women-face-high-out-of-pocket-costs-for-breast-cancer-treatment
 

Humana Will Leave Employer Group Insurance Business to Focus on Public Plans

Humana has announced plans to leave the employer group insurance  business and direct its focus toward its government-funded health plan  offerings.  The payer’s employer group commercial medical. Read More  https://healthpayerintelligence.com/news/humana-will-leave-employer-group-insurance-business-to-focus-on-public-plans 

Hospice Enrollment from Community Setting More Common in Medicare Advantage

 Medicare Advantage beneficiaries were more likely to enroll in hospice  from a community setting rather than a hospital or nursing home setting  compared to traditional Medicare beneficiaries, 

Read more. https://healthpayerintelligence.com/news/hospice-enrollment-from-community-setting-more-common-in-medicare-advantage

How the Inflation Reduction Act Impacted Medicare Part D Benefit Design

Medicare Part D plan liability could lead to major changes in benefits  and formulary design for beneficiaries in the coming years, according to  an Avalere study that was funded by PhRMA 

Read more https://healthpayerintelligence.com/news/how-the-inflation-reduction-act-impacted-medicare-part-d-benefit-design

Employer-Sponsored Health Plans Pay More for Drugs than Medicare

 Employer-sponsored health plans paid more than Medicare for most  physician-administered drugs with the highest use and the highest  spending, according to data published in JAMA Health Forum. 

Read More https://healthpayerintelligence.com/news/employer-sponsored-health-plans-pay-more-for-drugs-than-medicare

HHS Introduces Models for Lowering Prescription Drug Spending

 The Department of Health and Human Services (HHS) has released three  models intended to bring down prescription drug spending for consumers  in Medicare and Medicaid. Read More https://healthpayerintelligence.com/news/hhs-introduces-models-for-lowering-prescription-drug-spending

medicare in the news

Eli Lilly said it would cut the price of insulin, capping the monthly out-of-pocket cost of the life

The drugmaker Eli Lilly and Company said on Wednesday that it would significantly reduce the prices of several of its lifesaving insulin products that are used by diabetes patients and whose prices Lilly has repeatedly increased in the past.

Lilly also said it would cap at $35 a month what patients pay out of their own pockets for the company’s insulin.The move marks at least a partial retreat for a company that has been a primary contributor to soaring prices for an injection that millions of Americans rely on to keep their blood sugar levels in check. It comes at a time of mounting political pressure on drug companies to rein in what lawmakers and other critics view as the industry’s pattern of abusive profiteering.

Read the full article https://www.nytimes.com/2023/03/01/business/insulin-price-cap-eli-lilly.html?smid=tw-nytimes&smtyp=cur

More MA plans to offer supplemental services this year

An ATI Advisory analysis found the number of Medicare Advantage plans offering supplemental, non-medical benefits jumped to more than 2,200 this year from over 600 in 2020, the first year these benefits were allowed. A total of 1,091 MA plans will offer in-home support services this year, up more than fourfold since 2020, while 929 plans will offer food deliveries, up from 101 plans.

Full Story: Forbes (tiered subscription model) 

Study links sweetener erythritol to increased CVD risks

 Erythritol, a sugar alcohol often added to reduced-sugar products and sweeteners like stevia and monk fruit, has been linked to blood clotting and a heightened risk of cardiovascular events and mortality, according to a study published in the journal Nature Medicine. Researchers said people with existing heart disease risk factors, including diabetes, who had the highest levels of erythritol in their blood, had double the risk of a heart attack or stroke.

Full Story: CNN  

People with insomnia, diabetes at higher heart attack risk

 A study published in the journal Clinical Cardiology found that people with insomnia had 13% higher odds of experiencing a heart attack, with even greater risk seen in those with insomnia and diabetes. Researchers also found that older adults who had trouble staying or falling asleep had twice the risk of heart attacks compared with non-insomniac counterparts. Read the full story https://consumer.healthday.com/insomnia-2659454105.html

Getting Rehab at Home After Heart Attack Can Extend Lives

f you have had a heart attack, getting cardiac rehab at home could save your life

Patients who did rehab were 36% less likely to die of cardiac complications during a four-year study

But one barrier is lack of insurance coverage, experts say, although a bill before Congress would extend rehab coverage to Medicare and Medicaid patients Read the full article HealthDay https://consumer.healthday.com/cardiac-rehab-2659464316.html

Remote monitoring tech could enhance patient outcomes

The COVID-19 pandemic accelerated the adoption of wearable health trackers, which give clinicians a broader view of patients' health as well as baselines for individuals. Ambient sensors in homes that track biomechanics could help older people remain at home, and a combination of wearables and ambient technology could help patients actively participate in their own care as well as clinical trials and reduce inequalities, writes Brian Anthony, co-director of the Medical Electronic Device Realization Center at MIT. Read the full story https://medcitynews.com/2023/02/how-patient-monitoring-is-poised-to-revolutionize-healthcare/

MEDICARE IN THE NEWS

Humana to exit employer health plan market, focus on government programs

Humana Inc. will exit the employer-based insurance business over the  next 18 to 24 months, to focus primarily on government-backed programs  such as Medicare and its specialty businesses, the insurer announced  Feb. 23, Reuters reports. In 2021, the last full year for which the  company broke out revenues for its group and specialty segment, the  Kentucky-based insurer’s group health business generated revenue of just  under $7 billion, less than 10% of the total revenue of $83 billion.                                     

