Pradeep Peddineni

Have Camera Will Travel.

[Pradeep Peddineni @p_peddineni]

In 2024, 3.5 million people on Medicare had part of their Part B premium paid by their Medicare Advantage plan. That's more than 4 times as many as in 2019. The ads call it money back in your Social Security check. So who pays?

Medicare does. Plans that bid under Medicare's benchmark get a rebate, and a lower Part B premium is one way to spend it (MedPAC).

The catch: a study found plans with a giveback had higher cost sharing (JAMA Health Forum). And in 2026 individual Medicare Advantage plans, KFF found 39% of enrollees in giveback plans get less than $10 a month.

Before December 7, compare the whole year, not just the premium.

Caveat: CMS counts person-years, and the cost sharing link is an association across plans, not proof about yours.

Where it's most common, and what to do:
https://t.co/JUbVBYE59Y

Day 15 of #365DaysOfCMSData
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

If Medicare or your plan denied your care, would you know how to appeal? In Medicare's own survey, only 54.9% of people on Medicare say they know how, barely changed from 54.0% a year earlier. That matters, because Medicare Advantage appeals usually win, at least in part (KFF).

KFF found only 11.5% of denied Medicare Advantage requests were appealed in 2024 (the latest year), yet 80.7% of those appeals were partially or fully overturned.

Your rights come in the denial letter. Keep it, find the deadline, and call your free State Health Insurance Assistance Program.

Who knows least, and what to do:
https://t.co/g4LE0WdRQa

Day 14 of #365DaysOfCMSData
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

Are small towns losing their rural health clinics? I tracked Medicare's list for nearly three years. Not overall: it grew by 437, to 5,626 clinics. Standalone clinics grew 15%, about three times as fast as the ones hospitals run. One reason may be how Medicare pays them.

Since 2021, their Medicare pay limit has gone up every year, to $165 a visit in 2026. CMS believes the law was meant to bring them "more in line with provider-based RHCs," meaning clinics run by hospitals.

Why, and what to check near you:
https://t.co/E61i94ER1e

Day 13 of #365DaysOfCMSData
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

I checked all 7,471 dialysis clinics Medicare lists for one thing: can they train you to do dialysis at home? 3,246 can't. That is more than 4 in 10, with no home option at all.

Medicare is raising its training payment from $95.60 to $138 in 2027. CMS says it will "better align the training payment with the actual cost."

Why, and what to ask before you start:
https://t.co/u2EY8jmGtH

Day 12 of #365DaysOfCMSData
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

https://t.co/NrZwko3rN2

[Pradeep Peddineni @p_peddineni]

In an average quarter of 2025, Medicare spent $4.3 billion on skin substitutes, patches for wounds that will not heal.

In January to March 2026: $118 million. A 97% drop, after one payment rule.

Why it fell, and what it means for you:
https://t.co/iDfZTilgbv

#365DaysOfCMSData

[Pradeep Peddineni @p_peddineni]

https://t.co/z1cIHf876S

[Pradeep Peddineni @p_peddineni]

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[Pradeep Peddineni @p_peddineni]

https://t.co/2geLYorlNq

[Pradeep Peddineni @p_peddineni]

Meanwhile, 4.7 million are in plans that climbed to 4 stars or more.

Check your plan's 2027 stars on Medicare Plan Finder before December 7. A few could still change: some insurers are suing.

Day 10 of #365DaysOfCMSData
Write-up: https://t.co/mwghw2OTYs
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

The 2027 Medicare Advantage star ratings are out.

4.9 million people are in plans that fell below 4 stars, compared with the 2026 ratings CMS updated in July 2026.

Sounds like a collapse. It is not: 7 in 10 members are still in plans rated 4 stars or more.

[Pradeep Peddineni @p_peddineni]

Why they fell: 72 of 215 contracts rated 4 stars or more for 2026 fell under 4, about 1 in 3.

The biggest drop was on Health Plan Quality Improvement, one of the two heaviest weighted scores. Next came members' own rating of their plan, then Drug Plan Quality Improvement.

[Pradeep Peddineni @p_peddineni]

Final rule due by November 1. If CMS finalizes it: from January 1, 2027, traditional Medicare only.

Outside company running your parent's monitoring? Ask the doctor who reads the numbers in January.

Day 9 of #365DaysOfCMSData
Write-up: https://t.co/ds3e2YZxsg
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

Does your parent have a blood pressure cuff that sends readings to a nurse?

In 2024, 389,000 people in traditional Medicare were billed for a home monitoring device.

In 2019: 17,000. About 23 times as many in five years.

[Pradeep Peddineni @p_peddineni]

Growth that fast is hard to check. A 2024 federal evaluation found 43% of patients missed a step: setup, the device or someone reading the numbers.

Now Medicare proposes paying for reading time only when the doctor's own staff do it. That time was 67% of 2024 payments.

[Pradeep Peddineni @p_peddineni]

The catch: that's before drug makers' rebates. CMS estimates net savings for all 10 drugs together nearer 22%.

If you take one of these drugs, compare plans for your exact drugs by December 7.

Day 8 of #365DaysOfCMSData
Write-up: https://t.co/3EcRzwdPFz
Data: @CMSGov

[Pradeep Peddineni @p_peddineni]

Does Medicare's drug price negotiation lower prices? I checked early 2026 claims.

The average Eliquis prescription cost $912 in 2025.

In early 2026, under its negotiated price: $399.

[Pradeep Peddineni @p_peddineni]

All 10 negotiated drugs got cheaper per prescription. For nine, the drop was 40% to 71%. NovoLog's 30% was mostly smaller fills.

The 50 top brand drugs with no negotiated price in effect? Up 2% at the median.