CMS Releases Part D Data For 2025; Sets Up Premium Stabilization Program
The Centers for Medicare & Medicaid Services (CMS) released preliminary technical Medicare Part D bid information for Contract Year 2025. The Part D base beneficiary premium is capped at 6% growth in 2025 due to a stabilization fund set up in the Inflation Reduction Act (IRA). This was because of all the transfers of costs to plans from the government and caps on out-of-pocket (OOP) costs. The anticipated enrollment weighted-average premiums were not released in part because CMS has proposed to create an additional voluntary premium stabilization demonstration program for standalone Part D (PDP) plans.
Many critics of the IRA reforms have suggested that premiums in 2025 could go up 50% to 100% (or more) due to the transfer of liabilities. The stabilization subsidy in the IRA only caps the base premium. Plans enhance benefits and will either have to cut enhancements, raise premiums, or both.
The proposed new premium stabilization program for PDPs features a number of caps and reductions to premiums and enhances risk corridor protections. It seems too good to be true – perhaps a sure sign that 2025 premium hikes filed were high and CMS is trying to find ways to mitigate impacts around election time so there is no October Surprise for the incumbent administration.
The potential premium hikes for Medicare enrollees are a huge problem for sure. CMS has some broad demonstration authority under statute, but the proposal does not seem to fit the normal parameters for a demonstration. CMS says it is testing “whether additional premium stabilization and revised risk corridors for stand-alone prescription drug plans (PDPs) increase the efficiency and economy of services. …” I am not convinced this is anything other than a massive additional subsidy to PDPs to deal with the unintended consequences of the IRA changes.
See my earlier blogs on this subject: https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ and https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ .
#medicareadvantage #partd #pdp #medicare #ira
Bipartisan Policy Center Wants Weight-Loss Drugs In Medicare
The Bipartisan Policy Center (BPC) met with the Congressional Budget Office (CBO) today to determine what data would be needed for the scoring agency to assess the cost of a proposal to expand weight-loss drugs in the Medicare program. BPC supports the bill. Costs in Medicare are rising for GLP-1s simply for coverage for disease states.
(Article may require subscription.)
#weightlossdrugs #drugpricing #medicare #partd
“Becker’s Payer Issues” Recounts Recent Medicare Advantage Activities
A number of articles recounting recent Medicare Advantage (MA) news, including:
- Lower Star ratings in socially vulnerable counties. Ratings in least vulnerable counties were 4.1 compared with 3.8 in most vulnerable counties.
- Centene will exit some states for MA in 2025.
- MA enrollees are less likely to receive burdensome treatments or transfers in the last months of life compared to those in traditional Medicare.
- HealthPartners will no longer take UnitedHealthcare Medicare Advantage at the end of 2024.
- At least six plans and growing will contract MA offerings or exit the program.
Additional articles: https://www.beckerspayer.com/payer/medicare-advantage-in-the-headlines-7-recent-updates-9.html and https://www.beckerspayer.com/payer/high-rated-medicare-advantage-plans-harder-to-find-in-more-vulnerable-areas.html and https://www.beckerspayer.com/uncategorized/how-medicare-advantage-traditional-medicare-differ-on-end-of-life-care.html
#medicareadvantage #healthplans #stars
https://www.beckerspayer.com/payer/5-payers-exiting-medicare-advantage-markets-in-2025.html
Connecticut May Look At Going Back To Medicaid Managed Care
Connecticut is looking at whether it will move back to Medicaid managed care from its current managed fee-for-service program.
#ct #medicaid #managedcare #healthplans
https://ctmirror.org/2024/07/25/ct-medicaid-costs-managed-care-model/
Congress May Need More Continuing Resolutions
With the chambers not meeting their timelines to pass appropriations bills and being far apart on funding, a continuing resolution will likely be needed for part of FFY 2026.
(Article may require a subscription.)
#crs #governmentshutdown #budget2026 #congress
— Marc S. Ryan