NEW YORK (AP) — Pharmaceutical companies have agreed to slash the Medicare prices for 15 prescription drugs after months of negotiations, reductions that are expected to produce billions in savings for taxpayers and older adults, the Trump administration said.

But the net prices it unveiled for a 30-day supply of each drug are not what Medicare recipients will pay at their pharmacy counters, since those final amounts will depend on each individual’s plan and how much they spend on prescriptions in a given year.

Health Secretary Robert F. Kennedy Jr. touted the deals as part of the administration’s efforts to address affordability concerns among Americans. The Medicare drug negotiation program that made them possible is mandated by law and began under President Joe Biden’s administration.

“President Trump directed us to stop at nothing to lower health care costs for the American people,” Kennedy said in a statement Tuesday evening. “As we work to Make America Healthy Again, we will use every tool at our disposal to deliver affordable health care to seniors.”

The announcement marks the completion of a second round of negotiations under a 2022 law that allows Medicare to haggle over the price it pays on the most popular and expensive prescription drugs used by older Americans, bringing the total number of negotiated drug prices to 25. The new round of negotiated prices will go into effect in 2027. Reduced prices for the inaugural round of 10 drugs negotiated by the Biden administration last year will go into effect in January.

Price negotiations apply to drugs treating diabetes, asthma, cancers and more

The latest negotiated prices apply to some of the prescription medications on which Medicare spends the most money, including the massively popular GLP-1 weight-loss and diabetes drugs Ozempic, Rybelsus and Wegovy. Some of the other drugs involved in the negotiations include Trelegy Ellipta, which treats asthma; Otezla, a psoriatic arthritis drug; and various drugs that treat diabetes, irritable bowel syndrome and different forms of cancer.

Dr. Mehmet Oz, Centers for Medicare and Medicaid Services administrator, said the administration delivered “substantially better outcomes for taxpayers and seniors in the Medicare Part D program” than the previous year’s deals.

Under the first round of Medicare price negotiations, the Biden administration said the program would have saved about $6 billion on net covered prescription drug costs, or about 22%, if it had been in effect the previous year. The Trump administration said its latest round would have saved the government about $8.5 billion in net spending, or 36%, if it had been in effect last year.

It’s unclear exactly how much money the newly announced deals could save Medicare beneficiaries when they are buying prescription drugs at the pharmacy because those costs are determined by various individual factors.

A new rule that kicked off this year also caps out-of-pocket drug costs for Medicare beneficiaries at $2,000, giving some relief to older adults affected by high-cost prescriptions. The administration said estimated out-of-pocket savings for Medicare beneficiaries with drug plans is about $685 million.

Spencer Perlman, director of health care research at Veda Partners, said the Trump administration’s improved outcomes probably resulted from the mix of drugs being negotiated and lessons learned from the first year of negotiations.

Net drug prices are proprietary, he said, but “if we take the administration at their word, I think it demonstrates that they have secured meaningful price concessions for seniors, meaning the Medicare Drug Price Negotiation Program is working as intended.”

Medicare recipients can’t get GLP-1 drugs for obesity, but the administration is making changes

The GLP-1 weight-loss drugs that were part of the negotiations have been especially scrutinized for their high out-of-pocket costs. Yet it’s still unclear to what extent Medicare beneficiaries who want to use the drugs to treat obesity will be able to do so.

Medicare has long been prohibited from paying for weight-loss treatments, but a separate deal recently announced between the Trump administration and two pharmaceutical companies included plans for a pilot program that will expand coverage for the drugs to additional high-risk obese and overweight people.

The Trump administration this year has also negotiated several unrelated deals with drug companies to lower the cost of their products for the wider population.

Pharmaceutical companies, meanwhile, have sued over the Medicare drug negotiations enabled by the 2022 Inflation Reduction Act and remain opposed to them.

“Whether it is the IRA or MFN, government price setting for medicines is the wrong policy for America,” Alex Schriver, senior vice president of public affairs at the Pharmaceutical Research and Manufacturers of America, or PhRMA, said in a statement. “These flawed policies also threaten future medical innovation by siphoning $300 billion from biopharmaceutical research, undermining the American economy and our ability to compete globally.”

Next year, Medicare will negotiate prices for another round of 15 drugs, including physician-administered drugs for the first time.

With other increases, Kluck expects that the couple’s annual Medicare premium costs might have risen by $2,000 in 2026. They are shopping for new Part D prescription plans during the annual enrollment period, which is underway and runs through Dec. 7. Kluck thinks she has some lower-cost drug plan options — although her husband’s choices are restricted because he needs an expensive blood thinner.

