CBO: Medicare Part A Trust Fund Bust in 2040
The Congressional Budget Office (CBO) has updated its estimates around the solvency of the Medicare Part A Trust Fund and now expects the fund to go bust in 2040. The balance will grow each year through 2031, but then spending will begin to overtake revenue until it eventually runs out in 2040. This is 12 years less than the last estimate.
The culprits are:
- Lower taxes in the One Big Beautiful Bill Act (OBBBA).
- Accelerating medical cost and spending in both traditional Medicare and Medicare Advantage (MA).
The CBO’s projection is better than the Medicare’s trustees’ last projection, which said the fund would be depleted by 2033.
Additional article: https://www.fiercehealthcare.com/regulatory/cbo-estimates-medicare-trust-fund-will-run-out-2040
#medicare #spending #insolvency
https://www.healthcaredive.com/news/medicare-trust-fund-expire-2040-cbo-gop-obbb/812937
UnitedHealthcare Expands Referral Requirements
Starting May 1, enrollees in UnitedHealthcare health maintenance organization (HMO) Medicare Advantage (MA) products will need a referral from a primary care provider to go to many specialists. This brings back an old-school managed care lever to reduce costs.
The prerequisite has already been in place in six states and now will go to the remaining 37 states where United has MA. Numerous specialists are exempt.
#referral #medicareadvantage #providers
https://www.medpagetoday.com/publichealthpolicy/medicare/119958
CT Sees Highest Exchange Enrollments
Bucking the trend, Connecticut enrolled a record 157,246 residents in the Exchanges for 2026, a 4% increase over last year. The state expanded its outreach navigator program to six locations, added mobile enrollment specialists, extended open enrollment, and is temporarily making up for the drop in national subsidy enhancements.
#exchanges #healthcare #coverage
https://www.beckerspayer.com/payer/aca/connecticut-bucks-national-trend-with-record-aca-enrollment/
Becker’s On Heath Systems Debating MA
Becker’s Payer has a good article on the various fights between health systems and Medicare Advantage (MA) plans. As penetration of MA rises, hospitals become very reliant on the revenue, but some have exited due to prior authorization (PA), delayed claims, and lower overall revenue. Different strategies have emerged as to how hospitals engage with MA plans. About 90 systems have terminated with MA plans in the recent past, with 15 for the 2026 plan year.
#medicareadvantage #hospitals #priorauthoriation #claimsdenials
https://www.beckerspayer.com/payer/medicare-advantage/medicare-advantages-sunk-cost-problem/
Novo Nordisk Lowers GLP-1 Costs
Novo Nordisk announced it will slash the list price of its GLP-1 medications — Ozempic, Wegovy, and Rybelsus, by up to 50 percent beginning next year. The list price for the drugs will be $675 across the board in the U.S.
The changes are driven by a few issues – drug price deals with President Trump, the new most-favored-nation models proposed by the president, and its slumping revenue due to being out-competed by competitor Eli Lilly’s GLP-1s.
#drugpricing #weightlossdrugs #glp1s
https://thehill.com/policy/healthcare/5752255-novo-nordisk-cuts-drug-prices
KFF Examines TrumpRx
Excellent briefer from healthcare policy group KFF on TrumpRx. It is a solid analysis and resource examining when TrumpRx could provide people relief from very high drug costs. It examines various scenarios as to whether someone is insured or not, whether given drugs are covered or on/off formulary, and whether generic equivalents are available. It also mentions how deductibles tie into use of drugs outside of insurance. In some cases, going to TrumpRx makes no sense. In others it very well could.
In general, I have given President Trump credit for moving fast on lowering drug costs. But people have to act cautiously in this transition to lower costs to ensure they are leveraging the right savings — TrumpRx, insurance, other discounts, or patient assistance. Always consider whether an exact generic is cheaper even with a brand discount of some sort. It is still an ugly, complex world.
#drugpricing #branddrugmakers #trumprx
— Marc S. Ryan
