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Medicare and Medicaid fraud involves illegal practices like billing for unprovided services, unnecessary tests, and receiving ineligible benefits, costing taxpayers over $146 billion annually. Fraud can be committed by medical professionals, facilities, patients, or impersonators. Medicaid Fraud Control Units investigate these cases across all states and territories. Penalties include fines, prison, and loss of benefits. The CARES Act expanded coverage and telehealth flexibility for COVID-19.

Medicare will discontinue a key service in 2026, affecting many beneficiaries. Recipients should review their coverage, monitor official updates, consult healthcare providers about alternatives, and consider supplemental insurance plans to cover services no longer provided. Staying informed will help ensure a smooth transition when the change occurs.

Medicare Advantage plans offer an alternative to Original Medicare, often including additional benefits like prescription drugs, hearing, and vision coverage. They typically have lower deductibles and out-of-pocket maximums than Original Medicare plus Medigap. You can switch between plans annually, even with pre-existing conditions. Original Medicare isn't free and has limited coverage, so comparing options is essential to find the best fit for your health needs.

IRMAA is an extra Medicare Part B and D surcharge for high-income retirees, based on Modified Adjusted Gross Income from two years prior. In 2026, standard Part B premiums are $202.90, but higher earners pay 35%-85% more. Even $1 over the threshold triggers IRMAA, though appeals are possible after life changes. Planning, like Roth IRA conversions, can reduce future IRMAA costs but requires careful timing.

Starting in 2027, prices for 15 high-cost Medicare Part D drugs, including treatments for cancer, diabetes, and respiratory diseases, will be significantly reduced by about 44%. This second round of price negotiations under the Inflation Reduction Act is expected to save Medicare $12 billion and beneficiaries $685 million in out-of-pocket costs. The program aims to improve drug affordability and access for millions of Medicare patients.

This winter, Medicare claim denials are rising due to tighter scrutiny on duplicate claims, stricter coding, out-of-network services, durable medical equipment, preventive services, telehealth, and increased documentation requests. Seniors face delays and financial strain, especially during high-demand seasons. Staying organized, verifying coverage, and maintaining clear communication with providers can help retirees manage these challenges and reduce denial risks.