“It’s so complicated, isn’t it?” said Kluck, 66, a retired teacher in New Jersey.

Some Part D costs will drop

The Klucks’ experience is an important reminder: Check your Medicare prescription drug coverage during fall enrollment. That’s especially true this year, as price changes will vary widely.

If you are enrolled in traditional Medicare Part A (which covers hospitalizations) and Part B (outpatient visits) and have a supplemental Medigap policy, there’s no need to review that coverage.

But the Part D insurance market is adjusting to stronger prescription drug coverage under the Inflation Reduction Act of 2022, which imposed a cap on patients’ out-of-pocket spending (like copayments and deductibles) for covered drugs — it will be $2,100 in 2026. The cap has helped protect beneficiaries who take pricey drugs for conditions like cancer and multiple sclerosis.

Concerned that shifting risk to insurance companies would result in much higher premiums, the Biden administration gave drug plans that agreed to participate in a special program for 2025 a subsidy. In return, plans agreed to limit monthly premium increases to $35.

That “premium stabilization” program will continue in 2026, but the Trump administration reduced the subsidies, explaining that “plan sponsors have built experience and are better equipped to understand and predict how the IRA benefit changes will affect utilization and costs.” In 2026, participating insurers may raise premiums as much as $50 per month; some, like Kluck’s, did not participate and will enact larger increases.

KFF, a health care research nonprofit, found that only a few national drug plans were raising premiums substantially this year. Four others will charge less in 30 or more states, and two offered by Humana have reduced premiums in nearly all states, according to KFF.

But the monthly premium for Wellcare Value Script, the most popular plan nationally, will increase in 32 states and the District of Columbia, hold steady in 16 states and drop in two, KFF found. Enrollees in another top plan, SilverScript Choice, will see their premiums increase by $50 in 30 states (and the District of Columbia) but fall in 20.

Zero premiums are possible

Depending on where you live, you may also be able to choose from as many as six plans that have a zero premium.

These plans are not offered in all states, but their numbers are growing. Such plans typically come with the highest allowable deductible — $615 in 2026, up from $590 this year, but they can be a good option if you use only a few generic medications. Look carefully, however, if you take costlier name-brand drugs, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF.

“You could end up paying much more overall if coverage for the drugs you take is limited,” Cubanski said.

If you select a zero-premium plan, keep an eye out for higher premiums in subsequent years, said Kylie Stengel, principal at Avalere Health, a research and consulting company. “They’re trying to attract a healthier beneficiary population so they can actually price the product lower,” she said.

Cubanski urges beneficiaries to look far beyond monthly premiums when shopping. Consider whether your drugs are covered, whether there are any restrictions on those drugs, and the deductibles and other out-of-pocket costs.

“People tend to focus only on the premium when they are shopping, perhaps to their detriment,” she said.

Medicare Advantage

Medicare Advantage enrollees should also be on the lookout for changes to drug coverage or to the list of in-network providers.

Advantage is the privately offered all-in-one managed care alternative to traditional Medicare, which is a fee-for-service program.

During fall enrollment, you can switch Advantage providers or shift to traditional Medicare — but don’t do that without confirming that you will be able to buy Medigap supplemental coverage. (Enrollees have a guaranteed right to buy a Medigap plan during its six-month open enrollment period, which starts on the first day of the month in which you’re 65 or older and enrolled in Medicare Part B; those who apply for Medigap after that can be rejected for preexisting conditions in most states.)

If you’re in an Advantage plan this year, or considering shifting to one for 2026, start by examining drug coverage, just as you would in a stand-alone Part D plan. Be sure to evaluate whether your drugs are covered, whether you’ll pay a premium and any deductible for drugs.

Then make sure the doctors and hospitals you prefer are in your plan for next year.

The government-run Medicare Plan Finder tool is adding directories of providers to Advantage listings this year, but it’s a work in progress, and listings may be incomplete or contain errors. That means it’s still best to check with your doctors about any plan you consider, said Philip Moeller, an expert on Medicare and the publisher of a Substack newsletter, Aging in America.

“I’d just call and ask which plans they are participating in next year, and whether the hospitals where they have privileges are included in those networks,” he said.

If you choose a plan based on incorrect information, you may switch plans during the first three months of the new year. There’s also an ongoing Advantage Open Enrollment Period during the same months that permits you to switch plans.

