Medicare coverage of  Hospice, Palliative & respite care

Trump  Make America Healthy Again

• The Supreme Court has determined that health insurance plans under the Affordable Care Act (ACA), also known as Obamacare, must continue to fully cover preventative services, including cancer screenings, HIV prevention medication, and mental health counseling, without co-pays or deductibles.  ^Forbes * 
• Nearly half of the U.S. population is pre-diabetic or has type-2 diabetes. Every month, diabetes causes 13,000 new amputations, 5,000 new cases of kidney failure and up to 2,000 new cases of blindness in our country. In 1960, approximately 13 percent of American adults were obese. Now, more than 40 percent of Americans are obese, and more than 70 percent are either obese or overweight.
• Even more shockingly, one-quarter of our teenagers today are pre-diabetic or have type-2 diabetes, and obesity is the leading medical reason that 71 percent of young Americans are disqualified from military service.  Learn More >>> The Hill 

6 positions 

• 1. Mr. Kennedy has prioritized addressing chronic disease, which accounts for over $1 trillion in annual U.S. healthcare costs. He has stated that President-elect Trump seeks "measurable impacts" to combat the chronic disease epidemic within two years — a goal that has drawn attention from healthcare leaders, some of whom have praised its ambition while noting potential challenges.
• Mr. Kennedy identified chronic disease as a key priority before his nomination to lead HHS. "I'm going to urge President Trump on day one to do the same thing they did in COVID, which is to declare a national emergency, but not for infectious disease, but for chronic disease," Mr. Kennedy said in a Sept. 26 interview, about one month after he dropped out of the presidential race.
• His vision extends beyond healthcare delivery to address broader contributors to chronic disease. Mr. Kennedy has criticized the influence of the pharmaceutical and food industries, linking issues like obesity and diabetes to ultra-processed foods, federal subsidies and dietary guidelines.
  • KFF on FDA research - ultra processed foods
• He has called for reforms targeting food additives, pesticides and environmental health risks, alongside overhauls of agencies like the CDC and FDA.
• Health systems may find some common ground in Mr. Kennedy's focus on prevention and early intervention to reduce chronic disease burdens, which could align with some of their efforts to address social determinants of health. However, experts, including former CDC Director Tom Frieden, MD, caution against oversimplification. "There are some things that RFK Jr. gets right," Dr. Frieden told NPR. "We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science."
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• 2. He's called for an end to direct-to-consumer advertising for prescription drugs. Mr. Kennedy has criticized the advertising relationships between pharmaceutical companies and news outlets, arguing that pharmaceutical advertising influences editorial content and public discourse beyond its intended purpose of promoting products. When his campaign was active in early 2024, Mr. Kennedy said if elected he would issue an executive order on his first day in office to ban pharmaceutical advertising on television.
• Direct-to-consumer advertising of prescription drugs surged after the FDA eased restrictions in 1997 and totaled nearly $10 billion in 2016. Proponents argue it educates consumers and empowers patient involvement, while critics warn it can misinform patients, drive inappropriate prescribing and inflate healthcare costs. Concerns also include promoting costly brand-name drugs over cheaper alternatives, straining patient-physician relationships.
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• 3. He has expressed interest in redirecting Medicare spending toward promoting healthy behaviors rather than covering certain pharmaceuticals. Mr. Kennedy has been a vocal opponent of Medicare and Medicaid funding for GLP-1 drugs used for weight loss, arguing that these programs should instead prioritize covering gym memberships and healthier food options for enrollees.
• "For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day and a gym membership, for every obese American," Mr. Kennedy said during a Congressional roundtable in September, as reported by the Associated Press.
• The Biden administration recently proposed broader coverage of GLP-1 and weight loss drugs for Americans with obesity, a move that could put Mr. Kennedy in a reactive position if he secures confirmation to lead HHS.
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• 4. He is considering changes to the Medicare physician fee schedule. Mr. Kennedy and his advisers are considering an overhaul of Medicare's payment formula, four anonymous sources told The Washington Post in November. The move could mark a bid to shift the health system's incentives toward primary care and prevention.
• The Medicare physician fee schedule was adopted in 1992, establishing a complex system of administrative pricing based on the resource inputs used in producing physician services. It influences not only Medicare payments, but also private insurance payment systems, which often mirror Medicare's methodologies.
• Sources told The Post that discussions about the fee schedule are in their early stages and have involved a plan to review the thousands of billing codes that determine how much physicians get paid for performing procedures and services. These codes are integral to determining reimbursement rates and have faced criticism for historically favoring procedural and specialty care over primary care services. An overhaul could address these disparities and potentially reshape the economics of medical practice across the country.
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• 5. He has raised controversial and widely challenged claims about vaccine safety for nearly 20 years. Mr. Kennedy's suspicion of vaccines dates back to at least 2005, when he published an article called "Deadly Immunity" in unusual publications for the topic: Rolling Stone magazine (print) and Salon (digital). The article claimed that thimerosal, eliminated in routine childhood vaccines in 2001, caused autism. The article was amended and corrected several times before, years later, Salon announced in 2011 that it was retracting "Deadly Immunity" in entirety. An explanation of that decision and the corrections made to Mr. Kennedy's article are detailed by Salon here.
  • Vaccine coverage under Medicare & Medi Cal
• More recently, Mr. Kennedy said in a 2023 podcast interview that, "There's no vaccine that is safe and effective." The nonprofit Mr. Kennedy was aligned with for nearly a decade, Children's Health Defense, has been a vocal critic of COVID-19 vaccines and public health mandates, with its claims frequently challenged by public health experts. The group has filed dozens of federal and state lawsuits since 2020, many challenging vaccines and public health mandates. Mr. Kennedy has been on leave from the group as its founder, chairman and chief litigation counsel since he announced his plans to run for president in April 2023.
• When described as anti-vaccine, Mr. Kennedy has pushed back. Instead, he argues that he wants to improve the science of vaccine safety. "We're not going to take vaccines away from anybody," he told NPR in November. "We are going to make sure that Americans have good information. Right now the science on vaccine safety particularly has huge deficits in it, and we're going to make sure those scientific studies are done and that people can make informed choices about their vaccinations and their children's vaccinations."
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• 6. He supports abortion rights up to the point of fetal viability, after which he favors restrictions. Mr. Kennedy believes abortion should be legal up to a point he describes as when the fetus becomes viable outside the womb, after which he supports restrictions. Mr. Kennedy clarified this position in a video released in June 2024, though he did not specify an exact number of weeks for viability. He acknowledged that his views on abortion have evolved over time as he continued to explore the issue. In May 2024, he had expressed support for a woman's right to choose an abortion at any stage of pregnancy, including full term.
• Mr. Kennedy has also pointed to the importance of addressing economic factors in discussions about abortion and reproductive health. "We should be looking at why there are so many abortions in the first place," he said, emphasizing the need to understand the financial challenges and economic pressures that contribute to abortion rates among individuals and families.
• Mr. Kennedy introduced a plan while running for president called "More Choices, More Life" that called for a subsidized daycare initiative aimed at making childcare more accessible. He said universal childcare has the capacity to add $1 trillion to the U.S. GDP. "And since economics is a major driver of abortion, this policy will do more to lower abortion rates than any coercive measure ever could," the website for the plan states.    ^{Becker Hospital Review} *

