Ep. 263 "Let’s Talk: Know Your Medicare Options and What Changes Mean for You"

Episode Description:

 Listen as Kim Beer, Senior Vice President of Policy and External Affairs with the National Health Council, and Dermatologist, Dr. Jeffrey Cohen discuss the 2025 Medicare changes in relation to psoriatic disease and what’s to come in 2026 with Jason Harris, Vice President of Government Relations and Advocacy at NPF.

 Join this discussion about what changes occurred with Medicare in 2025 that impact psoriatic disease care, outcomes to date, what’s to come in 2026, and what you should consider when choosing health care plans during open enrollment with Kim Beer, Senior Vice President of Policy and External Affairs with the National Health Council, Dermatologist, Dr. Jeffrey Cohen, Director of the Psoriasis Treatment Program at Yale University School of Medicine, and Jason Harris, Vice President of Government Relations and Advocacy at NPF.

 The intent of this episode is to increase knowledge of the 2025 Medicare changes, what’s to come, and how such changes impact psoriatic disease from coverage of prescriptions to overall health care.

This episode is sponsored by Novartis.

Timestamps:

  (0:24) Intro to Psoriasis Uncovered and guest welcome Kim Beer, Senior Vice President of Policy   and External Affairs with the National Health Council, and Dermatologist, Dr. Jeffrey Cohen, Director of the Psoriasis Treatment Program at Yale School of Medicine.

(2:25) Perspectives on current health care coverage in Medicare.   

(5:14) Biggest changes to Medicare in 2025.

(6:36) What is the Medicare Prescription Payment Plan and price negotiation for specific medications.

(8:22) Challenges associated with the 2025 Medicare changes from a physician’s perspective.

(13:10) Price negotiation process via CMS  (Centers for Medicare and Medicaid Services) with the first 10 drugs price effective in 2026.  

(17:52) Plan ahead and what to anticipate when choosing the right Medicare plan.

(20:04) What the National Health Council and other patient advocacy organizations are doing to assess the impact of the CMS changes and identify steps for moving forward.

(21:49) Medicare changes for 2026 that affect deductibles for health care services, prescription drug coverage, and vaccinations.

(28:38) Potential assistance options for people who have Medicare insurance.

(31:32) The role of patients in providing feedback on policy changes.

(33:45) Changing from a commercial insurance plan to a Medicare Plan and what to think about when viewing plan options during the open enrollment period.

(37:07) Be part of the process – let your voice be heard by sharing your experiences to help effect change.

3 Key Takeaways:

·       There are four key parts to Medicare health insurance (Part A, B, C and D) which underwent changes in 2025 including a payment cap for prescriptions and availability of a 12 month Prescription Payment Plan to opt in for medications. Additional changes are coming in 2026 including enactment of a price negotiated list of 10 medications.

·       The impact of such changes are both positive (better predictability and affordability) yet also reactionary. Such changes and potential impact should be considered when identifying plan coverage for health care and prescriptions during the open enrollment Medicare period of October 15 to December 7^th.  

·       Be involved by telling your story about the impact of Medicare changes and find a trusted health care provider who is willing to work with you to identify an effective treatment plan that aligns with your health care needs and coverage.

Guest Bios:  

Dermatologist Jeffrey Cohen, M.D., MPH, is the Director of the Psoriasis Treatment Program and the Director of Safety with the Department of Dermatology at Yale University School of Medicine where he is also an Associate Professor of Dermatology and Biomedical Informatics and Data Science. Dr. Cohen treats a variety of skin conditions with a special interest in diseases of the immune system such as psoriasis and eczema tailoring treatments for each individual. He is the author of over 150 peer-reviewed articles on psoriasis and other topics in dermatology. Dr. Cohen serves on the Editorial Board of the Journal of the American Academy of Dermatology, is a Senior Editor for NPF’s professional journal for health care providers Journal of Psoriasis and Psoriatic Arthritis, is a Councilor of the International Psoriasis Council, and serves on the Medical Board of the National Psoriasis Foundation.

 Kimberly (Kim) Beer is Senior Vice President of Policy and External Affairs at the National Health Council (NHC) of which the National Psoriasis Foundation is a member. Kim leads strategic policy initiative and advocacy efforts to improve the lives of individuals with chronic conditions and disabilities. As a member of the NHC’s executive leadership team, she helps to ensure access to high-quality, affordable healthcare for all Americans which includes advocating for policy and health care benefits within Medicare.

Resources:

For more reources and information about Medicare

Contact the Patient Navigation Center to learn more about Medicare, find a health care provider, learn about treatments, or programs that may lower costs.