Most enrollees can choose from 30 or more Advantage plans, KFF reports. But the options are very limited in some parts of the country. Four states have fewer than five.

How to shop your coverage

— Review your annual notice: Your plan provider must send you an Annual Notice of Change document each fall, by either mail or email. This will include the premium and the annual deductible. It will also tell you if coverage of your drugs will change or if changes are being made to your Medicare Advantage providers.

— Use the finder: The Medicare Plan Finder allows you to compare stand-alone drug and Advantage plans. Check your profile to make sure your list of medications is current. You’ll see premiums and total projected annual costs, including deductibles and out-of-pocket costs.

— Watch the tiers: Plans typically group drugs into tiers, with lower-cost drugs like generics in the lower tiers. The change notice will show if a drug has moved from the first to the second or third tier; if that happens, you may face higher out-of-pocket costs or hassles getting a medicine covered.

— Consult the stars — carefully: You can shop Advantage and stand-alone drug plans using the Medicare Plan Finder’s “star” ratings. The rating program is used to determine “bonus” payments to plans for quality improvements, and to help consumers make informed decisions. But Laura Skopec, a senior research associate at the Urban Institute, urged caution, saying the ratings reflect how numerous regional plans, grouped under one Medicare contract, perform.

“Overall, the ratings don’t tell beneficiaries much about the experience they’re likely to have in their local plan,” she said.

— Contact the SHIP: Each state has a State Health Insurance Assistance Program, which offers comprehensive, unbiased guidance on plans.

— Use caution with brokers: Independent insurance brokers are knowledgeable about the products they represent, and they “live and die on referrals, so they really are trying to do the best they can for their clients,” said Skopec, co-author of a recent report on their role in plan selection. But brokers don’t represent every plan available, she added — especially smaller regional offerings that may be a good fit.

She added that the higher commissions on Advantage plans allowed by Medicare and set by insurance companies encouraged brokers to sell these plans rather than separate Part D and Medigap policies.

— Seek Extra Help, a program for low-income seniors: Beneficiaries with low incomes and modest assets are eligible for assistance with Part D out-of-pocket costs. Assistance paying for Part B premiums is available through the Medicare Savings Programs.

This article originally appeared in The New York Times.

That always got laughs for Jack Benny, whose cheapness was essential to his shtick. When an armed robber announced a stickup and repeated the threat, Benny said: “I’m thinking it over!”

The classic radio skit is a serious present-day crisis for many Americans, and it’s about to get worse.

Some 27 million Americans already have no health insurance, according to the Census Bureau’s count last year.

Now, nearly 23 million more insured under the Affordable Care Act (ACA), popularly known as Obamacare, are in immediate jeopardy of having to pay sharply increased premiums that would price many of them out of that last-resort market.

Florida hit hardest

The loss of their existing supplemental subsidies from the Biden years will hit nowhere as hard as in Florida. Twelve of our 28 congressional districts are among the top 15 in Obamacare enrollments, and South Florida is particularly vulnerable.

All told, more than 1.1 million Floridians could lose health coverage next year, according to the minority staff of Congress’ Joint Economic Committee. Most of it is Obamacare disenrollment. A small part would owe to Medicaid cutbacks imposed by President Trump’s cynically mistitled One Big Beautiful Bill Act.

Florida is one of nine states, mostly in the South, all run by Republicans, that didn’t expand Medicaid to more working people under the ACA.

This is what the federal government shutdown is all about. It’s the only leverage available to the Democrats, the only party devoted to health care, to try to force Republicans to extend subsidies set to expire Dec. 31.

But Republicans demand that Democrats agree to fund the government and end the shutdown before they’ll even talk about subsidies. That calls for more trust from Democrats than the ruling Republicans have earned.

One path to a solution

An obvious way to break this four-week impasse is to have the House return to pass a single bill temporarily extending funding for both the government at large and the subsidies. But Speaker Mike Johnson seems to dread doing anything that President Trump doesn’t tell him to.

Trump so far is exploiting the shutdown to blame the Democrats. But polls show that it’s narrowly working against the GOP.

Seventy-some nations have some form of universal health care. They include Canada, Mexico, all of Western Europe and South America. The U.S., alone in the developed world, does not accept health care as a fundamental human right.

Our Medicare is universal single-payer coverage only for people over 65, which was achieved only after a multi-generational struggle. Medicaid is single-payer for some of the poor — not enough.

