Maskot / Getty Images Medicare costs are rising, but there are ways to save money on your plan and health care costs. Key Takeaways With Medicare open enrollment underway, you can shop for and switch to a more affordable 2026 plan until Dec. 7. You can also save by applying for assistance programs, checking drug formularies and provider networks, and tapping a licensed expert. Cut costs throughout the year by using preferred pharmacies, staying within your provider network, and using wellness benefi ...

二是稳步提高医保报销水平。目前，参保居民、职工住院使用报销范围内的药品、耗材等，分别可以享 受到70%左右、80%以上的报销待遇。不断健全门诊慢特病保障政策，统一将恶性肿瘤门诊治疗、肾透 析等门诊维持治疗周期长、医疗费用相对较高的81种慢性病，纳入门诊慢特病保障范围，参照住院报销 政策予以保障，减轻了患者大额门诊医疗费用负担。同时，全面建立普通门诊报销制度，参保群众因头 痛脑热、感冒发烧、腹泻等常见病、多发病发生的日常门诊费用，也能享受报销待遇，比如，城乡参保 居民在基层医疗机构发生的报销范围内的普通门诊费用，可以报销65%，城乡居民诊断为高血压、糖尿 病后，购买降压药、降糖药还能享受到75%的专项报销待遇。 三是完善大病保险和医疗救助政策。统一居民大病保险起付标准，分段报销比例均达到60%以上，一个 医疗年度内最高可报销40万元。特困人员、低保对象、返贫致贫人口、低保边缘家庭成员和防止返贫监 测帮扶对象等困难群众，可享受居民医保个人缴费部分补贴和医疗费用救助，年度救助限额提高到5万 元以上。"十四五"期间，医疗救助对象累计就医4292.02万人次，医保基金支付544.35亿元。 四是持续完善生育医疗费用报销 ...

此外，广西实行生育津贴发放至个人试点，切实提升民众获得感。广西落实"有条件的地方可探索 将生育保险生育津贴按程序发给参保女职工"工作部署，支持有条件的地市优化生育津贴支付方式，实 施生育津贴发放至个人。 目前，广西贵港、贺州、崇左3市已率先实现生育津贴直达个人。截至2025年10月底，上述3市已为 3879名参保女职工直接发放生育津贴6139.53万元。南宁将于2026年1月1日起实行生育津贴直接发放至 个人，桂林、梧州、防城港、百色4市正在部署推进相关工作。 中新网南宁11月18日电 （黄艳梅 庞雪娇）广西壮族自治区医疗保障局17日介绍，今年以来，广西 在提升产检保障水平、扩大生育保险覆盖面、优化生育津贴发放方式等方面精准发力，以制度支持提升 生育保障能力。 今年1月至10月，广西职工医保普通门诊统筹待遇享受人次1763.98万人次，同比增长20.56%；待遇 支出16.58亿元，同比增长15.68%。 广西将领取失业保险金人员全部纳入生育保险范围，试点将灵活就业人员纳入生育保险范围，生育 津贴保障范围进一步扩大。今年7月1日起，全区领取失业保险金人员在参加职工基本医疗保险的同时同 步参加生育保险，所需保费 ...

为让更多群体享受到生育保障的阳光，广西还将保障范围向更广阔的人群延伸。今年7月1日起，全 区将领取失业保险金人员全部纳入生育保险保障范围，其保费由失业保险基金代缴，个人无需缴费，并 能同等享受生育津贴。截至10月底，已有382名失业人员领取了总额超822万元的生育津贴。同时，广西 正积极试点将灵活就业人员、新就业形态人员等群体纳入生育保险，北海、贵港、防城港、梧州四市已 开展试点，符合条件的灵活就业人员最高可享受1万元生育津贴。 在降低生育成本方面，广西打通了职工医保与生育保险的衔接渠道。根据有关政策，当生育保险基 金支付的产检费用达到1500元上限后，后续符合规定的产前检查费用可无缝纳入职工基本医疗保险普通 门诊保障范围，在职职工最高可再报销2000元。这一举措让孕产保障更有力。数据显示，2025年1—10 月，全区职工医保普通门诊统筹待遇支出16.58亿元，同比增长15.68%；享受人次达1763.98万人次，同 比增长20.56%。 11月17日，记者从自治区医保局获悉，今年以来，广西在提升生育保障水平上持续精准发力，通过 优化产检报销、扩大生育保险覆盖面、改革津贴发放方式等一系列"组合拳"，切实减轻家 ...

