medigap Archives - Page 13 of 18 - The Healthcare Labyrinth

The Two Sides Of Drug Prices After Negotiations

December 26, 2024 No Comments

The discounted Medicare drug prices makes progress but much more has to be done In A Tale of Two Cities, Charles Dickens famously started his novel with: “It was the best of times, it was the worst of times.” In many ways, the adage could well describe the current state of Medicare drug price negotiations. Medicare drug price negotiations background Medicare drug price negotiations became possible with the passage of the Inflation Reduction Act of 2022. The law required Medicare to begin negotiating drug prices with brand drug manufacturers. These drugs largely lack generic competition. Eligible drugs are phased in over time, with the first ten already set to have discounted pricing as of January 1, 2026. The next fifteen drugs subject to negotiation will be announced in February 2025, with final negotiated prices taking effect on January 1, 2027. The bill over time covers both Part D retail and

National Healthcare Expenditure Data Issued for 2023: What Does It All Mean?

December 23, 2024 No Comments

2023 saw a major surge in healthcare spending coming out of the COVID pandemic One of my Christmas traditions is to write about the release of the Centers for Medicare and Medicaid Services (CMS) Actuary’s National Healthcare Expenditure Data (NHED) for a given calendar year. This usually is released in the middle of December each year for the prior year. It literally takes CMS about a year to capture, calculate, and categorize all the data for a year given the size and labyrinthine complexity of our healthcare system. Each year as well, usually in the first half of June, the CMS Actuary updates healthcare spending projections for ten outyears. Why is this so important? First, it is the main comprehensive source of data for calculating the history and future of healthcare spending. Most other studies rely in some form on the CMS Actuary’s NHED reports. Second, it is a treasure trove

November To December Medicare Advantage Enrollment Statistics Signal Some Trends For 2025

December 19, 2024 No Comments

Some evidence that MA enrollment is slowing and big national plans realigning The 2025 enrollment season for Medicare Advantage (MA), known as the Annual Election Period (AEP), has come to a close as of Dec. 7, with some getting through Dec. 31 due to plan terminations. In this period, people can make changes between the traditional fee-for-service (FFS) program and MA or between MA plans. Standalone Part D (PDP) can be added or switched as well. Then, from Jan. 1 to Mar. 31, we have the perhaps misnamed MA Open Enrollment Period (MA OEP). In these three months, only those in MA can switch back to FFS and add a Part D plan or switch MA plans. Those enrolling in an MA Part C only plan can also add a standalone Part D plan. We are in a very odd time. Plan terminations and geographic contractions were major. Benefit cutbacks,

Be Level-Headed On Medical Loss Ratio Rules

December 16, 2024 No Comments

CMS’ MLR proposals are understandable, but caution is needed In a parting shot at the private managed care industry, the Biden administration’s Centers for Medicare and Medicaid Services (CMS) issued a 2026 Medicare Advantage (MA) and Part D proposed rule for 2026 that would make major changes to the minimum medical loss ratio (MLR) requirements in the Medicare managed care program. This comes as Capitol Hill is shining a light on a number of MA program issues, including overpayments, risk adjustment abuses, supplemental benefits, marketing, poor Star performance, and the vertical integration of top national health insurers. These top national players control about three-quarters of all MA enrollment right now. Minimum MLR explained Most lines of business now have MLR requirements except self-funded employer plans. In these cases, businesses are at risk for healthcare expenditures as opposed to insurers. Insurers will still administer such plans usually for a set administrative

Stories From Open Enrollment Show The Problems With Our Healthcare System

December 12, 2024 No Comments

My work with everyday consumers shows how irrational and broken the healthcare system really is. I am known as the healthcare guy to family and friends. For the past many years, I have had a bit of a part-time job in Q4, unpaid as it is. Given my background, I receive calls from a rather extended network of people seeking my aid and advice on the enrollment seasons – traditional Medicare with Medicare Supplement, Medicare Advantage (MA), Medicare Part D, the Federal Employees Health Benefit Program (FEHBP), the Exchanges, and employer group coverage. In retirement I plan to expand this free service for a variety of reasons, all of which I have learned from the past decade working with people. Here are some of this year’s cases in hopes that some of them resonate (sometimes unfortunately) with your friends and family and you can offer some advice as well. In

