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Nearly $500 million a year in Medicare costs goes to 7 services with no net health benefits

UCLA RESEARCH BRIEF Shopify Partners/Burst Under the Affordable Care Act, the secretary of health and human services is authorized to prohibit payment for services given a “D” rating by the U.S. Preventive Services Task Force, the researchers say. Enrique Rivero | FINDINGS A UCLA-led study shows that physicians frequently order preventive medical services for adult Medicare beneficiaries that are considered unnecessary and of “low value” by the U.S. Preventive Services Task Force at a cost of $478 million per year. The researchers analyzed national survey data over a 10-year period, looking specifically at seven preventive services given a “D” rating by the task force, and discovered that these services were ordered more than 31 million times annually.

Nearly $500M a year in Medicare costs goes to 7 services with no net health benefits

FINDINGS A UCLA-led study shows that physicians frequently order preventive medical services for adult Medicare beneficiaries that are considered unnecessary and of low value by the U.S. Preventive Services Task Force at a cost of $478 million per year. The researchers analyzed national survey data over a 10-year period, looking specifically at seven preventive services given a D rating by the task force, and discovered that these services were ordered more than 31 million times annually. BACKGROUND The U.S. Preventive Services Task Force, an independent panel appointed by the Department of Health and Human Services, makes recommendations on the value of clinical preventive services. Services rated D are considered to have no likely health benefit to specific patients and may even be harmful to them. Overall, the utilization of a variety of services considered unnecessary by the task force drives up health care spending by billions of dollars each year.

Congressional Research Service Report: Health Insurance Premium Tax Credit & Cost-Sharing Reductions

The Congressional Research Service issued the following report (No. R44425) on April 26, 2021, entitled Health Insurance Premium Tax Credit and Cost-Sharing Reductions by health care financing specialist Bernadette Fernandez: Summary Certain individuals without access to subsidized health insurance coverage may be eligible for the premium tax credit (PTC) established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) and amended under the American Rescue Plan Act of 2021 (ARPA, P.L. 117-2) to include several temporary provisions. The dollar amount of the PTC varies from individual to individual, based on a formula specified in statute. Individuals who are eligible for the PTC may be required to contribute some amount toward the purchase of health insurance.

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