编者荐语： 日本经济新闻社与金融时报2015年11月合并为同一家媒体集团。同样于19世纪创刊的日本和英国的两家 报社形成的同盟正以"高品质、最强大的经济新闻学"为旗帜，推进共同特辑等广泛领域的协作。此次， 作为其中的一环，两家报社的中文网之间实现文章互换。 以下文章来源于FT中文网 ，作者李瀚明 FT中文网 . 英国《金融时报》集团旗下唯一的中文商业财经网站，旨在为中国商业菁英和决策者们提供每日不可或 缺的商业财经资讯、深度分析以及评论。 美国白宫（资料图，reuters） 为了解决医疗问题，特朗普搞了一系列操作，这也使得医保支出成为两党在预算案讨 论乃至政府停摆中的关键焦点。 文丨FT中文网专栏作家 李瀚明 截止到11月6日，美国政府停摆已经进入第37天，刷新史上最长停摆记录。这几天2026年美 国政府预算的讨论，共和党和民主党又一次谈崩了——而讨论的核心，还是医疗保险问题。 归属卫生与公众服务部Department of Health and Human Services的医保（Medicare）和医 疗援助（Medicaid）、归属社会保障署Social Security Administration的 ...

Core Viewpoint - The recent decision by Xinxiang, Henan to limit outpatient daily payment amounts for medical insurance has sparked significant public attention, but the policy was quickly revoked, highlighting the challenges in managing outpatient insurance funds effectively [3][4]. Group 1: Outpatient Insurance Fund Management - Xinxiang's initial policy aimed to reduce fraudulent expenditures from the medical insurance fund by imposing daily limits on outpatient claims, which was seen as a crude attempt at fund management [4]. - The rapid increase in outpatient visits, totaling 57.49 billion in 2024 compared to 48.7 billion in 2023, indicates a growing challenge for insurance fund oversight, as the number of claims outpaces the ability to monitor them effectively [6]. - The primary difficulties in managing outpatient insurance funds include the vast number of outpatient visits across numerous healthcare facilities and the inadequacy of current monitoring technologies to detect fraudulent activities [6][12]. Group 2: Regulatory Challenges and Responses - The regulatory environment is complicated by the high volume of outpatient claims and the diverse nature of treatments, such as traditional Chinese medicine, which complicates the establishment of effective oversight standards [6]. - Many regions have reported issues with fraudulent practices, including the manipulation of treatment codes and the substitution of non-insured medications for insured ones, making traditional regulatory methods insufficient [6][7]. - Recent announcements from various local medical insurance bureaus have prohibited year-end "spending sprees" where insured individuals rush to use their benefits, which can lead to unnecessary expenditures and strain on the insurance fund [10][11]. Group 3: Recommendations for Improvement - Experts suggest that improving the management of outpatient insurance funds requires advancements in intelligent regulatory systems, increased electronic medical record usage, and enhanced collaboration among regulatory bodies [12]. - There is a need for greater public awareness regarding the responsible use of medical insurance, as many insured individuals still perceive it as a welfare benefit rather than a shared responsibility [11].

Core Viewpoint - The recent decision by Xinxiang, Henan to impose daily payment limits on outpatient services has sparked public concern, but the local health insurance bureau has announced the cancellation of these limits effective November 12, 2025, highlighting the challenges in outpatient fund regulation [1][2]. Group 1: Outpatient Fund Regulation Challenges - The rapid increase in outpatient visits, totaling 57.49 billion in 2024 compared to 48.7 billion in 2023, poses significant regulatory challenges for health insurance funds [2][3]. - The primary difficulty in outpatient fund regulation is the vast number of outpatient visits across numerous healthcare facilities, making comprehensive oversight impractical [2][3]. - The lack of effective regulatory standards for specific treatment projects, such as traditional Chinese medicine, creates opportunities for fund misuse [2][3]. Group 2: Fraudulent Practices and Regulatory Responses - Innovative and covert fraudulent practices, such as altering treatment codes and substituting non-insured drugs for insured ones, complicate timely detection by traditional regulatory methods [3][4]. - The annual payment limits for outpatient services are relatively low for residents, while the limits for employees can reach thousands, making employee outpatient services more susceptible to fraud [3][4]. - Local health insurance bureaus have issued warnings against end-of-year spending sprees, where some healthcare providers may exploit the misconception that unused insurance funds will expire [4][5]. Group 3: Recommendations for Improvement - Research indicates that the current outpatient fund regulation faces challenges such as underdeveloped intelligent oversight systems, low electronic medical record usage, and insufficient collaboration among regulatory bodies [7]. - Recommendations include advancing intelligent regulatory systems, enhancing the electronic documentation of outpatient visits, and improving the professional capacity of regulatory personnel [7].

