January 13, 2025

MA Pay Hike Inadequate; Physicians Upset

Health plans stocks did well on the news that Medicare Advantage (MA) rate hikes would improve in 2026, but many are still calling the increase inadequate and hope the incoming Trump administration will offer more relief. Advocates for MA are saying individual plan offerings will still have to decrease in 2026 after a major contraction in 2025. See my blog today digesting the announcement: https://www.healthcarelabyrinth.com/calling-all-plans-advance-notice-released-for-2026-ma-and-part-d-rates-and-other-policies/ .

In related news, physicians are very upset that health plans will see an increase while they will see a fifth year of reductions. Docs feel plans are getting preferential treatment. I see the docs’ point.

In other news, the Centers for Medicare and Medicaid Services (CMS) want to continue a premium stabilization program for standalone Part D (PDP) plans. A spike in premiums would have occurred without the program. Republicans think the program could be extra-legal (as I do). The spikes are related to the misguided and unfunded Medicare Part D cost-sharing reductions pushed through by Democrats in the Inflation Reduction Act (IRA).

(Some articles may require a subscription.)

Additional articles: https://www.fiercehealthcare.com/payers/cms-proposes-increasing-medicare-advantage-benchmark-payments-223-or-21-billion and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/cms-aims-cement-part-d-stabilization-demo-new-admin-hits

#medicareadvantage #rates #physicians #cms #partd #pdp

https://insidehealthpolicy.com/daily-news/cms-projects-433-ma-pay-bump-ma-plans-look-trump-better-deal

Biden Finalizes Exchange Rule

The Biden administration has finalized the 2026 Exchange rule. Among the reforms includes new marketing restrictions to stop fraudulent enrollment activity, including sweeping penalties on agents and brokers. The rule also amends the risk adjustment program through user fee rates, new calculations to the Basic Health Program (BHP), quality reporting, and some protections against disenrollment for those with small delinquent balances.

Additional article: https://www.modernhealthcare.com/policy/cms-benefits-payments-rule-aca-exchange-marketplace-policies-2026

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#exchanges #aca #obamacare #cms

https://www.fiercehealthcare.com/payers/cms-finalizes-strict-broker-punishments-violations-2026-plan-year

Many Healthcare Rules Won’t Be Able To Be Finalized By Biden

Many healthcare rules will not be able to be finalized by the Biden administration. In some cases, comment periods will not have concluded. In other cases, the finaliation would be complex and the clock will run out on Biden’s tenure. That will leave it to the incoming Trump administration to decide their fate. Usually new administrations place a moratorium on rules that are pending.

Among the rules outstanding are the 2026 Medicare Advantage rule (which includes a major expansion of GLP-1 coverage), remote prescribing, and No Surprises Act billing disputes.

In related news, a Kaiser Health News article discusses the possible reductions to Medicaid. See my recent blog on spending reduction scenarios in 2025: https://www.healthcarelabyrinth.com/what-could-healthcare-spending-cuts-look-like/

Additional article: https://kffhealthnews.org/news/article/trump-republicans-gop-medicaid-expansion-aca-obamacare-matching/

(Some articles may require a subscription.)  

#medicaid #aca #obamacare #medicareadvantage #partd #pdp #nsa #nosurprisesact #transparency #glp1s #weightlossdrugs

https://www.modernhealthcare.com/policy/biden-trump-healthcare-regulations-medicare-advantage-remote-prescribing-no-surprises-act

— Marc S. Ryan

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