Social Security: An experienced acting commissioner is now in charge
One of Trump’s actions on the first day of his return to the White House could affect the operational aspects of Social Security. He named multiple acting cabinet members and department heads, including selecting Michelle King as the acting commissioner of the Social Security Administration (SSA). King has an extensive background at the SSA. She joined the agency in 1994 as a bilingual claims representative. Through the years, she moved into higher positions. Before being named acting commissioner, she was the deputy commissioner for operations.
Medicare : There have been several recent changes to Medicare that are worth noting:
- Telehealth Coverage: The Telehealth Coverage Act has been introduced to extend Medicare’s telehealth services, which were set to expire at the end of March 2025. This extension is particularly important for rural areas where access to medical facilities can be challenging1.
- Cost Adjustments: Starting January 1, 2024, the standard Part B monthly premium increased to $174.70, and the annual deductible rose to $240. Additionally, income-related monthly adjustment amounts (IRMAA) for higher-income beneficiaries have also increased2.
- Prescription Drug Costs: In 2025, Medicare will cap out-of-pocket costs for Part D prescription drugs at $2,000 per year. This change aims to reduce the financial burden on beneficiaries who require expensive medications3.
- Medicare Advantage Plans: Some Medicare Advantage plans have reduced services to compensate for lower government payments. However, there are also expansions in coverage for mental health services, cardiovascular risk assessments, and dental care linked to Medicare-covered treatment
- The new $2,000 cap on out-of-pocket prescription drug costs under Medicare is a significant change that will benefit many patients. Here’s what it means: Financial Relief: Patients will no longer have to pay more than $2,000 per year for their prescription medications. This cap is expected to save many seniors hundreds or even thousands of dollars annually . Elimination of the “Donut Hole”: The coverage gap, often referred to as the “donut hole,” has been eliminated. Previously, patients had to pay a higher percentage of their drug costs after reaching a certain threshold until they hit another limit. Now, once they reach the $2,000 cap, their plan will cover all further prescription drug costs. Predictable Costs: Patients can now plan their finances better, knowing that their maximum out-of-pocket expense for prescription drugs will be capped at $2,000. This predictability is especially beneficial for those on fixed incomes. Spreading Costs: Medicare will also offer an option to spread out the cost of medications over the year, rather than paying large sums all at once. This can help patients manage their budgets more effectively. Overall, this change aims to reduce the financial burden on Medicare beneficiaries, making it easier for them to afford necessary medications and improving their overall health and well-being.
These changes are part of ongoing efforts to improve Medicare services and make healthcare more accessible and affordable for beneficiaries.
Medicaid:
There have been several significant changes to Medicaid recently:
- Funding Cuts: The House Budget 2025 bill proposes $880 billion in cuts to Medicaid funding. This could lead to reduced coverage, benefits, and stricter eligibility requirements for millions of Americans.
- Work Requirements: There is a push to reinstate work requirements for Medicaid recipients. This means that non-disabled adults would need to work or qualify for an exemption to maintain their health insurance.
- State Flexibility: States may gain more flexibility in managing their Medicaid programs. This could include changes to how states fund their share of Medicaid expenditures and increased authority over program management.
- Program Integrity: Enhanced oversight and cost containment measures are being proposed to ensure the integrity of the Medicaid program. This includes stricter verification processes and regulatory changes affecting healthcare delivery systems.
Medicaid has undergone numerous changes since its inception in 1965. Here’s a comparison of recent changes with past policies:
- Funding Structure:
- Past: Medicaid was initially funded through a federal-state partnership, with the federal government matching state expenditures based on qualifying healthcare services.
- Recent: There are proposals to transition to block grants or per-capita funding models, which would provide states with fixed federal funding amounts adjusted annually for inflation.
- Eligibility Requirements:
- Past: The Affordable Care Act (ACA) expanded Medicaid eligibility to individuals under age 65 with incomes below 133% of the Federal Poverty Level (FPL).
- Recent: There is a push to reinstate work requirements for Medicaid recipients, meaning non-disabled adults would need to work or qualify for an exemption to maintain their health insurance.
- State Flexibility:
- Past: States have always had some flexibility in managing their Medicaid programs, but the ACA standardized rules for determining eligibility and providing benefits.
- Recent: States may gain more flexibility in managing their Medicaid programs, including changes to how they fund their share of Medicaid expenditures and increased authority over program management.
- Program Integrity:
- Past: Medicaid has had various oversight and cost containment measures to ensure program integrity.
- Recent: Enhanced oversight and cost containment measures are being proposed, including stricter verification processes and regulatory changes affecting healthcare delivery systems.
- Coverage and Benefits:
- Past: Medicaid has evolved to cover over 79 million people, with significant enrollment growth due to the ACA and COVID-19.
- Recent: Proposed funding cuts and changes could lead to reduced coverage, benefits, and stricter eligibility requirements for millions of Americans.
These changes are part of ongoing efforts to reform Medicaid and address budgetary concerns. However, they could also have significant impacts on healthcare access for millions of Americans.
Sources
https://www.medicaid.gov/about-us/program-history/index.html?form=MG0AV3&form=MG0AV3