Fewer drugs become eligible for Medicare drug price negotiation under the orphan drug exclusion
Potential Impact — May lead to higher Medicare and patient out-of-pocket costs that reduce visits or treatment options.
Medicare
Lawfully present immigrants — including refugees, asylees, and humanitarian parolees — are ineligible for Medicare
Potential Impact —Reduced visits or an increase in uncompensated care as people lose access to coverage.
Temporary 2.5% payment increase under the Medicare PFS ends
Potential Impact — An end to short-term relief from ongoing reimbursement challenges.
Temporary 2.5% payment increase under the Medicare PFS ends Read More »
Around January 22: Possible sequestration of Medicare funds due to OBBBA’s effect on federal deficit
Potential Impact — May lead to automatic cuts to Medicare of roughly $500 billion from 2026 to 2034 and $45 billion in 2026 alone and lead to reduced reimbursements to providers.
Temporary 2.5% payment increase under the Medicare physician fee schedule (PFS) through January 1, 2027 begins
Potential Impact — Some short-term relief from ongoing reimbursement challenges.
In Effect Prior to September 2025: End to enforcement of CMS rule on:
Medicare Savings Program (MSP) eligibility and enrollment, making it easier for Medicare recipients to enroll in MSPs Medicaid, CHIP, and the Basic Health Program prohibition, making enrollment easier for Medicare recipients Potential Impact — Possible decrease in Medicare recipients in MSPs, Medicaid, Chip and the Basic Health Program.
In Effect Prior to September 2025: End to enforcement of CMS rule on: Read More »