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Marc Ryan

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53. The Medicare Advantage and Part D Rule For 2026 Is Out With Major Changes

December 13, 2024 No Comments

The Medicare Advantage and Part D Rule For 2026 is out with major changes in both the Part C and Part D worlds. 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

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December 12, 2024

December 12, 2024 No Comments

Centene Earnings Guidance Released For 2025 Centene released its earnings guidance for 2025 at its investor day. Centene says revenue will be between $166.5 billion and $169.5 billion. It says utilization will continue to be elevated and its medical loss ratio (MLR) will be between 88.4% and 89%. Centene reaffirmed that it expects to bring in between $143.5 billion and $144.5 billion in premium and service revenue for 2024. Its MLR will be between 88.3% and 88.5% for this year. Centene expects to lose $250 million on Medicare Advantage (MA) this year but intends to break even by 2027. It also lost 20% of its MA enrollment during the 2025 enrollment season that just concluded. Centene will gain $200 million in additional MA Star Ratings bonus payments in 2026 after the Centers for Medicare and Medicaid Services (CMS) revised its ratings. Additional articles: https://www.modernhealthcare.com/insurance/centene-medicare-advantage-ratings-investor-sarah-london and https://www.beckerspayer.com/policy-updates/centenes-predictions-for-trump-administration-policy-3-things-to-know.html (Some articles may require

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Stories From Open Enrollment Show The Problems With Our Healthcare System

December 12, 2024 No Comments

My work with everyday consumers shows how irrational and broken the healthcare system really is. I am known as the healthcare guy to family and friends. For the past many years, I have had a bit of a part-time job in Q4, unpaid as it is. Given my background, I receive calls from a rather extended network of people seeking my aid and advice on the enrollment seasons – traditional Medicare with Medicare Supplement, Medicare Advantage (MA), Medicare Part D, the Federal Employees Health Benefit Program (FEHBP), the Exchanges, and employer group coverage. In retirement I plan to expand this free service for a variety of reasons, all of which I have learned from the past decade working with people. Here are some of this year’s cases in hopes that some of them resonate (sometimes unfortunately) with your friends and family and you can offer some advice as well.  In

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December 11, 2024

December 12, 2024 No Comments

Bipartisan Bills Seek PBM Divestitures From Health Plans More evidence that some kind of pharmacy benefits manager (PBM) reform is coming on Capitol Hill: Democratic and Republican lawmakers now have bills to have health plans divest their PBMs. In the Senate, the bill is co-led by a very unlikely pair – liberal Sen. Elizabeth Warren, D-MA, and conservative Sen. Josh Hawley, R-MO. In the House, a companion bill is sponsored by Rep. Jake Auchincloss, D-MA. and Diana Harshbarger, R-TN. Hawley is among those anti-corporate welfare Republicans who are getting more active on healthcare issues. The Patients Before Monopolies Act of 2024 would require insurers to sell off their PBMs within three years. The bill also would prohibit corporations that own PBMs or health plans from also owning pharmacies. Other PBM reform proposals continue to gain bipartisan momentum. Some changes could come in the end-of-year stop-gap bill or sometime in 2025.

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December 10, 2024

December 10, 2024 No Comments

Democrats Ramping Up Opposition To Mehmet Oz For CMS Administrator Democrats are beginning to ramp up efforts in opposition to Mehmet Oz as Administrator of the Centers for Medicare and Medicaid Services (CMS). Democrats question the numerous investments he holds, including in UnitedHealth Group. As well, they question his previous endorsement of Medicare Advantage for All, which would enroll those currently covered by private insurance, all Medicare beneficiaries, and the uninsured in Medicare Advantage (MA). Oz now says he favors expansion of MA not a radical healthcare transformation. Additional articles: https://insidehealthpolicy.com/daily-news/senate-democrats-scrutinize-oz-s-ma-all-proposal-insurance-ties and https://thehill.com/policy/healthcare/5032680-warren-democrats-oz-medicare-privatization/ (Some articles may require a subscription.) #medicareadvantage #medicare #oz #trump https://www.modernhealthcare.com/politics-policy/dr-oz-medicare-advantage-investments-elizabeth-warren-ron-wyden Ailing Walgreens May Go Private Walgreens is weighing a potential sale to a private equity firm. The ailing drug store chain may sell to Sycamore Partners. The Wall Street Journal says the deal could come together early next year. Additional article: https://www.fiercehealthcare.com/retail/walgreens-talks-sale-pe-firm-wsj (Article may require a