Extending Medicare to everyone is so far beyond the wisdom and courage of Congress that Obamacare is the best they could do, and then only barely.

Millions more ‘go bare’

The Congressional Budget Office estimates that some 2 million Obamacare enrollees will be uninsured next year, and as many as 3.8 million will “go bare” by 2035 if Congress does not extend supplemental subsidies for people who buy their own policies through Obamacare marketplaces.

It’s especially heavy in those 12 Florida congressional districts that rank among the 15 nationwide where people depend most on Obamacare.

The looming crisis will be most severe in South Florida.

Miami-area Rep. Maria Salazar’s 27th District leads the nation with 38% Obamacare enrollment. Close behind are her Miami Republican colleagues Carlos Giménez with 36% and Mario Diaz-Balart with 30%.

In raw numbers, Diaz-Balart’s 26th District reportedly has more Obamacare enrollees, some 300,000, than any other House member.

District by district

Other Florida Obamacare percentages in the top 15: Democrats Frederica Wilson of Miami, 35%; Darren Soto of Kissimmee, 30%; Maxwell Frost of Orlando, 29%; Debbie Wasserman Schultz of Weston, 28%; Jared Moskowitz of Parkland, 26%; Sheila Cherfilus-McCormick of Miramar, 25%; Lois Frankel of West Palm Beach, 21%.

In Republican Byron Donalds’ Naples-based district, 19% of his constituents depend on Obamacare, yet the candidate for governor is one of its most ardent critics.

The Republican Party hasn’t given up on repealing Obamacare, which survived during Trump’s first term only by the grace of the late Republican Sen. John McCain. Now, their consultants tell them that Obamacare is so popular that repeal would be suicidal, so they are now trying to destroy it without saying so, piece by piece.

The expiration of subsidies is part of that strategy.

Ron DeSantis is no help. He, his wife (a cancer survivor) and their three small children are conspicuous beneficiaries of good government health insurance, but Florida’s governor says people under 50 need only catastrophic plans that cover major illnesses and accidents — not preventive care.

That notion is as irresponsible as his administration’s anti-vaccine policies.

People under 50 do die of treatable morbidities like heart disease and diabetes. Many who die of them later could have been saved by diagnosis and treatment earlier in life.

Obamacare, with its imperfections, is a wise program on which the lives of millions of Americans depend.

A major schism between our two political parties is the simple but profound question of whether health care is a human right — or a privilege reserved only for those who can afford it.

The Sun Sentinel Editorial Board includes Opinion Editor Steve Bousquet, Deputy Opinion Editor Dan Sweeney, editorial writers Pat Beall and Martin Dyckman and Executive Editor Gretchen Day-Bryant. To contact us, email at letters@sun-sentinel.com.

NEW YORK (AP) — The Center for Medicare and Medicaid Services will temporarily bring all its furloughed employees back to work starting Monday to manage health insurance open enrollment, according to an agency spokesperson.

The recall to duty amid the more than three-week-long government shutdown is what’s needed to “best serve the American people amid the Medicare and Marketplace open enrollment seasons,” the spokesperson said Thursday.

It will be paid for by user fees gathered from sharing data with researchers, the agency said.

The decision to call the employees back shows how significantly shutting down the government and losing staffing has impacted federal government operations during a crucial season, as millions of Americans are selecting their health insurance plans for next year. CMS provides health coverage to more than 160 million people, according to its website.

It also comes during a moment of uncertainty for Affordable Care Act enrollees, with Congress deadlocked on how to handle expiring subsidies that have made marketplace health insurance less expensive for millions since 2021. Democratic lawmakers are demanding a deal to extend the COVID-era subsidies before they agree to fund the government, while Republican lawmakers want to reopen the government before negotiating that question.

As their stalemate and the resulting government shutdown continue, the cost of next year’s health insurance for many of the 24 million ACA enrollees is still unknown, even with open enrollment beginning in a week.

Though CMS didn’t specify for how long the employees will return, the open enrollment period for Medicare runs between Oct. 15 and Dec. 7, while the open enrollment period for the Affordable Care Act marketplace runs between Nov. 1 and Jan. 15.

While the agency didn’t answer questions about how many employees would return to work, about 3,300 of CMS’s staff, or a little over half, were expected to be retained during the shutdown, according to the agency’s contingency plans. That would mean about 3,000 furloughed workers are being called back to work Monday.

