audits

One of the most important surveys performed to understand the year-to-year status as well as long-term trends in employer coverage is the Business Group on Health’s annual healthcare strategy survey. The 2025 survey was fielded between June 3 and July 12, 2024. The survey was completed by 125 employers, which cover more than 17.1 million lives in the United States. U.S. and multinational companies completed the survey and range from under 10,000 employees to 100,000 employees and over. About 73% of respondents had more than 10,000 employees. They represent a broad range of industries. Remember that a majority of Americans are covered by employer-furnished insurance, usually self-insured ERISA coverage. What does the survey tell us overall? Looking at projected annual increases before plan design changes, the projected trend rose from 6% in 2022 to almost 8% for 2025. Even after design changes, actual healthcare costs continued to grow at a

I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024.   Many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, new regulatory burdens (such as the new prior authorization restrictions), and the greater costs MA plans will bear due to the Inflation Reduction Act’s (IRA) Part D changes. See my earlier blogs on this Part D topic here: https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ and https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ . While we are outside of the two regular annual enrollment windows, increases in MA enrollment still occur given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes

Medicare Advantage (MA) plans are going to want to take note of two recent HPMS memos from the Centers for Medicare and Medicaid Services (CMS). Each touches on major areas of controversy for the program. Supplemental Benefits User Group CMS will host a user group to provide an overview of supplemental benefits data submission for encounter data records on September 26, 2024, 2:00 p.m. – 3:00 p.m. ET. You need to register in advance. See the flyer distributed with the September 10 HPMS memo on the topic. The issue of supplemental benefits is an explosive one right now. Opponents of MA say that MA plans are submitting bids that misrepresent supplemental benefit utilization and thereby inflating their margins. CMS has little to go by because encounter data for supplemental benefits is rarely submitted. CMS did two things to attack the controversial issue. First, it issued a memo requiring plans to submit