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FAQ’s  Catheters

• What catheters providers are in network with my plan
  • What plan do you have?Anthem Provider Finder

     

    Blue Shield Provider Finder
    https://www.blueshieldca.com/fad/home

     

    • Here’s the reply on 180 Medical about how Insurance covers catheters.180medical.comMedicare Coverage per 180 Medical 180medical.comWhat does your prescription say?

      Unlike Medicare, most Medicaid – Medi Cal? programs and most commercial insurers, UnitedHealthcare—the nation’s largest insurer—excludes urinary catheters from coverage for many commercial plans, lumping them in the same category as other excluded disposable supplies like elastic bandages and gauze. modernhealthcare.com

      Coloplast.com FAQ’s on Insurance Coverage .coloplastcare.com

    • Anthem Medi Blue Plus HMO
      • OK, let’s check the Evidence of CoverageLet’s check for participating pharmacy’s https://shop.anthem.com/medicare/ Scroll down for the tool.CVS Pharmacy on Catheter’s

        You can use ANY participating pharmacy!

        • What about the 20% Co Pay?I wasn’t paying that with 180 Medical.
          • You’re right. Since you are not in CA, I can’t really help you. Try calling the agent who you purchased the coverage from or Blue Cross in your State.excerpt of CA Summary of Benefits
          • I’m not 100% sure if a Medicare Provider is allowed to waive the 20% charge. Here’s some links. It’s beyond my pay grade…oig.hhs.gov/fraudbakerdonelson.com

            healthreformquotes.com/fraud-waste-abuse/

• Catheter Fraud???