Medicare Advantage Plans Want Fewer Members
Modern Healthcare covers a real oddity – Medicare Advantage (MA) plans want fewer members. Given upside down financials right now and the need to get back to investor margins, MA plans are trying all things to ensure they do not get members into plans that are underwater or even less profitable. The past few years and into 2026, the plans are eliminating commissions on a number of their plans and products. In addition, marketing budgets overall appear to be being reduced dramatically.
The lack of commissions, reduced marketing, and overall contraction of offerings has led the Centers for Medicare and Medicaid Services (CMS) to predict an actual contraction of 900,000 enrollees in 2026 compared with 2025. I see why they see a sea change, but I still have my doubts that we will see an actual contraction. Clearly growth will come down from a reduced rate in 2025. It might even be flat perhaps. But contract? Wow that we are even talking about it. How times change.
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#medicareadvantage #enrollment #marketing
Trump Demands GLP-1 Makers Shed Some Price Pounds
President Donald Trump said his goal is to get the price of Novo Nordisk’s and other GLP-1 weight-loss drugs’ price down dramatically and quickly. Trump made the comments during an announcement on fertility treatments and drug pricing. Novo Nordisk and Eli Lilly stock fell on Friday after Trump’s remarks. Trump said the monthly price of Ozempic would be reduced to $150, down from its current list price of around $1,000.
In other news, on October 16, a third drug price deal was announced. with EMD Serono will reduce the costs of its fertility drugs for in vitro fertilization (IVF). In return it would receive tariff protection in exchange for investing in U.S. manufacturing. The discounted drugs will be available through the new “TrumpRx” website, expected to launch in early 2026.
#drugpricing #glp1s #weightlossdrugs #branddrugmakers
Exchange Subsidy Negotiations
More news on backroom discussions on extending the enhanced Exchange subsidies. Some in the GOP favor new income caps, minimum out-of-pocket premiums and perhaps cost-sharing, and grandfathering people into the higher subsidies. But prospects remain doubtful given most of the GOP caucuses in each chamber do not favor extension. House Speaker Mike Johsnon, R-LA, wants the government open first, but Senate Majority Leader John Thune, R-SD, said he would consider negotiating the enhanced tax credits if he sees a “critical mass” of Democrats supporting the current funding bill.
#governmentshutdown #congress #trump #coverage #healthcare #exchanges
https://www.beckerspayer.com/payer/aca/where-aca-enhanced-subsidies-stand-7-updates/
Seniors Can’t Find Things In The Plan Finder
The Centers for Medicare & Medicaid Services (CMS) released a new Medicare Advantage (MA) provider search tool on the Medicare Plan Finder website. Beneficiaries can enter up to five of their preferred providers to view their network status in plans. A more complex function lets beneficiaries sort available plans in their area by a “must-have provider” in network. The problem: it may not work. Healthcare policy group found that:
- Many plans still do not list providers and instead prompt the beneficiary to contact the plan for provider information.
- If beneficiaries select two or three plans to compare side by side, they can compare premiums and benefits, but not whether their doctors are in-network.
- Once beneficiaries click on a specific plan for more details, providers can have multiple versions of the same address which may be featured as both in-network and out-of-network.
- If a beneficiary enters a provider name that does not participate in an MA plan, the tool says, “No providers found.” But very likely the doctor is in the traditional program.
#medicareadvantage #cms #providers
https://www.kff.org/quick-take/is-medicares-new-provider-search-tool-a-step-in-the-right-direction/
Mayo Dumps UnitedHealthcare and Humana MA
Mayo Clinic will be out of network next year for most UnitedHealthcare and Humana MA plans in Minnesota, Wisconsin, and Iowa. UnitedHealthcare members in MA individual and dual eligible special needs plans (SNPs) will not have network access, while those in employer group MA plans will. Mayo facilities in the same states will not be in any of Humana’s MA plans.
#medicareadvantage #providers #networks
https://www.modernhealthcare.com/providers/mh-mayo-clinic-unitedhealthcare-humana-medicare-advantage
— Marc S. Ryan