Insurers: Medicare drug regulations could drive up costs

 Medicare Advantage and Medicare drug plan insurers told the Centers for  Medicaid and Medicare Services that too much regulation at once could  drive up costs and result in increased premiums or fewer benefits, Axios  reports. The public comment closed this week on a proposal to crack  down on Medicare Advantage marketing practices, impose other standards  on Medicare drug plans and create requirements to increase access to  behavioral health and culturally competent care.                                    

Value-based MA plans have better outcomes than Medicare: Optum

Value-based models in Medicare Advantage achieve better patient outcomes  and more efficient care compared to traditional Medicare, according to a  recent study from Optum, reports Fierce Healthcare. The researchers  found that the MA model produced better outcomes and greater efficiency  across all eight metrics studied, including admissions for certain  diseases, avoidable emergency department visits and readmissions.                                     

Hospitals may face reforms of high billing for outpatient services

Hospitals could be playing defense this year as bipartisan scrutiny  builds in Congress over the way facilities charge more for outpatient  services that can be done in less-expensive settings, like a private  doctor's office, Axios reports. So-called site-neutral payment reforms  could save Medicare upward of $100 billion over a decade, according to  various projections, and those with private health insurance could see  savings, too.                                    

CMS pilot programs aim to lower prescription drug costs

The Centers for Medicare and Medicaid proposed on Feb. 14 three new  pilot projects aimed at lowering prescription drug prices for people  enrolled in government health insurance plans, including offering some  essential generic drugs for $2 a month, Reuters reports. The CMS said it  would test the models in the Medicare health program for people aged 65  or over and the disabled and the Medicaid program for the poor.                                     

Denial of inpatient care claims up, especially for Medicare Advantage

Initial denials of inpatient claims filed by providers rose in 2022 with  the highest denial rates coming from Medicare Advantage plans,  according to a report from Crowe Revenue Cycle Analytics, reports  Becker’s Payer Issues. Through November 2022, the dollar value of  initial clinical denials by payers represented 3.2% of billed inpatient  dollars, a rate that is 18.5% percent higher than in 2021

Physician lobby faces political headwinds for higher Medicare payments

The American Medical Association and nearly 100 other physician groups  recently called for "long-term, substantive payment reforms," saying  Medicare payments to clinicians have declined 22% from 2001 to 2021,  when adjusted for inflation, Axios reports. The doctors want an  inflation adjustment built into their rates, to help ensure they can  make enough treating Medicare patients while costs rise.                                     

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AHIP responds to Becerra's remarks on MA payment cuts

AHIP objected to recent statements made by HHS Secretary Xavier Becerra about the impact of the CMS' proposed 2024 Advance Rate Notice for Medicare Advantage and Part D plans, where Becerra said the administration is not proposing cuts to Medicare Advantage. AHIP says changes in the MA risk model, quality bonus payments and benchmarks proposed in the advanced notice will actually lead to a 2.27% cut to average MA rates instead of the 1.03% increase estimated by the CMS, and the rules "will have real-world consequences in 2024 for the more than 30 million seniors and people with disabilities who choose MA -- they will face increased costs and reduced benefits."

Study: Value-based MA models deliver better outcomes than FFS Medicare

A study in JAMA Network Open found value-based Medicare Advantage models deliver better outcomes and efficiency than traditional Medicare across eight metrics examined, including avoidable emergency department visits, readmissions and admissions for certain conditions. The findings, based on data from 316,000 individuals, found MA members in two-sided risk accountable care models had 18% lower odds of hospital admission, among other care metrics, compared with traditional Medicare beneficiaries.

70% of hospitals comply with price transparency rules

About 70% of US hospitals had both a consumer-friendly price display and a machine-readable price file by the end of last year, compared with only 27% in 2021, and 82% of hospitals had one or the other, according to an article in Health Affairs. However, side-by-side price comparisons are still difficult, and some private companies are devising ways to aggregate price information from different hospitals for easier shopping, says Lovisa Gustafsson with The Commonwealth Fund.

COVID-19 vaccines protect heart after breakthrough infection

People who are fully or partially vaccinated against COVID-19 have lower risks for heart attack, stroke and other cardiovascular issues if they subsequently develop COVID-19 than patients with COVID-19 who have not been vaccinated against the disease, researchers reported in the Journal of the American College of Cardiology. Researchers studied data from more than 1.9 million COVID-19 patients and found protection against cardiovascular events related to COVID-19 was associated with both mRNA vaccines and Johnson & Johnson's viral vector vaccine

20 minutes of physical activity may cut admission risk

Research published in JAMA Network Open found adults who increased their physical activity by 20 minutes more per day had lower hospitalization risk for various common illnesses such as stroke and venous thromboembolism. The study, based on data from 81,717 UK Biobank participants ages 42 years to 78 years, "provided evidence that increasing MVPA levels may help to lower hospital burdens

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medicare in the news

COVID as a pre-existing condition

Globally one-fifth of insurers are now treating long COVID as a pre-existing condition, potentially excluding coverage for  individuals’ claims for the condition. This is most evident in Latin  America, where 25% now exclude it. 

