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The numbers are in…US Healthcare spending grew 7.5% in 2023, year over year… with increased utilization and spend by commercial insurers at 30% share of the pie, up from 19.5% in 2022. Commercial insurers are dominating the US healthcare system.

The numbers are in: insurers are dominating the healthcare system. U.S. healthcare spending reached a staggering $4.9 trillion in 2023, growing 7.5% year-over-year. While this reflects increased medical service use, commercial insurers claimed the largest share of spending at 30%, up from 19.5% in 2022. This dominance isn't just about numbers; it's about who controls the flow of money in our healthcare system. Insurers are reaping record profits, fueled by rising enrollment in employer-sponsored and Affordable Care Act (ACA) plans. Enhanced subsidies under federal programs, like the American Rescue Plan Act, boosted enrollment by 2.7 million people in ACA plans in 2023. Even though more Americans have insurance, access to care remains hindered by rising claim denials and prior authorization hurdles. Insurers are gatekeeping how much is spent and who gets care. With healthcare now consuming a whopping 17.6% of the U.S. economy, it’s time to demand greater accountability from payers who profit while patients and providers shoulder the burden. https://lnkd.in/eQtr4B_u

Past the point of return. Employer sponsored healthcare is driving this bus and it’s heading off the cliff. Employees cannot pay more as the middleman derived system is forcing they forego needed preventative & ongoing care. Disease acceleration! Eliot Listman Eliot Listman ? Following ? Following CEO, Allia Group: Financing Healthcare Litigation CEO, Allia Group: Financing Healthcare Litigation 1w ? 1 week ago The numbers are in: insurers are dominating the healthcare system. U.S. healthcare spending reached a staggering $4.9 trillion in 2023, growing 7.5% year-over-year. While this reflects increased medical service use, commercial insurers claimed the largest share of spending at 30%, up from 19.5% in 2022. This dominance isn't just about numbers; it's about who controls the flow of money in our healthcare system. Insurers are reaping record profits, fueled by rising enrollment in employer-sponsored and Affordable Care Act (ACA) plans. Enhanced subsidies under federal programs, like the American Rescue Plan Act, boosted enrollment by 2.7 million people in ACA plans in 2023. Even though more Americans have insurance, access to care remains hindered by rising claim denials and prior authorization hurdles. Insurers are gatekeeping how much is spent and who gets care. With healthcare now consuming a whopping 17.6% of the U.S. economy, it’s time to demand greater accountability from payers who profit while patients and providers shoulder the burden. …more US healthcare spending neared $5 trillion in 2023, government report says

Past the point of return. Employer sponsored healthcare is driving this bus and it’s heading off the cliff. Employees cannot pay more as the middleman derived system is forcing they forego needed preventative & ongoing care. Disease acceleration! Eliot Listman Eliot Listman ? Following ? Following CEO, Allia Group: Financing Healthcare Litigation CEO, Allia Group: Financing Healthcare Litigation 1w ? 1 week ago The numbers are in: insurers are dominating the healthcare system. U.S. healthcare spending reached a staggering $4.9 trillion in 2023, growing 7.5% year-over-year. While this reflects increased medical service use, commercial insurers claimed the largest share of spending at 30%, up from 19.5% in 2022. This dominance isn't just about numbers; it's about who controls the flow of money in our healthcare system. Insurers are reaping record profits, fueled by rising enrollment in employer-sponsored and Affordable Care Act (ACA) plans. Enhanced subsidies under federal programs, like the American Rescue Plan Act, boosted enrollment by 2.7 million people in ACA plans in 2023. Even though more Americans have insurance, access to care remains hindered by rising claim denials and prior authorization hurdles. Insurers are gatekeeping how much is spent and who gets care. With healthcare now consuming a whopping 17.6% of the U.S. economy, it’s time to demand greater accountability from payers who profit while patients and providers shoulder the burden. …more US healthcare spending neared $5 trillion in 2023, government report says

?? **Big Changes to Medicare in 2025: What This Means for the Healthcare Industry and Beneficiaries** ?? The healthcare industry is about to witness another major shift as significant Medicare reforms are set to take effect in 2025. These changes, highlighted by AARP, represent a monumental step toward affordability, transparency, and accessibility in senior healthcare. For those of us engaged in healthcare innovation, insurance, or service delivery, there’s much to unpack here. Let’s take a closer look at the key adjustments and consider their broader implications: --- ### 1?? **Removal of the 'Donut Hole' in Part D** The elimination of the coverage gap, or “donut hole,” simplifies Part D into three stages and caps costs for catastrophic coverage at $2,000 annually. No more hidden surprises for beneficiaries. ?? **Industry Insight:** Simplification and predictability are two critical consumer demands in health plans today. This change aligns with the broader trend in healthcare to eliminate complexity in benefit design—a signal for insurers and PBMs to rethink their consumer journeys and adapt to these clearer frameworks. --- ### 2?? **Out-of-Pocket Spending Cap** With a $2,000 annual limit on drug costs for beneficiaries, this reform could have far-reaching implications for affordability. Currently, the financial burden of prescriptions remains a major issue for seniors on fixed incomes. ?? **Industry Insight:** This cap may drive **increased drug adherence** and patient compliance as costs become more predictable and feasible. For pharmaceutical companies, the stakes of competitive pricing might increase, and this could alter revenue models tied to Medicare reimbursements. --- ### 3?? **Increased Support for Caregivers** Caregiver training will now be billable to Medicare, boosting support for family members assisting with health management. ?? **Industry Insight:** This could lead to better health outcomes and reduced patient readmissions, while also addressing provider shortages. Expect to see increased demand for caregiver education programs

