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Celebrating since 2008 as a Medicare Insurance Specialist

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📧 tcangemi@RetirementHPMS.com

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MEDICARE SECTION:t

Weight Loss GLP-1 Bridge Demonstration program

Beginning July 1, 2026, CMS (Centers for Medicare and Medicaid) will make certain GLP-1 medications available to eligible Medicare Part D beneficiaries for the treatment of obesity and weight loss.

This is a temporary demonstration that will run through December 31, 2027.

CMS will manage this program; it is separate from the beneficiary’s Medicare Part D coverage.

What this means for the Medicare eligible population?:

• Those seeking GLP-1 medications for weight loss may be eligible through the Medicare GLP-1 Bridge if they meet the program’s criteria related to age, BMI, prescribed usage indication for weight loss in combination with lifestyle modifications, and other qualifying conditions.

• To determine eligibility, work with your provider to submit the Medicare GLP-1 Bridge prior authorization request to CMS.

• Pharmacies will collect the $50 copay amount and send a claim to the Medicare GLP-1 Bridge processor. If the pharmacy attempts to bill the beneficiary’s Part D plan, they will receive a rejection.

Medicare Advantage plans with Part D coverage

• The Medicare GLP-1 Bridge program does not change the beneficiary’s Part D coverage.

• Those using GLP-1 medications for Part D covered indications, such as diabetes, diabetes and cardiovascular, or sleep apnea, may continue to have coverage through their plan. Please see the plan’s Formulary and Evidence of Coverage (EOC) for complete coverage details.

• Medicare GLP-1 Bridge program medication costs do not count toward Part D maximum out-of-pocket costs.

The Medicare GLP-1 Bridge is a CMS demonstration and is subject to change or termination by CMS at any time.

To Learn more, visit the website below:

MEDICARE SECTION:

Targeted By A Medicare Scam?

Here are common situations where Medicare fraud can occur, and what to do to recognize and prevent it. This helps you recognize higher risk situations and take actions to protect yourself and Medicare. 

Billing fraud 

Billing fraud occurs when Medicare, and you, are charged for services you didn’t need or receive. It could be from a provider you didn’t see at all. Or a provider could include inaccurate claims along with legitimate ones.

Keep in mind that:  

• Suppliers should not send you equipment, supplies, or orthotics that you did not ask for.  
• Your doctor should not charge you cost-sharing for most preventive services. 
• Your doctor should not offer tests or other services that you don’t need. It is unusual for a provider to offer incentives for using a service. This can be a sign that something is not right.  
• If you return durable medical equipment (DME), you no longer need your supplier should not continue to charge you or Medicare for rental fees or maintenance. 

Always check  your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB) to make sure the services listed are ones that were necessary and that you actually received.  

Misleading marketing  

Misleading marketing can involve misrepresenting the benefits you are entitled to through Medicare or Medicaid. It can also involve pressuring or threatening you with negative outcomes if you do not enroll in a plan. Someone may try to improperly influence your decision to enroll or change your Medicare Advantage or Part D plan.  

Never feel pressured to join any plan. Always make sure you understand what the plan is offering you, and how all your benefits are affected. Ask for written information about the plan’s benefits. If you suspect that an agent isn’t following the rules, keep documented proof. For example, the agent’s business card or marketing materials.  

If you enrolled in a plan due to misleading marketing, you may be eligible for a Special Enrollment Period (SEP) to disenroll from your plan and switch to another one. 

Protect your information 

Medicare will not call you to ask for your Medicare number, Social Security number, or for any financial information.  If someone contacts you and says they are from the government or your health insurance plan, use publicly available contact information to confirm that the person is who they say they are.   

To report fraud contact: 

• 1-800-MEDICARE (633-4227) 
• Senior Medicare Patrol (SMP) Resource Center (877-808-2468) 
• Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477) 
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Remember the three steps from the SMP: Prevent, Detect, Report! 

• Prevent: Open and read your Medicare statements. 
• Detect: Look for things like double charges or services you don’t recognize. 
• Report: Contact the SMP for questions or concerns. 

Find your local SMP at www.smpresource.org. 

Information in this article, taken from: Medicare Rights Center, Dear Marci

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