CMS Proposes Benefit Expansion for Mobility Devices, Advancing Health Equity for People with Disabil

Proposal supports coverage of power seat elevation equipment for power wheelchairs 

  

The Centers for Medicare & Medicaid  Services (CMS) released a proposed National Coverage Determination (NCD)  decision that would, for the first time, expand coverage for power seat  elevation equipment on certain power wheelchairs toMedicare  individuals. The proposed NCD is open for public comment for 30 days.


“Millions of people with Medicare rely on medically  necessary assistive devices to perform daily tasks that directly impact  their quality of life. CMS remains committed to ensuring persons with  disabilities are receiving available benefits that improve their  health,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s  proposal promotes a first of its kind benefit expansion providing people  with Medicare additional tools to improve their lives.”


If finalized, power seat elevation equipment would be  covered by Medicare for individuals with a Group 3 power wheelchair,  which are designed to meet the needs of people with Medicare with severe  disabilities, in order to improve their health as they transfer from  the wheelchair to other surfaces. Transfers often strain shoulder and  back muscles and constrain an individual’s daily mobility at home and  other customary locations.

HHS Secretary Responds to the President’s Executive Order on Drug Prices

The Centers for Medicare &  Medicaid Services (CMS) announced that the Secretary of the Department  of Health and Human Services (HHS) has selected three new models for  testing by the CMS Innovation Center to help lower the high cost of  drugs, promote accessibility to life-changing drug therapies, and  improve quality of care. The Secretary released a report describing  these three models to respond to President Biden’s Executive Order  14087, “Lowering Prescription Drug Costs for Americans,” which  complements the historic provisions in the Inflation Reduction Act of  2022 (IRA) that will lower prescription drug costs.


“HHS is using every tool available to us to  lower health care costs and increase access to high-quality, affordable  health care,” said HHS Secretary Xavier Becerra. “We are full steam  ahead in delivering the cost savings from the President’s Inflation  Reduction Act of 2022, and people on Medicare are already feeling the  benefits. But as President Biden has made clear, we must build on the  new prescription drug law with further action, which is why HHS is  implementing these new projects to bring down prescription drug costs.”

AHIP strikes back against HHS claims over Medicare Advantage payments Three changes in the Advance

On February 1, the Centers for Medicare and Medicaid Services  released the 2024 Advance Notice for the Medicare Advantage and Part D  Prescription Drug Programs in which CMS said MA plans are expected to  receive a 1.03% increase in revenue.

However, three changes in the rate notice would, on average, cut MA rates in 2024 by 2.27%, AHIP president and CEO Matt Eyles said by statement on Friday.

These three changes include: a 3.12% reduction due to the MA risk  model that accounts for the health status and demographic  characteristics of enrollees; 1.24% lower quality bonus payments under  the Medicare Star Ratings program; and increase benchmarks used to set  maximum payment rates on average by 2.09%, which is less than half the  growth rate in 2023 (4.88%) and well below the projected growth in per  enrollee Medicare costs (5%).    

CMS takes big steps to fix prior authorization in Medicare Advantage

 The AMA and nearly 120 physician organizations are strongly supporting  proposed reforms of prior authorization in Medicare Advantage and the  Medicare prescription drug benefit. 

          

What’s the news: The AMA and  nearly 120 physician organizations are strongly supporting proposed  reforms of prior authorization in Medicare Advantage and the Medicare  prescription drug benefit.

 

The AMA helps physicians build a better future for medicine,  advocating in the courts and on the Hill to remove obstacles to patient  care and confront today’s greatest health crises.

  

The physician organizations sent a letter (PDF) to Centers for Medicare & Medicaid Services (CMS)  Administrator Chiquita Brooks-LaSure thanking her and urging the agency  to finalize proposed reforms that target the inappropriate use of  prior-authorization requirements by Medicare Advantage plans to delay,  deny and disrupt the provision of medically necessary care to patients.

“Physicians appreciate the efforts of CMS to address the significant  and multifaceted challenges that prior authorization requirements pose  to Medicare beneficiaries and physicians,” said AMA President Jack Resneck Jr, MD.  “We applaud CMS for listening to physicians, patients, federal  inspectors, and many other stakeholders, and recognizing a vital need to  rein in Medicare Advantage plans from placing excessive and unnecessary  administrative obstacles between patients and evidence-based  treatments.”

Among other things, CMS should finalize provisions requiring that Medicare Advantage plans:

  • Only use prior authorization to confirm diagnoses or other  medical criteria and ensure the medical necessity of services. That is,  prior authorization is not a tool to be used to delay or discourage  care.
  • Give their beneficiaries access to the same items and services as  they would under traditional Medicare. When no applicable coverage rule  exists under traditional Medicare, plans must use current evidence from  widely used treatment guidelines or clinical literature for internal  clinical coverage criteria, which must then be made publicly available.
  • Establish a utilization-management committee to review their  clinical coverage criteria and ensure consistency with traditional  Medicare guidelines.
  • Not be allowed to deny care ordered by a contracted physician based  on a particular provider type or setting, unless medical necessity  criteria are not met.