While CMS has not seen any layoffs during the current shutdown, its parent agency — the U.S. Department of Health and Human Services — was among the hardest hit by the government-wide reduction in force. Nearly 1,000 HHS staff were abruptly fired earlier this month, though a judge has temporarily paused those layoffs from taking effect.

Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans’ members, a new federal watchdog report says.

The investigators allege that some insurers effectively set up “ghost networks” of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered by the publicly financed Medicare and Medicaid plans. In fact, many of those professionals do not have contracts with the plans, do not work at the locations listed, or are retired, the investigators said.

The Office of Inspector General for the Department of Health and Human Services, which oversees the giant Medicare and Medicaid health programs, released its findings in a recent report.

The report focuses on insurers the government pays to cover people in Medicare Advantage plans and in privately managed Medicaid plans. About 30% of all Americans are covered by such insurance, the report says. The government pays the insurers hundreds of billions of dollars annually.

The companies are paid set rates per person they cover and are allowed to keep whatever money they don’t spend on patient care. The insurers are required to have adequate numbers of health care professionals under contract to serve patients in each region they cover.

But the new report found that 55% of mental health professionals listed as in-network by Medicare Advantage plans were not providing such care to any of the plans’ members. The figure was 28% for Medicaid managed care plans.

Some mental health professionals told investigators they shouldn’t have been listed as in-network care providers for the insurers’ members, because they no longer worked at the locations listed or because they didn’t participate in the Medicare Advantage or Medicaid managed care plans. Others said they were working as administrators and no longer providing patient care.

In one case, the report says, a private Medicaid plan listed a mental health professional as providing care in 19 practice locations. But when the investigators checked, a receptionist at one of the clinics said the person had retired a few years ago.

Jeanine Simpkins of Mesa, Arizona, learned how skimpy the networks can be when a 40-year-old family member was in crisis this fall. Simpkins struggled to find a drug rehabilitation program that would accept the Medicare Advantage insurance the relative is on because of a disability.

Simpkins said she contacted about 20 rehab programs, none of which would take the Medicare insurance plan. “You feel kind of dropped,” she said. “I was pretty surprised, because I thought we had something good in place for her.”

Simpkins’ relative eventually enrolled in part-time hospital care instead of an inpatient rehabilitation center.

It can be challenging for patients to find timely, nearby care, for all kinds of health problems, from colds to cancer.

But Jodi Nudelman, a regional inspector general who helped write the federal report, said in an interview that the stakes can be especially high for patients seeking mental health care.

“They can be particularly vulnerable,” she said. It can be daunting for people to acknowledge they need such care, and any roadblock can discourage them from trying to find help, she said.

She added that taxpayers aren’t getting their money’s worth if insurers fail to meet obligations to provide sufficient care options for Medicare and Medicaid participants in the plans.

The federal report focused on a sample of 10 counties in five states: Arizona, Iowa, Ohio, Oregon, and Tennessee. It included urban and rural areas. It did not identify the insurers whose networks were checked.

Susan Reilly, vice president of communications for the Better Medicare Alliance, a trade group representing Medicare Advantage plans, said managed care companies support federal efforts to improve access to mental health services. “While this report looks at a small sample of plans, we agree there’s more work to do and are committed to continuing that progress together with policymakers,” she said in a statement.

The report’s authors said their sample was a good representation of the national situation. It looked at 40 Medicare Advantage plans and 20 Medicaid managed care plans.

The report recommends government administrators make more use of medical billing data to confirm whether health professionals listed as in-network are providing care to patients covered by private Medicare and Medicaid insurance plans.

The watchdogs also recommend that federal regulators create a national, searchable directory of mental health providers, listing which Medicare and Medicaid insurance plans each one accepts. Such a directory would help patients find care and would make it easier to double-check the accuracy of plans’ listings of in-network providers, they said.

Federal administrators overseeing Medicare and Medicaid have taken steps toward creating such a directory, the authors said. Reilly, the industry representative, said managed care companies support the effort.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

This type of technology in AI-assisted hearing aids uses data to self-adjust and help the wearer focus on relevant conversations while minimizing background noise. The devices continuously learn to improve the user’s hearing ability in noisy situations.

When Rosen, 73, is shopping for groceries near her home in Weston and a call comes in, the hearing aids block out the background shoppers so she can hear only the caller.

“It’s amazing how I can focus on the call and not hear background noise at all,” Rosen said while in Publix.

All of the major hearing aid brands, such as Starkey, Phonak, Oticon, ReSound, Signia and Widex, now make hearing aids that incorporate artificial intelligence and machine learning. Two of the brands — Phonak and Starkey — have just come out with an improved, smaller version that resembles a flat earbud.

