A combination of worrying drug trends, MA growth, and political interference has undermined the Part D program’s stability.
About The Podcast:
Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.
Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.
Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.
Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.
Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.
Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.
About The Episode:
On this episode, Marc discusses that a combination of worrying drug trends, MA growth, and political interference has undermined the Part D program’s stability.
Key Takeaways:
The Part D program was designed to be a narrow margin program with risk-sharing with the federal government.
Rising drug costs and utilization as well as increased enrollment in Medicare Advantage (MA) have made the program riskier for plans along the way.
Democrats then passed cost-sharing reduction to gain political points in 2022 and 2024.
The combination of the two has deeply undermined the financial stability of the Part D program, increasing risk to plans and costs of the program.
MA has the advantage of being able to subsidize Part D from Part C revenues, but standalone Part D (PDP) plans cannot. They are in the worst shape.
All this has led to less choice, premium and cost-sharing increases for many, and narrower benefits.
While the federal cost-sharing changes aimed to improve affordability, it has also introduced new forms of cost shifting—many of which are less visible, but no less real.
The federal government had to introduce a premium stabilization program to stop further surges.
Lawmakers and CMS will have to recalibrate and restructure the program to preserve it.
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Resources:
The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