Government Lets Health Plans That Ripped Off Medicare Keep the Money

 Medicare Advantage plans for seniors dodged a major financial bullet  Monday as government officials gave them a reprieve for returning  hundreds of millions of dollars or more in government overpayments —  some dating back a decade or more. 


 The health insurance industry had long feared the Centers for Medicare  & Medicaid Services would demand repayment of billions of dollars in  overcharges the popular health plans received as far back as 2011. 


But in a surprise action, CMS announced it would require next to  nothing from insurers for any excess payments they received from 2011  through 2017. CMS will not impose major penalties until audits for  payment years 2018 and beyond are conducted, which have yet to be  started.


While the decision could cost Medicare plans billions of dollars in  the future, it will take years before any penalty comes due. And health  plans will be allowed to pocket hundreds of millions of dollars in  overcharges and possibly much more for audits before 2018. Exactly how  much is not clear because audits as far back as 2011 have yet to be  completed.

MEdicarein the news

MA plan enrollment up by more than 7% this year

New federal data indicate that Medicare Advantage enrollment has grown from 29.1 million last year to nearly 31.2 million this year, an increase of 7.1%. The annual growth rate is at its lowest point in seven years, but the MA plans now cover about half the population of Medicare beneficiaries.

Majority of Medicaid enrollees unaware of eligibility renewals

About 64% of adults enrolled in Medicaid or those with a family member enrolled in the program were not aware that states will resume Medicaid eligibility renewals in April, and awareness was low across the US regardless of geographical location, according to a new survey from the Urban Institute and the Robert Wood Johnson Foundation. As of December 2022, around 16% had heard only a little, 13.9% had heard some, and 5.1% had heard a lot about the resumption of Medicaid renewals.

Study: Surgery prices far higher at hospitals in networks

A study in JAMA Network Open showed the median negotiated prices for certain surgical procedures are substantially higher at hospitals within networks compared with independent hospitals. An analysis of negotiated prices for 16 surgical procedures at 3,195 hospitals showed prices vary widely for each procedure, including prostatectomy, with a median price of $8,601 at independent facilities and $9,567 at facilities within hospital networks.

Medicare Advantage enrollees need less retirement savings for healthcare costs: Report

 Medicare beneficiaries who enroll in a Medicare Advantage plan may need less retirement savings to cover their healthcare costs, an analysis published Feb. 9 by the Employee Benefits Research Institute found. 

The study's authors note that healthcare costs are largely dependent on individual circumstance, but enrollees in Medicare Advantage have lower retirement savings targets than counterparts in traditional Medicare. 

A couple enrolled in a Medigap plan with average premiums would need $212,000 in savings to have a 50 percent chance of affording all their healthcare expenses, and $318,000 saved to have a 90 percent chance of covering all these expenses.

Compared to counterparts in Medigap plans, MA enrollees would need less savings, on average, the study's authors found. 

A couple in a MA plan would need $123,000 in savings to have a 50 percent chance of covering all their healthcare expenses and $184,000 for a 90 percent chance.

New Bill seeks harsher fines for hospitals lacking price transparency

A bill that would implement stricter penalties on hospitals that don't comply with the federal hospital price transparency rules was introduced by Sen. John Kennedy, R-La. The Hospital Transparency Compliance Enforcement Act would double the monetary penalties for noncompliant hospitals, block hospitals from shielding pricing data using webpage coding, require the CMS to release the names of noncompliant facilities and give noncompliant hospitals 60 days to pay their financial penalties after receiving notice of noncompliance 

CBO warns of sharp uptick in Social Security, Medicare spending

Federal spending on Social Security and Medicare is projected to outpace revenues and the economy over the next decade, with combined spending projected to nearly double by 2033, according to the Congressional Budget Office. The CBO also said Social Security will face a funding gap by 2032, which is two years sooner than earlier forecasts. 

Medicare In the news

Before you enroll in Medicare, what to know about new rules that eliminate coverage gaps

 As of this year, people new to Medicare won’t face big delays in coverage — an unenviable situation that some beneficiaries used to find themselves in.

Thanks to legislation passed in late 2020, months-long delays in certain Medicare enrollment circumstances are now eliminated. Additionally, individuals who missed signing up when they were supposed to due to “exceptional circumstances” may qualify for a special enrollment period.

Signup rules for Medicare can be tricky

Medicare’s enrollment rules can be confusing. People who are already receiving Social Security benefits before the reach age 65 — which is when you become eligible for Medicare — are automatically enrolled in Part A (hospital coverage) and Part B (outpatient care coverage).

Otherwise, you are required to sign up during your “initial enrollment period” when you hit age 65 unless you meet an exception, such as having qualifying health insurance through a large employer (20 or more workers).

Initial enrollment period gap is eliminated

 Your initial enrollment period starts three months before your 65th birthday and ends three months after it (seven months total). The new rule makes it so coverage takes effect the month after you sign up if you do so in the latter part of that enrollment window. In the past, some beneficiaries waited up to three months for coverage to take effect.