“There is so much more technology people are missing because they are consumed by over-the-counter amplifiers at retail stores instead of getting fitted for new customized computers they can wear in their ears,” said Valerie Rossetti, an audiologist with Hearing Matters in Fort Lauderdale.

Advancements are happening as need increases: One in four people over 60 is affected by hearing loss.  Hearing loss among seniors is expected to worsen.

Fewer choices, higher costs: Lots of changes ahead with Medicare in 2026

A relatively recent development is the creation of hearing aids with deep neural networks (DNN),  a more advanced version of AI. The hearing aid feeds the deep neural networks with information and uses an algorithm to classify sounds better, improve decision-making, and make adjustments, Rossetti said.

“It makes the sound more pleasing,” she said. “It might not relate to hard numbers in improved hearing scores, but wearers like how it sounds and find them more comfortable. Every year, things get incrementally better.”

The more sophisticated AI-driven hearing aids can analyze 80 million sounds and as many as 2 billion adjustments in a day.

A study by Ohio State University revealed that AI-driven hearing aids increased the ability to hear amid background noise by 55%, and over time, wearing them reduced the effort required to hear by 30%. Technological advances are expected to make wearing aids even more enticing.

Rossetti says making a purchase of a hearing aid with AI is just the first step, though. Her customers return every four to six months for an adjustment and, potentially, an update to the software in their devices.

“As an audiologist, I can see percentage-wise how much noise they have been in, the changes they made versus the changes AI made, and I can make sure the changes AI makes are appropriate for their amount of loss and lifestyle,” she said.

If a customer prefers not to remove their hearing aids, Rossetti said she also offers a device that can be implanted in the ear for periods of up to two or three months. “For patients with memory issues, this is a great option. They can sleep and shower with it,” she said.

Original Medicare does not cover hearing aids or exams for fitting them, but some Medicare Advantage and commercial PPO plans do offer some coverage. Beneficiaries would need to check their specific plan. A set of the newest AI devices costs between $1,500 and $3,000 on average, but can sell for as much as $10,000.

For individuals with minimal hearing loss, Rossetti works with them on auditory exercises. Using a mobile app, she recommends that a person work 15 minutes a day to teach their brain how to ignore noise and pick up the speech signal. She can see if patients are logging in and what they are working on.

“Even if they have only mild hearing loss, I want them to keep their brain engaged,” she said.

Hearing loss is a significant risk factor for dementia, and research has found that hearing aids may help prevent or delay its onset and progression.

“If you notice a loss, get evaluated so you can see where you stand and we can come up with a good game plan, ” said Caroline Dadowski, assistant professor in the Department of Audiology at Nova Southeastern University’s Dr. Kiran C. Patel College of Osteopathic Medicine.

Dadowski said in addition to AI, the Bluetooth feature on hearing aids is also improving, and some will soon be Auracast-enabled, meaning they can connect to public devices such as the audio from TVs in a gym or airport lounge.

Already, all hearing aids can be paired with smartphones.

“You can use an app on the phone to adjust volume, switch programs for different listening situations, troubleshoot, enable a ‘find my hearing aids’ setting,” Dadowski said. “Some have language translation, and fitness tracking, or you can set reminders to clean them or answer your phone hands-free.”

Need Medicare help? Here’s where to find it and what you will need

Dadowski classifies the advancements in hearing aids as incremental, yet definitely improving the user experience. “I wouldn’t say anything has changed the game completely, but there are more advancements in general,” she said.

Rosen, who has had her hearing aids for only a few weeks, said she is happy with the advanced features, but mostly appreciates the basics.

“I wasn’t following the conversation around the mahjong table,” she said. “Now I can hear what they are saying.”

South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

The Medicare GUIDE program acknowledges the significant toll of caring for someone with dementia and offers free support to their caregivers.

Sidney Chugani, president of Right at Home Dania Beach, assists local families in enrolling in the GUIDE program. Once enrolled, an unpaid caregiver such as a family member can request relief on a part-time basis, ask for help finding a support group, or tap into a 24/7 support line. The caregiver can also access training programs on best practices for caring for a loved one with dementia. Through this program, an individual with dementia will get assigned a Care Navigator to help them access medical services and supports, such as meals and transportation.

“It’s about time Medicare recognized this need,” Chugani said. “It’s a growing problem and it’s going to keep on growing.”

