The Biden administration introduced Tuesday that it’s proposing a lot of adjustments to non-public Medicare plans designed to alleviate protection boundaries, put guardrails round using synthetic intelligence, and guarantee entry to behavioral well being suppliers and supplemental advantages.
The proposed rule would additionally handle deceptive advertising practices by Medicare Advantage plans, inaccurate supplier directories, and vertical integration among the many insurers that provide the plans, which cowl over half of Medicare beneficiaries. The rule, which would take impact in 2026, additionally seeks to expand Medicare coverage for the blockbuster weight reduction medicine Wegovy and Zepbound for weight problems.
In a information launch asserting the adjustments, Medicare stated that information reported to the company present that on common, Medicare Advantage plans overturn 80% of their choices to deny claims when these denials are appealed. The information additionally present that fewer than 4% of denied claims are appealed within the first place. In the end, what these and different information present is that Medicare Advantage enrollees is probably not getting entry to the care they want, the discharge stated.
This text is unique to STAT+ subscribers
Unlock this text — plus day by day market-moving biopharma evaluation — by subscribing to STAT+.
Have already got an account? Log in
To learn the remainder of this story subscribe to STAT+.