If you enroll before the month you turn 65, coverage starts the first of your birthday month (that hasn’t changed).

Cancer death rates fall steadily in the US, with more survivors than ever

Cancer  is the second leading cause of death and even with recent clinical  innovation, it remains costly and complex to treat. A steady decline in  death rates is a significant milestone in the fight against this disease  and shows that commitments to end smoking can have an impact. 

Penalties may still apply for some late enrollment

If you miss your initial enrollment period and don’t qualify for a special enrollment period, you generally can only sign up during the first three months of the year during a “general enrollment period.”

Going that route also has meant waiting until July 1 for coverage to take effect. Starting this year, it will be effective the month after you sign up.

‘Exceptional’ situations may result in special enrollment

Starting this year, individuals may be able to sign up outside of current enrollment periods if they have “exceptional circumstances.” This is already a flexibility available with Part D, as well as Medicare Advantage Plans (which deliver Parts A and B and usually D), Schwarz said.

“It’s really designed to provide relief for people who are impacted by exceptional situations and need access to health insurance,” she said.

Additionally, beneficiaries who qualify for the special enrollment period will not face Part B late enrollment penalties.          .

Medicare Advantage Plans Now Cover Close to Half of Beneficiaries

Soon more than half of Americans who get their hospital and medical  coverage through Medicare are likely to be enrolled in Medicare  Advantage (MA), the private insurance alternative to the government-run  coverage, according to a new analysis by the Kaiser Family Foundation (KFF).

       

Of the nearly 59 million people who get their health care  from both Medicare’s Part A, which covers hospital care, and Part B,  which covers doctor visits and other outpatient services, 48 percent now  get their coverage through a Medicare Advantage (MA) plan, according to  the KFF findings.

Medigap Plans Help Bridge Gap of Original Medicare Costs

 If you decide to enroll in original Medicare, one way you can help  pay the extra costs the program doesn’t cover is to buy a supplemental —  or Medigap — insurance policy.

Private insurers sell Medigap policies, but states and the federal  government strictly regulate them. These plans are available for people  enrolled in Medicare parts A and B, not for those who elect a Medicare  Advantage plan. Medigap plans pay for costs such as deductibles and  copays and other charges that Medicare doesn’t cover.


 In 2010 the federal government standardized the types of Medigap plans,  creating 10 options designated by A, B, C, D, F, G, K, L, M and N. In  January 2020 two of the more comprehensive and popular plans, C and  F, ceased to be available to people newly eligible for the  program. That’s because in 2015, Congress decided to prohibit Medigap  from covering the annual deductible for Part B, which pays for doctor  visits and other outpatient services. 

Choosing a Medigap Plan

Don’t get confused by the way these policies are named. The Medigap  policies’ letter designations have nothing to do with which Medicare  program you chose.

Because the Medigap plans are standardized, an A or F plan sold by  one insurer covers the same things as an A or F plan from another  insurer. 


Medigap plans are consistent in all but three states:  Massachusetts, Minnesota and Wisconsin have their own standard policies.

So how do the 10 policies differ? “Some are high deductible, some  require higher cost-sharing, and some cover more costs,” says Mary  Mealer, life and health manager at the Missouri Department of Insurance,  Financial Institutions & Professional Registration. Consumers  should “evaluate their individual situation as to what plan meets their  needs and what they can afford.”

How to Find, Enroll in a Medicare Advantage Plan

If your 65th birthday is approaching, or if you are thinking of retiring it may be time to start thinking about what kind of Medicare coverage you’ll need.
 

You have two choices: original Medicare, the government-run program  that includes Part A hospitalization coverage and Part B doctor and  outpatient services; or a Medicare Advantage Plan. These plans bundles together Parts A and B and usually adds Part D prescription drug coverage.

       

Private insurers sell Medicare Advantage plans, also known as  Part C. Some plans help pay for certain services that original Medicare  doesn’t cover, such as routine dental, hearing and vision care.

CMA sets 2.09% rate increase for Medicare Advantage plans in 2024

Medicare Advantage plans are in line for a 2.09% rate increase in 2024,  the Centers for Medicare & Medicaid Services said in a notice, Axios  reports. The adjustment is driven by growth in Medicare fee-for-service  costs. But analysts said the bump is offset by other policy changes  that would translate into a net reduction of 2.27%.                                    

Medicare In the news

Almost 40% of US households affected by tripledemic

About 40% of US households were affected by the tripledemic of COVID-19, influenza and respiratory syncytial virus during the holiday season, with at least one person in the household getting infected with one of the respiratory viruses, according to a Kaiser Family Foundation survey. Flu affected 27% of households, while COVID-19 and RSV affected 15% and 10% of households, respectively, during the holidays, but the tripledemic has since declined, with flu, COVID-19 and RSV cases all down recently.

Biden calls for permanent expansion of ACA tax credits

During his State of the Union address Tuesday, President Joe Biden called on Congress to permanently extend the enhanced Affordable Care Act tax credits and to expand the $35 monthly cap on insulin costs to all Americans and not just those on Medicare. Biden vowed to protect Medicare and Social Security by not allowing any spending cuts to either program as part of any deal to raise the debt ceiling, and he indicated he will unveil a provision to extend the Medicare Trust Fund by at least 20 years.

