Q&A: Medicare Enrollment and Rooting Out Fraud

Q&A: Medicare Enrollment and Rooting Out Fraud

With U.S. Senator Chuck Grassley

Q: What do Iowans need to know about Medicare Open Enrollment?

A: The annual open enrollment season runs now through December 7, 2025. During the government shutdown, enrollment will continue online at medicare.gov. Iowans can create or log into their online Medicare account to compare plans, find providers and talk to a representative. In 2026, out-of-pocket costs for covered drugs under Medicare Part D are capped at $2,100. When I served as chairman of the Senate Finance Committee, I steered through Congress historic reforms that added the first-ever, voluntary prescription drug coverage benefit to Medicare. Since then, I've worked to ensure Part D is implemented as Congress intended.

New Medicare enrollees should consider getting a drug plan with a low monthly premium even if you don't take prescription medication today to avoid the late enrollment penalty in the years ahead. Be mindful if you wait to enroll for drug coverage when you "need it," an extra 1 percent of the national base beneficiary premium calculated for each month you could have signed up for Part D will be added to your monthly premium. In addition, examine the "annual notice of change" to determine if your current plan will meet your needs in the coming year. Take care to cross check that your current prescription medicines are on the formulary and pricing tier (a list of pharmaceutical drugs covered by a specific health plan) and confirm which providers and pharmacies are in network or listed as preferred providers. Iowans may contact the Senior Health Insurance Information Program (SHIIP) for personalized counseling that is free, confidential and objective to learn more about their Medicare options. Set up an appointment at shiip.iowa.gov, or call (800) 351-4664.

Q: How are you working to root out wasteful spending in federal health programs?

A: As a taxpayer watchdog, I conduct robust oversight of federal programs to ensure hard-earned taxpayer dollars aren't lost to waste, fraud and abuse. When there's a whiff of wrongdoing, I use my oversight tools to get answers. As chairman of the Senate Judiciary Committee, I recently wrote a letter to UnitedHealth Group demanding information on the company's Medicare billing practices. Reports of apparent misconduct, including schemes to misdiagnose enrollees to generate revenue, allegedly contributed to $8.7 billion in extra payments in the year 2021. Stories like these undermine confidence in our health care system and fraudulent activity drives up costs to beneficiaries and the taxpayer. That's why I've continuously pushed the Centers for Medicare & Medicaid Services (CMS) to claw back improper payments and improve its stewardship of taxpayer dollars. Most recently, improper Medicare payments exceeded a staggering $87 billion in fiscal year 2024.

My oversight work also includes efforts to root out fraud in Obamacare. Information provided to my office revealed insurance agents have used targeted internet advertisements to fraudulently enroll consumers. Reports say five million consumers may have inappropriately received health insurance through subsidized plans in the federal marketplace, costing the taxpayer an estimated $20 billion. Last year, I also pressed CMS after a federal watchdog found the state of California improperly claimed nearly $53 million in federal Medicaid reimbursement for illegal immigrants. More recently, I followed up with Dr. Mehmet Oz, the CMS administrator, to dig into details about provider taxes that may be exploited as a kickback scheme to increase the share of federal dollars to provide coverage for illegal immigrants and other populations ineligible for federal Medicaid funds.

Proper stewardship of federal health care programs is essential to keep affordable access to health care for tens of millions of Americans for whom these taxpayer-funded programs are intended to serve.

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