Medicare Part D Program For 2026 Analyzed
Healthcare policy group KFF does its usual fabulous job analyzing Medicare Part D. In its new briefer, KFF sends a bit of a cautionary tale. While choice continues to exist in standalone Part D (PDP), the program continues to face financial headwinds and contract.
KFF finds:
- In 2026, beneficiaries in each state will have a choice of between 8 and 12 PDPs as well as Medicare Advantage (MA) Part D plans.
- A total of 360 PDPs will be offered by 17 different parent organizations across the 34 PDP regions nationwide (excluding 7 PDPs in the territories), a 22% decrease from 2025.
- Roughly the same number of PDPs will be available for enrollment of Part D Low-Income Subsidy (LIS) beneficiaries for no premium. These are called “benchmark” plans. But just 1 to 4 PDPs will be available across states.
- The 2026 Part D base beneficiary premium will be $38.99, a 6% increase from 2025.
- Actual monthly premiums paid by Part D enrollees in stand-alone PDPs in 2026 will vary considerably, ranging from $0 to $100 or more in most regions.
A series of misguided cost-sharing reductions made by Democrats in the Inflation Reduction Act has created a difficult financial environment for Part D, causing plan exits and eroded benefits. The total number of stand-alone drug plans available in 2026 will fall for the third year in a row, as plan sponsors scale back their PDP offerings. But plans did their best to keep premiums low to avoid even greater concerns. Consumers likely will see higher costs within the benefit design. The big question is what will happen if and when the special premium stabilization program expires.
Additional articles: https://www.kff.org/medicare/a-current-snapshot-of-the-medicare-part-d-prescription-drug-benefit/ and https://www.kff.org/medicare/medicare-part-d-premiums-are-decreasing-for-many-stand-alone-drug-plans-in-a-number-of-states-in-2026/
#medicare #partd #pdp #medicareadvantage
Nonprofit Hospital Arbitrage
A new study finds that larger nonprofit hospitals and health systems are using their low-interest debt to indirectly offset billions of nontaxable investments. This gives them a competitive advantage over smaller non-profits and for-profit peers. The practice is referred to as indirect tax arbitrage, which generated nonprofit hospitals and health systems an estimated $9.4 billion in profit during 2022. About $2.9 billion of that was generated by the largest 1% of nonprofits — 23 of more than 2,200 entities nationwide.
Nonprofits are under attack on Capitol Hill for receiving major tax benefits without giving back comparably to the community in the form of uncompensated and discounted care. They are also accused of abusing the 340B program and taking advantage of higher rates compared with other providers.
#hospitals #medicare #medicaid
Oz Defends Administration Policies At Aspen
Appearing at the Aspen Institute, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz defended the administration on a number of fronts. He told the audience:
- A clean funding bill should be passed and discussions on Exchange subsidy extensions can occur later after agency experts return to the job.
- He continues to single out Medicare Advantage (MA) overpayments and the needs for reform. He said that CMS can navigate the striking down of the risk adjustment data validation audit (RADV) rule. Oz is also pursuing voluntary reform with regard to risk coding.
- Despite spending reductions and projected increases in the uninsured, Oz continues to argue the budget reconciliation bill does not cut Medicaid and defended work requirements.
- Oz did not rule out covering GLP-1s for weight loss in Medicare down the road.
In other news, rightist Rep. Marjorie Taylor Greene, R-GA, signaled a willingness to negotiate with Democrats on their healthcare demands. She said she is “absolutely disgusted” that health insurance premiums could double if enhanced Exchange premium subsidies expire at the ed of the year. President Trump signaled a willingness to discuss the issue but softened that stance quickly.
Additional article: https://thehill.com/homenews/house/5542078-greene-breaks-republican-health-care/
#medicare #governmentshutdown #medicareadvantage #oz #trump #overpayments #riskadjustment #radv #exchanges #coverage #glp1s #weightlossdrugs #workrequirements
https://www.healthcaredive.com/news/oz-government-shutdown-medicaid-cuts-medicare-audits/802171
— Marc S. Ryan