Study links extreme weather to risk of CV-related death

 A study in the journal Circulation linked exposure to extreme hot or cold weather to an additional 11.3 cardiovascular-related deaths among patients with heart disease for every 1,000 incidents. Researchers said patients with heart failure had a higher risk of negative effects from extreme weather when compared with patients who had other types of heart disease. The study included data on more than 32 million cardiovascular deaths in 27 countries between 1979 and 2019.

Cancer death rates fall steadily in the US, with more survivors than ever

Cancer  is the second leading cause of death and even with recent clinical  innovation, it remains costly and complex to treat. A steady decline in  death rates is a significant milestone in the fight against this disease  and shows that commitments to end smoking can have an impact. 

Social Security Increase 2023

Finally, some good news. Social Security is set to increase for next year! The most recent estimate is ~8.7% for 2023.


Like the Medicare Part B increases, the final amounts are just speculation for now and will be announced on October 13th. Everyone on Social Security will get the increase. It doesn’t matter what type of benefit you are getting, you will get the increase in your January check. Stay tuned for more.

AHIP blasts government plan to pursue Medicare Advantage overpayments

The America's Health Insurance Plans trade group blasted the Biden  administration for finalizing a rule that seeks to claw back millions of  dollars from health insurers through Medicare Advantage audits that  will apply retroactively to payments beginning in 2018, Healthcare Dive  reports. AHIP called the final rule “unlawful” and “fatally flawed” in a  Jan. 30 statement following the its release by the Centers for Medicare  & Medicaid Services.                                    .

Biggest Medicare Changes for 2022

The  biggest change Medicare's nearly 64 million beneficiaries will see in  the new year is higher premiums and deductibles for the medical care  they'll receive under the federal government's health care insurance  program for individuals age 65 and older and people with disabilities.

   
Medicare's benefits will remain largely the same in 2022. As the new  year begins, Congress is still debating several proposals that would  change the face of Medicare, including adding a hearing benefit and several proposals to lower the price of prescription drugs,  including capping out-of-pocket costs in Part D plans. But even if  Congress adopts these changes, they wouldn't take effect this year.

Medicare Advantage Plans Now Cover Close to Half of Beneficiaries

Soon more than half of Americans who get their hospital and medical  coverage through Medicare are likely to be enrolled in Medicare  Advantage (MA), the private insurance alternative to the government-run  coverage, according to a new analysis by the Kaiser Family Foundation (KFF).

       

Of the nearly 59 million people who get their health care  from both Medicare’s Part A, which covers hospital care, and Part B,  which covers doctor visits and other outpatient services, 48 percent now  get their coverage through a Medicare Advantage (MA) plan, according to  the KFF findings.

Medigap Plans Help Bridge Gap of Original Medicare Costs

If you decide to enroll in original Medicare, one way you can help  pay the extra costs the program doesn’t cover is to buy a supplemental —  or Medigap — insurance policy.

Private insurers sell Medigap policies, but states and the federal  government strictly regulate them. These plans are available for people  enrolled in Medicare parts A and B, not for those who elect a Medicare  Advantage plan. Medigap plans pay for costs such as deductibles and  copays and other charges that Medicare doesn’t cover.


In 2010 the federal government standardized the types of Medigap plans,  creating 10 options designated by A, B, C, D, F, G, K, L, M and N. In  January 2020 two of the more comprehensive and popular plans, C and  F, ceased to be available to people newly eligible for the  program. That’s because in 2015, Congress decided to prohibit Medigap  from covering the annual deductible for Part B, which pays for doctor  visits and other outpatient services. 

Choosing a Medigap Plan

Don’t get confused by the way these policies are named. The Medigap  policies’ letter designations have nothing to do with which Medicare  program you chose.

Because the Medigap plans are standardized, an A or F plan sold by  one insurer covers the same things as an A or F plan from another  insurer. 


Medigap plans are consistent in all but three states:  Massachusetts, Minnesota and Wisconsin have their own standard policies.


So how do the 10 policies differ? “Some are high deductible, some  require higher cost-sharing, and some cover more costs,” says Mary  Mealer, life and health manager at the Missouri Department of Insurance,  Financial Institutions & Professional Registration. Consumers  should “evaluate their individual situation as to what plan meets their  needs and what they can afford.”

How to Find, Enroll in a Medicare Advantage Plan

If your 65th birthday is approaching, or if you are thinking of retiring it may be time to start thinking about what kind of Medicare coverage you’ll need.
 

You have two choices: original Medicare, the government-run program  that includes Part A hospitalization coverage and Part B doctor and  outpatient services; or a Medicare Advantage Plan. These plans bundles together Parts A and B and usually adds Part D prescription drug coverage.

       

Private insurers sell Medicare Advantage plans, also known as  Part C. Some plans help pay for certain services that original Medicare  doesn’t cover, such as routine dental, hearing and vision care.