The government launched the program to reduce Medicare and Medicaid expenditures by helping people with dementia remain at home and minimizing their hospitalization, emergency department use, and long-term nursing home care.

Chugani said someone with dementia cannot be left alone, and through the GUIDE program, a caregiver can ask for four hours of relief at a time from duties.

“Hopefully, as the government realizes how meaningful this is, they will increase the number of hours,” he said.

The challenges of managing health care, providing constant support, and dealing with the behavioral and psychological symptoms of dementia can present a significant mental, physical, emotional, and financial burden for caregivers. People with dementia often have multiple chronic conditions.

On its website, CMS says, “when used over time, respite services have been found to help unpaid caregivers continue to care for their loved one at home, preventing or delaying the need for facility care.”

To qualify, an individual must have a confirmed diagnosis of dementia and be enrolled in traditional Medicare, not a Medicare Advantage Plan. The dementia patient cannot be in hospice or a living in a nursing home.

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired Oct. 1.

The telehealth and in-home hospital care programs were both temporary — but increasingly popular — options for Medicare recipients. They allowed doctors and hospitals to bill Medicare for telehealth appointments and in-home visits from nurses to provide care that is generally only available in hospitals.

The shutdown has prevented Congress from extending them.

More than 4 million Medicare beneficiaries used telehealth services in the first half of the year, according to Brown University’s Center for Advancing Health Policy through Research.

As of last fall, 366 hospitals had participated in the hospital-at-home program, serving 31,000 patients, according to a federal report. The program, officially called Acute Hospital Care at Home, allows patients who would otherwise be hospitalized to get inpatient care at home with a combination of nurse visits, monitoring equipment and remote doctor visits.

The programs have their roots in the pandemic, when doctors and hospitals wanted to keep patients safe from the risks of travel and hospital stays. Both are for Medicare recipients, generally people over 65 or who are disabled. But since many private insurers follow federal guidelines, some physicians have stopped booking telemedicine appointments for non-Medicare patients, rather than risk a change in insurance coverage.

Alexis Wynn, who is in her mid-30s and covered by private insurance through her employer, tried to switch an in-person doctor appointment in Pennsylvania to a video visit last week. The office told her that “all telemedicine is uncovered by insurance as of Oct. 1” — so she had to cancel the routine appointment.

“It was just a follow-up appointment to make sure the dosing of my medication was still accurate, nothing that was pertinent to being face-to-face,” Wynn said. Her health insurance company later told her it still covered telehealth visits.

There have been other reports of insurers turning down non-Medicare telehealth appointments, said Alexis Apple, director of federal affairs for the American Telemedicine Association, a trade group.

“It’s a misunderstanding,” Apple said. “I’m not really sure what’s happening, but it’s unfortunate and very scary. There’s so much uncertainty out there now, and we see insurance payers start to pull back.”

Both telehealth and home hospital services can be a lifeline for older people, especially in rural areas, where residents may struggle to travel long distances for health care in person.

“In rural America, it’s often telemedicine or no medicine at all,” said Dr. David Newman, chief medical officer of virtual care at Sanford Health in South Dakota, in a September statement supporting congressional action to make Medicare telehealth permanent. Bipartisan bills that would have allowed telehealth to continue stalled in committee earlier this year in the Senate and House.

There’s an exception for telehealth rural residents — but only if they travel to a brick-and-mortar health care facility to get the remote health care service.

“The patients have to go to a clinic to receive that telehealth visit from a provider in a different location,” Apple said. “It kind of defeats the purpose.”

According to the Brown University report, California had the highest rate of Medicare telehealth usage in the first six months of this year, with 26% of beneficiaries using at least one telehealth appointment, followed by 23% in Massachusetts and 21% in Hawaii.

There’s no reason for non-Medicare insurers to stop covering any telehealth visits during the shutdown, and even most Medicare Advantage programs will continue to cover telehealth, according to Tina Stow, a spokesperson for AHIP, a health industry trade association.

Nevertheless, at least some health care centers are refusing to take new telehealth appointments or are converting existing ones to office visits.

“This is causing a lot of confusion. We are still working with our members who are insurers and providers to get a gauge on what folks are doing — because at this point reports we’ve seen seem to suggest it is company by company, provider by provider,” said Sean Brown, a spokesperson for the Health Leadership Council, representing CEOs of health care firms and insurers.

The hospital-at-home program serves a smaller number of patients but its pause has caused more disruption: The federal government required patients to be discharged from the program or transferred to a brick-and-mortar hospital by Oct.1.

