Core Insights - Understanding the distinction between wellness visits and routine physical exams under Medicare can lead to significant cost savings for patients [1][5] Group 1: Medicare Coverage - Medicare Part B provides yearly wellness visits at no cost to patients, covering preventative and medically necessary services [1] - Routine physical exams are not covered by Medicare Part B, requiring patients to pay 100% of the cost [1][5] Group 2: Appointment Types - Wellness visits involve reviewing medical history, lifestyle information, and providing guidance on screenings, while routine physical exams are more comprehensive, including blood tests and physical examinations [2] - To ensure coverage, patients should focus on typical wellness visit components and avoid discussing unrelated medical issues that could incur additional charges [3] Group 3: Scheduling and Frequency - Wellness visits are covered only once every 12 months, and patients must wait at least 12 months after enrolling in Medicare Part B or after their initial preventive visit before scheduling a wellness visit [4]

Key Points It's common for Medicare Advantage plans to change from one year to the next. You may be looking at higher deductibles or copays than you were in 2025. Your plan's network may have changed, and the same applies to your plan's benefits. The $23,760 Social Security bonus most retirees completely overlook › The nice thing about being signed up for original Medicare is that the rules are pretty much the same for everyone. Granted, some people pay more for Medicare Part B if their income i ...

Core Insights - Medicare beneficiaries will have the option to choose between original Medicare and Medicare Advantage plans starting in 2026, with Medicare Advantage plans being offered by private insurers that must provide at least the same level of care as original Medicare [1] Group 1: Benefits of Medicare Advantage Plans - Medicare Advantage plans often provide supplemental benefits not covered by original Medicare, such as dental benefits, eye exams, and hearing aids, which can be financially beneficial for enrollees [2] - These plans limit annual out-of-pocket spending, a significant advantage for retirees on fixed incomes, particularly those relying on Social Security [3] Group 2: Drawbacks of Medicare Advantage Plans - Enrollees may find that their preferred doctors are out of network, limiting their choice of healthcare providers [4] - Going out of network can result in higher out-of-pocket costs, as Medicare Advantage plans may not cover care received outside the network [5] - Prior authorization requirements for costly treatments or diagnostic tests can lead to delays in receiving necessary care, with some plans having high denial rates for these requests [6][8] - Individuals who split their time between two states may struggle to access care due to network limitations, making original Medicare a more suitable option for them [9]

Financial Data and Key Metrics Changes - In Q3 2025, the company reported revenue of approximately $1.2 million from 2,841 EsoGuard tests, maintaining volume and revenue levels consistent with the previous quarter [5][22] - The quarterly burn rate was $10.3 million, slightly better than the average burn rate of the previous four quarters [22][28] - The company ended the quarter with $47.3 million in cash, bolstered by a public offering that netted approximately $27 million [9][22] Business Line Data and Key Metrics Changes - EsoGuard test volume remained within the target range of 2,500-3,000 tests per quarter, essential for ongoing engagements with commercial payers [5][8] - Revenue recognition for the majority of claims is based on the probability of collection, with 76% of claims submitted in Q3 adjudicated [26][30] Market Data and Key Metrics Changes - The company is focusing on expanding its market access, particularly targeting Medicare patients, which represent about 50% of the 30 million target population [7][8] - The company has strengthened its market access leadership team to enhance payer engagement and secure broader commercial insurance coverage [6][11] Company Strategy and Development Direction - The company is in the final stages of securing positive Medicare coverage policy outcomes, following a successful Contractor Advisory Committee meeting [4][9] - The strategy includes transitioning to target Medicare patients while maintaining volume with commercial payers [5][8] - The company is also hosting events to strengthen relationships with fire departments, focusing on esophageal cancer prevention [19][20] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the upcoming Medicare coverage, anticipating a draft local coverage determination soon [12][14] - The company is actively engaging with commercial payers and has seen positive movement in discussions, indicating a shift in strategy to pursue coverage even before Medicare approval [45][48] Other Important Information - The company has a strong pipeline of contracted testing events and is expanding its efforts to drive Medicare testing [20][19] - The company reported a non-GAAP net loss of $10.3 million for Q3, consistent with previous quarters [28][30] Q&A Session Summary Question: Can you provide insights on the recent CCLA meeting and its implications? - Management highlighted that the meeting was positive, with significant time spent discussing the company's CAC meeting, reinforcing confidence in the Medicare coverage process [34][35] Question: What is the expected timeline for the draft LCD? - Management indicated that they believe the timeline for the draft LCD publication is reasonable, with expectations for it to be issued by year-end 2025 [43][44] Question: How is the company engaging with commercial payers? - Management noted that there has been increased activity and positive movement in discussions with commercial payers, with expectations for positive coverage policies to emerge soon [45][48] Question: What is the conversion rate for referrals to EsoGuard tests? - Management stated that the conversion rate for patients referred for EsoGuard tests is over 90%, indicating strong follow-through on testing [78]

Heard on the Street: Medicare coverage will cut obesity-drug prices but open the door to millions of new patients https://t.co/qAkfJbTe0q ...

While a government shutdown won't prevent Social Security checks from going out or interrupt Medicare coverage, parts of the programs may slow down or shutter for the duration. https://t.co/Nvt2PqN6Ky ...

Market Trend - Cannabis stocks experienced a rally following President Trump's video promoting CBD coverage under Medicare [1]