CMA sets 2.09% rate increase for Medicare Advantage plans in 2024

Medicare Advantage plans are in line for a 2.09% rate increase in 2024,  the Centers for Medicare & Medicaid Services said in a notice, Axios  reports. The adjustment is driven by growth in Medicare fee-for-service  costs. But analysts said the bump is offset by other policy changes  that would translate into a net reduction of 2.27%.                                    

Medicare In the news

Medicare Advantage enrollment explodes in last 15 years

Enrollment in Medicare Advantage has exploded over the past 15 years, a  new study shows, reports Fierce Healthcare. From 2006 to 2022, MA  enrollment increased by 337% as enrollment in traditional Medicare  declined by 2.9%, according to a study in Health Affairs. Meanwhile, the  number of Medicare beneficiaries grew to about 63 million in 2022 from  41.8 million in 2006.                                    

Employers pay more for top drugs than Medicare plans, report shows

 Employer-sponsored health plans pay significantly more than Medicare for  costly physician-administered drugs, threatening access to lifesaving  treatments, according to a newly published analysis of claims data and  Medicare files, reports Axios. Price markups increased between 2016 and  2020 for five of the top 10 drugs that account for the most spending and  more than doubled for three: the white blood cell-booster pegfilgrastim  and the cancer drugs trastuzumab and rituximab, according to a report  by the Health Care Cost Institute published in JAMA Health Forum.                                      

Study finds 6% of Medicare Advantage prior authorization requests denied

Medicare Advantage insurers denied or partially denied 2 million – or 6%  -- of more than 35 million prior authorization requests in 2021, of  which about 2 million, or 6%, according to an analysis by Kaiser Family  Foundation, reports Axios. Medicare Advantage plans have previously come  under fire for denying too many services which should have been paid  for under Medicare coverage rules.                                    
 

Audits show widespread overcharges by Medicare Advantage plans

Newly released federal audits reveal widespread overcharges and other  errors in payments to Medicare Advantage health plans for seniors, with  some plans overbilling the government more than $1,000 per patient a  year on average, reports Fierce Healthcare. The government’s  audits uncovered about $12 million in net overpayments for the care of  18,090 patients sampled, though the actual losses to taxpayers are  likely much higher.                                    

Cancer death rates fall steadily in the US, with more survivors than ever

Cancer  is the second leading cause of death and even with recent clinical  innovation, it remains costly and complex to treat. A steady decline in  death rates is a significant milestone in the fight against this disease  and shows that commitments to end smoking can have an impact. 

Medicare Will Not Lower Part B Premium in 2022

 Medicare's Part B $170.10 basic monthly premium will not be reduced  this year, but instead any savings from lower spending will be passed on  to beneficiaries in 2023.

U.S. Health and Human Services Secretary Xavier Becerra had ordered  the Centers for Medicare and Medicaid Services (CMS) to reassess its  record-high premium increase in 2022 for Part B, which covers doctor  visits, diagnostic tests and other outpatient services. The $21.60 basic  premium hike in 2022 was the largest dollar increase in the health  insurance program’s history.
 

Among the reasons CMS gave for the outsize increase was that it  needed to set aside money in its reserves in the event it decided to  cover Aduhelm, the new Alzheimer’s drug approved in June by the U.S.  Food the Drug Administration (FDA). At the time, Biogen, the  medication’s manufacturer, estimated the drug’s price would be $56,000 a  year. After considerable pushback, Biogen cut its price estimate  roughly in half, saying the drug would cost $28,200 annually effective  Jan. 1, 2022. Also, since the premium increase was announced, CMS  decided that Medicare coverage of Aduhelm will be limited to  beneficiaries enrolled in approved clinical trials.

Social Security Increase 2023

Finally, some good news. Social Security is set to increase for next year! The most recent estimate is ~8.7% for 2023.


Like the Medicare Part B increases, the final amounts are just speculation for now and will be announced on October 13th.

Everyone on Social Security will get the increase. It doesn’t matter what type of benefit you are getting, you will get the increase in your January check. Stay tuned for more.

Biggest Medicare Changes for 2022

 The  biggest change Medicare's nearly 64 million beneficiaries will see in  the new year is higher premiums and deductibles for the medical care  they'll receive under the federal government's health care insurance  program for individuals age 65 and older and people with disabilities.

   
Medicare's benefits will remain largely the same in 2022. As the new  year begins, Congress is still debating several proposals that would  change the face of Medicare, including adding a hearing benefit and several proposals to lower the price of prescription drugs,  including capping out-of-pocket costs in Part D plans. But even if  Congress adopts these changes, they wouldn't take effect this year.

Medicare Advantage Plans Now Cover Close to Half of Beneficiaries

Soon more than half of Americans who get their hospital and medical  coverage through Medicare are likely to be enrolled in Medicare  Advantage (MA), the private insurance alternative to the government-run  coverage, according to a new analysis by the Kaiser Family Foundation (KFF).

       

Of the nearly 59 million people who get their health care  from both Medicare’s Part A, which covers hospital care, and Part B,  which covers doctor visits and other outpatient services, 48 percent now  get their coverage through a Medicare Advantage (MA) plan, according to  the KFF findings.

Medigap Plans Help Bridge Gap of Original Medicare Costs

If you decide to enroll in original Medicare, one way you can help  pay the extra costs the program doesn’t cover is to buy a supplemental —  or Medigap — insurance policy.