**LinkedIn Post Draft** ?? **Breaking Down Medicare Changes for 2024: What Industry Professionals Need to Know** ?? Big changes are on the horizon for Medicare in 2024, and as healthcare continues to evolve, these updates signal important opportunities and challenges for both providers and the broader industry. Whether you're in healthcare administration, insurance, or medical services, it's critical to stay informed about how these developments shape patient care, system efficiencies, and cost-management efforts. Let’s dive into the key highlights and their broader implications. --- ### ?? **Key Updates and Insights** 1?? **Lower Prescription Drug Prices**: Through historic legislation, Medicare is continuing to address rising drug costs for older Americans. This is part of an ongoing trend of tackling the affordability crisis in healthcare. For the industry, this reduces financial strain on beneficiaries, but it also calls on pharmaceutical and insurance sectors to adapt to revenue shifts. 2?? **Growth of Medicare Advantage (MA) Plans**: With **over 50% of beneficiaries opting for MA plans**, the industry is witnessing a significant pivot toward coverage models that offer **additional benefits** like behavioral health services. This growth highlights rising consumer demand for more comprehensive care coordination. For providers, this signals heightened competition but also an opportunity to expand patient services. 3?? **Revised Premiums and Deductibles**: While Part A premiums remain stable, the deductible increase reflects larger trends of balancing costs between the program and its enrollees. For industry professionals, understanding how this impacts access to care and beneficiary decision-making is critical. 4?? **Enhanced Affordability with Expanded Extra Help**: The expansion of the Extra Help program means broader affordability for **low-income beneficiaries** struggling with prescription costs. Insurers and broker/agent networks must navigate how this impacts enrollment, benefits utilization, and consumer expectations. 5?? **Out-of-Pocket Cost Caps**: The new cap on out-of-pocket drug costs

Good read on the challenges hospital and health system leaders face in securing reimbursement from Medicare Advantage plans.

From a healthcare provider perspective, the issue with Medicare Advantage is that CMS has squeezed reimbursement while providing significant premium increases to health plans. Plans have been printing money and expanding until 2024. Providers now expect further reimbursement pressure and tighter prior auth and claims payment when there is no margin in the services.

"Why India's Healthcare System May Outshine the US Despite a Smaller Budget" Budget Overview The United States' healthcare budget is a staggering $4.5 trillion, with significant spending across various sub-sectors. In contrast, India allocated approximately $11 billion to its Ministry of Health and Family Welfare for the fiscal year 2024-25. The healthcare systems of the United States and India are as different as chalk and cheese. The US, with its colossal healthcare budget, faces criticism for inefficiency, while India, with its modest spending, shows signs of a system that could potentially offer better outcomes for its citizens. Healthcare Services In the US, healthcare services are synonymous with cutting-edge technology and high-quality care. However, these come at a prohibitive cost, often inaccessible to those without comprehensive insurance. In contrast, India's government-run hospitals and medical colleges provide a spectrum of services, many at no cost, making basic healthcare accessible even to the less privileged. Government Funding The US healthcare system is a tapestry woven with private insurance and government-funded programs like Medicare and Medicaid. The government supports healthcare companies through tax benefits, which indirectly aid service provision. India takes a more direct approach, with government funding ensuring that public hospitals can offer free or subsidized care. Affordability Affordability is where the Indian healthcare system shines. Free services at government hospitals stand in stark contrast to the US, where healthcare expenses are a leading cause of financial distress. The Indian model is designed for wide accessibility, reflecting the government's commitment to healthcare as a fundamental right. Tax Distribution In the US, tax money is funneled into healthcare through a complex system of subsidies and incentives for private companies. This indirect funding model is often criticized for creating inefficiencies and not directly benefiting the consumer. India's straightforward allocation of tax money to public healthcare aims to eliminate middlemen, ensuring that funds are used for patient care. The Capitalist Conundrum As India grows economically, there's a looming question: will it fall into the same capitalist-driven healthcare pitfalls as the US? With a strong foundation of public healthcare and recent initiatives aimed at universal health coverage, India may continue to prioritize affordability over profit, potentially avoiding the American scenario where healthcare is a luxury many cannot afford. Conclusion Despite a smaller budget, India's healthcare system may outperform the US in terms of accessibility and affordability. The US system, with its high costs and complex insurance dependencies, could learn from India's more straightforward, inclusive approach. As India progresses, it must carefully navigate its economic growth to maintain and improve upon its healthcare successes.

Medicare Advantage vs. Original Medicare with Medigap: What's the Difference? Many of you have asked about the differences between Medicare Advantage plans and Original Medicare combined with a Medigap policy. Let’s break it down! Medicare Advantage Plans: Benefits: Often include extra perks like dental, vision, hearing, and wellness programs. Costs: Typically have lower monthly premiums but come with higher out-of-pocket costs when you need care. Network: Generally require you to use a network of doctors and hospitals, which can mean less flexibility. Convenience: Offer an all-in-one approach, combining hospital, medical, and often prescription drug coverage. Original Medicare + Medigap: Benefits: Provides broader access to healthcare providers without network restrictions. Costs: While the monthly premiums are usually higher, the out-of-pocket costs are more predictable, helping you budget better. Coverage: Medigap policies cover many of the out-of-pocket costs that Original Medicare doesn’t, such as copayments, coinsurance, and deductibles. Flexibility: No need for referrals to see specialists and generally no network restrictions. Which is Right for You? The best choice depends on your healthcare needs, budget, and personal preferences. If you value additional benefits and are okay with network restrictions, a Medicare Advantage plan might be for you. If you prefer predictable costs and the freedom to choose any doctor who accepts Medicare, consider Original Medicare with a Medigap policy. Still have questions? We're here to help you navigate your options and find the best fit for your healthcare needs. #Medicare #Healthcare #Insurance #Medigap #MedicareAdvantage #VeracityInsurance