The Minnesota-based Mayo Clinic had 30 patients in the program in Arizona, Florida and Wisconsin — all of whom either had to be released from the program or sent to brick-and-mortar hospitals. One of Mayo’s hospitals in Florida was already over capacity and had no room for transfers, according to reporting by Becker’s Hospital Review.

In Massachusetts, which requires commercial insurers to follow Medicare guidelines, all insured patients had to leave the program. Mass General Brigham, which operates many hospitals in the state, has rejiggered its plans to create more home care without relying on the hospital-at-home program, according to the Becker’s report.

Congress was unable to avert a shutdown by late September, and some individual providers and patients were caught unawares.

Nurses on social media discussed losing home-care jobs or being reassigned overnight when the hospital-at-home program closed Oct. 1. They worried about patients being taken away from children at home, or placed in hallway beds at overcrowded emergency rooms because of the abrupt change.

“Management scheduled a random call this morning with a super vague title. Then drop the bomb on us,” wrote one poster in Texas. “So no job. Perfect!”

In a direct message, the poster, who didn’t want their name used for fear of getting in trouble at their hospital, told Stateline, “This obviously wasn’t ideal for the patients. One of them had four children and now could no longer be home with them. Some didn’t even get to have a bed in the hospital because there were none available and had to stay in the ER in a hallway bed.”

Parkland Health System in Dallas started tapering off its hospital-at-home program in September because of the impending shutdown, and the last patients were discharged from the program by Sept. 30 without returning to the hospital, spokesperson Wendi Hawthorne said.

“We are hopeful that Congress will renew this innovative model of care in the future,” Hawthorne said.

Likewise, OSF Healthcare in Peoria, Illinois, had started to wind down its hospital-at-home program “to avoid needing to return multiple patients to a very crowded facility,” said Jennifer Junis, president of OSF OnCall, which handles home hospital care.

There were only three patients in the program Sept. 30, all of whom were ready to be discharged without returning to the hospital, Junis said. Since the program’s start in 2020, it has helped 980 patients with home care through OSF’s Saint Francis Medical Center in Peoria.

“It is unfortunate that we will not be able to benefit by treating qualifying patients at home, where they are most comfortable and recover faster,” Junis said. “Our digital hospital program has allowed us to free up beds for our sickest patients who need them most.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

• Oct. 15 to Dec. 7, 2025:  You can switch from Medicare to Medicare Advantage or do the reverse and return to Original Medicare. You can also switch Medicare Advantage plans or change prescription drug plans, known as Part D. If you did not enroll in Part D plans when you were first eligible for Medicare, you can do so during this period.
• Jan. 1, 2026:  Changes made during fall enrollment will take effect.
• Jan. 1 to Mar. 31, 2026: If you have a Medicare Advantage plan, you can change to a different plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Any changes you make will take effect on the first day of the month following the plan’s receipt of your request.
• Exceptions:  You can make changes to your Medicare Advantage and Medicare prescription drug coverage anytime in 2026 if you have special circumstances, such as if you move, are no longer eligible for Medicaid, your plan goes out of business, or you lose coverage from your employer.
• 5-Star Special Enrollment:  If a 5-star rated Medicare Advantage plan is available in your area,  you can switch to it from Dec. 8, 2025, through Nov. 30, 2026. You can make this switch only once during this time period. Use the Medicare Plan Finder on medicare.gov to find plans with a 5-star rating in your area.

The federal agency will require each Medicare Advantage plan to include its provider network list so enrollees can determine if their preferred doctors and hospitals are in-network. The Medicare Plan Finder will also include more details about Medicare Advantage supplemental benefits, such as weight management programs, enhanced security measures to safeguard Medicare accounts, and additional filtering options to match beneficiaries’ specific needs. Additionally, an AI-powered prescription cost estimator will be available to users across local pharmacies over the next several months.

Experts say these are the most significant additions to the Medicare Plan Finder since its launch in 2005. They expect some carriers to have a difficult time complying. Health insurance companies have long struggled to maintain current, accurate directories of their network agreements.

“It’s an attempt to course-correct and create a competitive environment to incentivize plans to get the data right and get the data posted,” Betsy Seals, principal and CEO at  Alerion Advisors, a healthcare consulting firm, said in an interview with Modern Healthcare.

The Medicare Plan Finder was updated with 2026 Medicare health and prescription drug plan information on Oct. 1.