Private insurers sell Medigap policies, but states and the federal  government strictly regulate them. These plans are available for people  enrolled in Medicare parts A and B, not for those who elect a Medicare  Advantage plan. Medigap plans pay for costs such as deductibles and  copays and other charges that Medicare doesn’t cover.


 In 2010 the federal government standardized the types of Medigap plans,  creating 10 options designated by A, B, C, D, F, G, K, L, M and N. In  January 2020 two of the more comprehensive and popular plans, C and  F, ceased to be available to people newly eligible for the  program. That’s because in 2015, Congress decided to prohibit Medigap  from covering the annual deductible for Part B, which pays for doctor  visits and other outpatient services. 

Choosing a Medigap Plan

 Don’t get confused by the way these policies are named. The Medigap  policies’ letter designations have nothing to do with which Medicare  program you chose.

Because the Medigap plans are standardized, an A or F plan sold by  one insurer covers the same things as an A or F plan from another  insurer. 


Medigap plans are consistent in all but three states:  Massachusetts, Minnesota and Wisconsin have their own standard policies.

So how do the 10 policies differ? “Some are high deductible, some  require higher cost-sharing, and some cover more costs,” says Mary  Mealer, life and health manager at the Missouri Department of Insurance,  Financial Institutions & Professional Registration. Consumers  should “evaluate their individual situation as to what plan meets their  needs and what they can afford.”

Arbitrator: NYC should shift to Medicare Advantage for retirees

An arbitrator is directing New York City to quickly move ahead with a  plan to transfer some 250,000 municipal retirees from their current  Medicare coverage to a Medicare Advantage plan operated by Aetna Inc. –  despite ongoing and persistent efforts by some retirees to block the  move, Gothamist reports. The switch was proposed in 2018 to save the  city about $600 million annually thanks to federal subsidies available  to Medicare Advantage plans, according to city estimates.                                     

MEDICARE IN THE NEWS

Patina Health inks deals with insurers to provide senior home care

Patina Health, a startup providing in-home care for older adults, is  expanding to serve members of Aetna Inc., UnitedHealth Group Inc. and  Cigna Corp. Medicare Advantage plans, reports Becker’s Payer Issues. The  startup, based in Bala Cynwyd, Pennsylvania, was previously only  available to Independence Blue Cross Medicare Advantage members.                                     

HHS Secretary Responds to the President’s Executive Order on Drug Prices

 Action announces new models and supports access to $2 generic drugs

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the Secretary of the Department of Health and Human Services (HHS) has selected three new models for testing by the CMS Innovation Center to help lower the high cost of drugs, promote accessibility to life-changing drug therapies, and improve quality of care. The Secretary released a report describing these three models to respond to President Biden’s Executive Order 14087, “Lowering Prescription Drug Costs for Americans,” which complements the historic provisions in the Inflation Reduction Act of 2022 (IRA) that will lower prescription drug costs.

New CMS rule strengthens various Medicare Advantage elements

A new Center for Medicare and Medicaid Services rule designed to  strengthen Medicare Advantage is generating positive feedback for its  proposal to streamline the prior authorization process, expand access to  behavioral health care, make prescription drugs more affordable and  stop misleading advertising, reports Healthcare Dive. Among other  changes, the rule released Dec. 14 would revise prior authorization  requirements to reduce disruption for enrollees, so that an approval  would remain valid for a full course of treatment.                                    

GAO urges faster background checks on providers in Medicare program

A government watchdog agency is urging federal health regulators to  speed up checks on providers and conduct background checks after raising  concerns about the risk for fraud during the coronavirus pandemic,  reports Healthcare Dive. The Center for Medicare and Medicaid Services  relaxed provider enrollment requirements during the pandemic to ensure  continuity for both providers and enrollees during the public health  emergency.                                    

FCC OKs robocalls, texts to communicate Medicare eligibility changes

Managed care plans and states can now deliver robocalls and texts to  Medicaid beneficiaries without fear of violating a federal law, a  critical change as states face eligibility redeterminations in a few  months, Fierce Healthcare reports. The Federal Communications Commission  released new guidance Jan. 24 on the change after getting a letter from  the Department of Health and Human Services back in April 2022.                                     

Medicare Advantage audit rules could result in clawbacks from insurers

The nation's largest health insurers are gearing up for upcoming changes  to Medicare Advantage risk adjustment rules that could collectively  cost them up to $3 billion in returned payments, Bloomberg reported Jan.  24, according to Becker’s Payer Issues. To date, nearly every major  insurer has been accused of exploiting the program through elaborate  "upcoding" schemes that make patients appear sicker on medical records  than they are – thereby leading to higher payments from the Centers for  Medicare & Medicaid Service

Medicare Blog

Preliminary data from the CDC's National Center for Health Statistics showed 8% of the US population lacked health insurance in the first quarter this year, compared with 9.5% in the same period last year. The US uninsured rate, however, could increase again with the expiration of enhanced Affordable Care premium subsidies and the return of Medicaid eligibility redeterminations once the COVID-19 public health emergency ends. 


    We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov 

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