Core Insights - The article discusses the implementation of direct payment of maternity benefits to female employees in 25 provinces in China, addressing concerns about childbirth among young people [1][2] - The National Healthcare Security Administration (NHSA) is actively promoting a direct payment model for maternity benefits, which reduces the risk of delays or withholding by employers [2][4] Group 1: Maternity Benefits Policy - The average maternity allowance for female employees has exceeded 26,000 yuan, and it can be claimed without a marriage certificate [1][2] - As of November 1, 2023, 25 provinces, including Jiangsu and Liaoning, have implemented direct payment of maternity benefits to individuals, covering nearly 90% of the regions [1][2] Group 2: Simplification of Claim Process - The NHSA has simplified the application process for maternity benefits, with most regions no longer requiring a marriage certificate or other non-essential documents [2][4] - In some areas, mothers can experience "seamless application" for maternity benefits through automated systems, reducing the need for in-person visits [3][4] Group 3: Comprehensive Maternity Support - The NHSA is working to establish a comprehensive maternity support system, enhancing coverage for hospitalization and maternity medical expenses [4] - Seven provinces have achieved a model where childbirth incurs minimal costs, and all provinces have included assisted reproductive services in their insurance coverage [4]

Group 1 - The article highlights the significant reduction in drug prices and the improvement in healthcare coverage for rural residents over the past fifteen years, particularly through the New Rural Cooperative Medical Scheme [1][3] - The reimbursement rate for inpatient care has increased from a low level at the start of the program to around 70% currently, indicating a substantial enhancement in financial support for medical expenses [3][8] - The article provides specific examples of individuals, such as Liu Guiying, who have experienced a decrease in monthly medication costs, with the price of a commonly used drug, Captopril, dropping from 28 yuan to 4 yuan per box, resulting in over a 50% reduction in her monthly drug expenses [2][4] Group 2 - Despite the improvements, there are still challenges faced by patients, such as the withdrawal of certain effective imported drugs from the reimbursement list, leading to increased out-of-pocket expenses for patients like Liu Guiying [4][6] - The disparity in healthcare benefits between different insurance schemes is evident, with urban employees enjoying better coverage compared to rural residents, as seen in the cases of Liu Guiying and Ai Fenglan [7][8] - The funding structure for urban employee insurance is more robust due to contributions from both employers and employees, while rural resident insurance relies heavily on government subsidies and individual payments, resulting in a smaller overall funding pool [8][9]

（原标题：小药盒，大政策：慢性病证明与医保改革的民生共鸣） 小药盒，大政策：慢性病证明与医保改革的民生共鸣 （作者：张硕、李鑫霖、姚早晖、王艳曦 指导老师：陈广宁） 清晨六点，72岁的退休教师张桂兰准时坐在餐桌前，将降压药、冠心病药、补钾片分门别类摆开。这个 动作她已重复了二十多年，药盒从最初的单一纸盒变成如今的多层药盒，而伴随药盒变化的，还有她手 里的医保账本——"2020年这药360块得全自付，现在36块就够了。"从2023年到2025年，吉林省职工医 保政策三次调整，让她每月的药费负担一直在减少。 与此同时，68岁的农民王建国正拿着医保卡去社区医院买降压药。在他的药盒里，高血压药占了大半。 王建国患高血压已十年，但由于他所参与的居民医保对高血压药品的补贴微乎其微，每个月百余元药费 对于他这样的农民家庭来说是不小的负担。 药盒里的药片，是老年慢性病患者的"生命线"；药盒外的医保政策，则是这条"生命线"的重要支撑。来 自国家卫生健康委的数据显示，全国60岁及以上人口达2.9亿，其中患慢性病人数超1.9亿。他们用药负 担的轻重与医保政策的迭代之间的关联，是观察民生保障与社会政策演进的重要窗口。 个人账户之变： ...