CMS Says Medicare Advantage and Part D Stable For 2025
Contrary to everything we hear on the street, the Centers for Medicare and Medicaid Services (CMS) is reporting that all is well in Medicare Advantage (MA) and the standalone Part D (PDP) program. It reports that the average monthly plan premium for all MA plans, which includes MA plans that provide prescription drug coverage and MA Special Needs Plans (SNPs), is projected to decrease from $18.23 in 2024 to $17.00 in 2025. It also says benefit options will remain stable. CMS says the average standalone Part D plan total premium is projected to decrease from $41.63 in 2024 to $40.00 in 2025 (a decrease of $1.63). This is largely due to the special demonstration program put in place by CMS when it saw standalone Part D premiums slated to skyrocket. It says approximately 99% of people with Medicare enrolled in a standalone Part D plan in 2024 are currently enrolled in a standalone Part D plan offered by a plan sponsor that opted into the demonstration for 2025. Why not – free government money! I still argue the program is extra-legal.
I tend to think CMS is painting the rosiest of pictures here. I do think there are benefit reductions, which allowed plans in major penetration areas to keep premiums stable. And likely high enrollment areas are masking the impact of benefit reductions and premium increases in certain areas that will be hit somewhat hard. There is a great deal of already reported geographic contraction, plan exits, and benefit changes from some of the nation’s largest plans. There also is some evidence of standalone Part D premium hikes in areas despite the stabilization program. If the program was able to keep weighted average premiums stable, no doubt the trend toward fewer choices, higher cost-sharing, and formulary changes will also occur.
We will see the real impact around the country come mid-October with the start of the enrollment season for 2025.
Additional articles: https://www.cms.gov/newsroom/press-releases/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-cms-implements-improvements
#medicareadvantage
Healthcare Election News
A few interesting election year articles on healthcare. Another article on the vast differences between Kamala Harris’ and Donald Trump’s views on Medicaid. Another article on Medicare and Medicare Advantage (MA) suggests neither party would make radical changes to Medicare, but that Democrats could be more active on reining in overpayments in MA and in return expanding traditional program benefits. And a third article discusses JD Vance’s discussions on the campaign trail on overhauling the Affordable Care Act (ACA). It all points to what the GOP tried to do in 2017 with reinsurance pools. A bad idea even in the minds of some GOP policy experts.
Additional articles: https://www.managedhealthcareexecutive.com/view/medicaid-and-the-2024-election-clash-of-two-different-ideologies- and https://rollcall.com/2024/09/26/on-campaign-trail-vance-lays-out-concept-of-a-plan-for-health-care/
#healthcare #healthcarereform #election2024 #vance #trump #harris
Powerful Hospital Lobbies Feeling The Capitol Hill Heat
There is no question that the powerful hospital lobbies have been the most successful over the past many years. They won huge victories at the state and federal levels on prior authorization reform as one example. However, things could be changing. With hospitals eating up 30% of the healthcare pie and huge inflation returning and having some high-profile failures, Capitol Hill is now looking at reforms that impact hospitals’ top and bottom lines. Mentioned as big policy issues that are generating interest are site neutral payments and 340B reform.
In other news, a new study adds to concerns that some health system mergers can decrease quality and raise prices. The study questions the value of acquisitions when one hospital system gobbles up another system.
Additional article: https://www.healthcaredive.com/news/efficiency-gains-from-hospital-acquisitions-study/728156/
(Some articles may require a subscription.)
#hospitals #manda #siteneutral #340b #healthcarereform
Another Study Showing Employers’ Struggles With Healthcare Costs
Another study shows ballooning costs expected in 2025 and how employers are dealing with these ongoing increases in costs of employer coverage. The latest survey finds employers expecting a 7.7% hike – in line with other surveys and a measurable increase from 2023.
As we have seen over time, employers are looking not to shift these costs to employees but looking at economizing. Just 34% will shift costs. Others are looking at plan design changes, including high-deductible plans and network changes as well as drug changes.
#employercoverage #healthcare
Texas Botched Medicaid Redeterminations
A devastating piece from Pro Publica that shows how Texas hastily began redeterminations and dropped two million enrollees, most of them children. About 1.4 million were disenrolled for procedural reasons and hundreds of thousands likely were disenrolled wrongfully and against federal rules. It is a lesson in what happened when ideology overtakes public policy. As well, the feds need a plan for better oversight moving forward. They need to closely watch states as they get their acts together by 12/31/2026 based on a new federal directive.
(Article may require a subscription.)
#medicaid #redeterminations
Ransomware Attacks Up
More than two-thirds of healthcare providers reported a ransomware attack in the past year compared with 60% in 2023. This is up from just 34% of providers in 2021.
(Article may require a subscription.)
#cyberattacks #providers #hospitals #healthcare
VBID Still Going Strong
The Value-Based Insurance Design (VBID) in Medicare Advantage (MA) continues to be strong. For CY 2025, the VBID Model has sixty-two participating MA plans testing models in forty-eight states, D.C., and Puerto Rico through 967 plan benefit packages (PBPs). The types of models in VBID have also grown considerably from the early year, which tested differential benefits for subsets of a plan population.
#medicareadvantage #vbid #healthcarereform
Epic Pushes Back On Particle Health Suit
Epic is pushing back on the Particle Health lawsuit in a very public way. Particle Health is suing Epic for anti-competitive behavior. Epic is now saying that a dispute should be made public to show how Particle Health was placed on a corrective action plan by a collaborative organization based on concerns about privacy of data.
Additional article: https://www.modernhealthcare.com/digital-health/epic-lawsuit-particle-health-dispute-results-carequality
(Some articles may require a subscription.)
#epic #interoperability #particlehealth
— Marc S. Ryan