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December 9, 2024

December 9, 2024 No Comments

Trump Wants PBM Reform Pressure is mounting to pass pharmacy benefits manager (PBM) reform. Donald Trump came out over the weekend in favor of PBM reform. Brand drug makers have gotten to Trump, getting him to focus on PBMs rather than high brand drug prices at the beginning of the drug channel. Discussions are occurring on whether PBM reform should go in the lame-duck session bill. (Article may require a subscription.) #pbms #drugpricing https://insidehealthpolicy.com/inside-drug-pricing-daily-news/trump-pegs-pbm-reform-priority-wyden-pushes-hard-lame-duck-reforms House Republican Says Medicare And Social Security Could Be On Efficiency Cut List While Donald Trump has said Medicare and Social Security will not be touched, a prominent Republican is arguing differently. Rep. Mark Alford, R-MO, is floating the two programs as potential areas of focus for the Department of Government Efficiency (DOGE). #efficiency #doge #trump #medicare #socialsecurity https://thehill.com/business/budget/5030214-republican-alford-medicare-social-security-doge/?tbref=hp Rural Providers Urge No More MA EGWP Conversions Interesting article discussing how some rural providers are actively

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I Am Shocked By The Vitriol Post UnitedHealthcare Executive’s Assassination

December 9, 2024 No Comments

Somehow the overall failings of the healthcare system are the fault of health plan executives I wade into this debate with some anxiety, but I am frankly astonished by the online vitriol since the blatant assassination of UnitedHealthcare CEO Brian Thompson. Law enforcement believes the killing was clearly targeted, especially given the inscriptions on shell casings which said “delay, deny and defend.” Terribly, some have celebrated Thompson’s death or argued that he deserved to die given his business’ practices. Others have used the tragedy to attack health plans as evil entities that seek simply to deny or delay care. The social media comments single health insurers out as the sole bogeyman in the national healthcare debate. Far-left groups’ posts speculate about soon-to-be-unearthed sinister plots and treachery that are at the heart of the assassination. To me, all the comments are unfortunate and lack important perspective. Bruce Japsen, a writer for

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December 6, 2024

December 6, 2024 No Comments

KFF Finds Spending Higher When MA Enrollees Return To Traditional Medicare A new analysis from Kaiser Family Foundation (KFF) finds higher Medicare spending among those who switch from Medicare Advantage (MA) to traditional Medicare as compared with similar beneficiaries who were in traditional Medicare all along. KFF says Medicare spent an average of 27% more on those switching in, after adjusting for differences in health status and other characteristics. This amounts to a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022. The difference in spending among people with certain health conditions varied from 15% for those with pneumonia to 34% for people with diabetes. The causes for the higher spending are as follows: skilled nursing facility spending (34%), outpatient hospital spending (23%), and inpatient hospital spending (20%). Differences in spending were greater for people of color and dual eligibles and increased with age.

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52. MA’s Challenges, Its Future, And Its Value

December 6, 2024 No Comments

Medicare Advantage is struggling right now, but a new study shows how important MA is to Medicare’s future. 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

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December 5, 2024

December 5, 2024 No Comments

Primary Care Market To Shift by 2023 A Bain & Company study on primary care suggests non-traditional providers, including retailers, payers, and advanced primary care providers, are expected to capture 30% of the U.S. primary care market by 2030. Bain says payers will continue to invest in primary care and population-focused models and will capture 20% of the market. How retailers will fare is more of a question. Bain also says providers will pivot to and grow their value-based care focus. #primarycare #healthplans #insurers #providers https://www.fiercehealthcare.com/providers/primary-care-market-will-see-major-shifts-2030-payers-nontraditional-providers-gain CMS Says Exchanges To Hit Record Numbers Again, But That May Be In Doubt The Biden administration says nearly 1 million new customers have enrolled in coverage through the Affordable Care Act’s (ACA’s) Exchanges during open enrollment so far and that 4.4 million people have returned to a marketplace plan for 2025. The Centers for Medicare and Medicaid Services (CMS) says 2025 could set yet

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