Medicare's New Rules: A Big Win for Insurers, But What About Patients?

Medicare Advantage insurers are celebrating a major victory with new rating rules. The Trump administration has revived a bonus system that rewards insurers with high ratings. This change means insurers could see a $13 billion boost. But what does this mean for patients? The new rules bring back the "reward factor, " a provision that was last used in 2023. This factor increases payments to insurers who consistently perform well. However, this change comes at a cost. Medicare has decided to scrap the "health equity index, " which was supposed to start in 2027. This index aimed to address disparities in healthcare. Meanwhile, Medicare is making another big change. It will phase out the Inpatient-Only List over the next three years. This list includes complex surgical procedures that could now be done in outpatient facilities. Some see this as a win for patients and taxpayers. But others worry about the clinical risks. In rural healthcare news, North Carolina is seeking $1 billion to overhaul its rural health system. This plan could reshape healthcare across the state. But not all rural areas are struggling. Garrett Regional Medical Center is expanding its services despite the uncertainty in healthcare. In other news, the trial of Luigi Mangione, charged with killing UnitedHealthcare CEO Brian Thompson, is heating up. Mangione's defense team is trying to block evidence that prosecutors say links him to the crime. Meanwhile, Advocate Health CEO Gene Woods saw his salary jump by 49% in 2024. Lastly, a transgender cancer patient shared her story. Jennifer Capasso recorded her surgery to understand what was being said. Her experience highlights the challenges faced by transgender patients in healthcare. These changes in Medicare and healthcare policies have big implications. They could mean more money for insurers and better care for some patients. But they also raise questions about equity and access. As always, the devil is in the details.