The popular debit cards that Medicare Advantage plans give older adults as a perk for signing up may be cutting off their access to some public assistance because of conflicting interpretations on what counts as income.

Why it matters: The "flex cards" are becoming more common in plans targeted to disabled and low-income older adults, according to an analysis from ATI Advisory shared with Axios. Almost half of all Medicare Advantage plans will feature the cards next year.

• Medicare advocates and members of Congress are pressing the Biden administration to clarify that such supplemental benefits shouldn't be considered income as the Medicare open enrollment period continues.

How it works: Medicare Advantage plans heavily market the debit cards, which can be used for groceries, utility payments or extra medical equipment such as walkers. The dollar amounts and restrictions on what they can be used for vary by plan, and the cards have sometimes been marketed in misleading ways.

• In 2025, the average standard flex card benefit will be $996 for the year, per ATI Advisory.

State of play: The hitch, according to seniors and aging services providers, is that flex cards are being counted as income in eligibility determinations for some other benefits and limiting older adults' ability to tap rental assistance or Supplemental Security Income.

• The IRS generally excludes payments from social welfare programs from recipients' gross income.
• But every agency that offers assistance programs has its own rules and restrictions around what counts as income.
• Most Medicare Advantage benefits are excluded from a renter's income when applying for assistance from the Housing and Urban Development Department, but the law requires some benefits that can be used toward utilities and rent to count as income, a HUD spokesperson told Axios.

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Health insurers would be required to cover over-the-counter birth control and additional FDA-approved contraceptives without cost-sharing under a proposal the Biden administration unveiled today.

Why it matters: The effort is aimed at keeping a focus on reproductive health in the final weeks before the election while expanding the Affordable Care Act's mandate that insurers cover at least one form of each FDA-approved contraception method at no cost.

The big picture: In addition to Opill, the first FDA-approved birth control that doesn't require a prescription, the proposal would expand no-cost coverage to all over-the-counter birth control such as emergency contraception and spermicide, officials said.

• It also would require plans to cover every FDA-approved birth control without cost-sharing, unless the plan covers a therapeutic equivalent.
• Currently, the ACA requires most private health insurance plans to cover only one drug per category of contraception, which can make it difficult for enrollees to get the specific birth control they want.

Yes, but: The policy, which is subject to a 60-day comment period, likely won't be finalized by the end of the administration and could be overturned by a future president.

Catch up quick: Democrats and reproductive rights advocates have long complained that some insurers are denying coverage of some birth control or improperly charging women for contraception.

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Weight-loss surgery is more cost-effective than taking blockbuster GLP-1 drugs, delivering two more healthy years of life and saving patients about $9,000 a year, according to a new analysis.

Why it matters: Such side-by-side comparisons could be critical to insurers' coverage decisions as demand for drugs such as Ozempic and Wegovy surges.

What they found: Northwestern University researchers found GLP-1s are only cost-effective when used in tandem with weight-loss surgery, to control whatever weight is regained.

• Combining surgery and GLP-1s yielded average savings of about $7,200 a year and five more quality-adjusted life years, compared with surgery alone.
• But the one-time surgery has more up-front expense, costing between $17,400 and $22,850. That's compared with the average annual costs of between $9,360 and $16,200 for the drugs, which can be taken over a lifetime.
• The findings were presented at an American College of Surgeons meeting in San Francisco.

What they're saying: "As evidence of health benefits of [GLP-1s] continues to come out, insurance companies will have to decide whether they will cover these medications and in which case scenarios," said Anne Stey, the study's senior investigator.

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Cigna is reviving efforts to merge with Humana after talks fell apart late last year, Bloomberg News reported, quoting people familiar with the matter.

Why it matters: The combined company would be one of the nation's biggest health insurers, but would also likely attract antitrust scrutiny.

Driving the news: The companies have held informal, early-stage discussions about a potential deal, but Cigna is looking to close the sale of its Medicare Advantage business before moving on to other transactions, Bloomberg reported.

• While that could eliminate one area of overlap, Cigna still is facing scrutiny from regulators and Congress over its Express Scripts pharmacy benefit business. A recent Federal Trade Commission report blamed the nation's biggest PBMs for rising drug prices. Express Scripts has since sued over the report, calling for a retraction.
• Humana recently took a hit on Medicare quality ratings that are linked to payments, a setback that threatens billions in revenue for 2026 and poses what one analyst called a "worst-case scenario" for the company, per Bloomberg.

Singer Lance Bass' efforts to eat right, exercise and take medication weren't helping to manage his newly diagnosed Type 2 diabetes symptoms — until doctors determined he actually had a lesser-known condition known as Type 1.5 diabetes.

Why it matters: The disease — which mimics Type 1 diabetes but kicks in during adulthood — is not yet widely recognized, even by doctors. But appropriate early treatment using insulin can result in much better outcomes for those with the disease, experts say.

• The condition, also known as latent autoimmune diabetes in adults, or LADA, occurs when the pancreas stops making insulin, usually because an autoimmune process is damaging cells in the organ.
• It's estimated between 4% and 12% of adults diagnosed with Type 2 diabetes later are found to have the condition.

What he's saying: Bass, of N'Sync fame, has been raising awareness about LADA on his social media platform and joined pop star Nick Jonas as an ambassador for the continuous glucose monitor maker Dexcom.

• It was only once he started using it that doctors were able to see his blood sugar readings weren't typical of a Type 2 diabetic and zeroed in on the LADA diagnoses, he said.

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⚡️ CVS Health ousted CEO Karen Lynch as the pharmacy and health care conglomerate struggled with sluggish growth and rising medical costs and its shares tumbled. (NYT)

💉 Data from the southern hemisphere suggests flu shot effectiveness is on a downward trend and the U.S. could be looking at less successful vaccine effectiveness this winter. (Medpage Today)

✈️ Baxter International plans to import 18,000 tons of IV products by year's end to ease shortages while hurricane recovery efforts continue at a key company plant in North Carolina. (Fierce Pharma)