August 1, 2024

August 1, 2024 No Comments

Cigna Exceeds Expectations for Q2 The Cigna Group reported Q2 earnings that exceeded expectations, driven by growth in its services business. Total revenue in Q2 was $60.5 billion, up 24.6% year over year. It reported $1.5 billion in net income, up 6%. Cigna is more isolated from Medicare pressures (small line being sold) and Medicaid pressures (no line). Evernorth’s services revenue rose nearly 30% year over year to $49.5 billion. Pharmacy service revenues grew more than 41% to $26.6 billion. In great measure this was due to the migration of Centene from CVS Caremark to ESI. CEO David Cordani also committed to more aggressive defense of the value of its pharmacy benefit manager, ESI. In related news, Cigna says its GLP-1 weight-loss program has enrolled two million. Additional articles: https://www.healthcaredive.com/news/cigna-aggressive-pharmacy-benefit-manager-defense/722638/ and https://www.beckerspayer.com/payer/cigna-posts-1-5b-profit-in-q2-2.html and https://www.fiercehealthcare.com/payers/evernorth-drives-double-digit-revenue-growth-cigna-q2 and https://www.beckerspayer.com/payer/cignas-glp-1-program-enrolls-2-million.html (Some articles may require a subscription.) #healthplans #cigna https://www.modernhealthcare.com/insurance/cigna-earnings-call-evernorth-health-services-revenue-growth-medicare-medicaid Alignment Reports Positive Results Alignment

July 31, 2024

July 31, 2024 No Comments

Humana Meets Expectations in Q2 But With Some Mixed News Medicare Advantage (MA)-dominant Humana released its Q2 2024 results. It had $679 million in profit for the second quarter, down from $959 million a year ago. It had $29.5 billion in revenue for the quarter, compared to $26.7 billion in the second quarter of 2023. It affirmed its already conservative guidance. It revealed that MA rates have complicated its financial performance and that it would shutter some plans in geographies and has reduced benefits in others. It expects to lose about 5% of its projected 2024 enrollment next year, or about a few hundred thousand. It will increase its enrollment this year by about 225,000. Only Humana and CVS Aetna performed well on the enrollment front recently. Its medical loss ratio (MLR) was 89.5% in the quarter, compared to 86.8% in the second quarter of 2023. Humana blames the increased

July 30, 2024

July 30, 2024 No Comments

Biden Administration Will Accelerate 2026 MA and Part D Rule Before Leaving Office Interesting article in Modern Healthcare on plans of the Biden administration to accelerate the Medicare Advantage (MA) and Part D rule for 2026. The draft will be published in September, with the final rule sometime before President Biden leaves office. This could mean huge new policy changes for MA and Part D. Trump did something similar. On one hand, Biden may want to leave office proposing some major reforms. On the other hand, the striking of the Chevron deference precedent could complicate enacting major changes. The possible list of changes I see — they can’t do all of them, could they?: Separately, will he do more on antitrust and horizontal and vertical integration? (Article may require a subscription.) #election2024 #biden #healthcare #regulations #medicareadvantage #partd https://www.modernhealthcare.com/policy/health-rules-2024-medicare-pay-prior-authorization Bipartisan Momentum For Site-Neutral Policies The Health and Human Services secretaries of

July 29, 2024

July 29, 2024 No Comments

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,

July 26, 2024

July 26, 2024 No Comments

What If Exchange Premium Subsidy Enhancements Lapse? A new Kaiser Family Foundation (KFF) analysis determines the potential effects of the lapsing of the enhanced premium subsidies in the Exchanges after 2025. KFF concludes that enhanced subsidies have cut premium payments by an estimated 44%. It says if the enhancements lapse, individuals in twelve of the states that use HealthCare.gov would see their annual premium payments at least double on average. Enrollees with low incomes would see the greatest jump in their premium payments, but all income groups would be hurt (including middle-income earners). The Congressional Budget Office (CBO) said that Exchange enrollment would drop from an estimated 22.8 million in 2025 to 18.9 million the following year if the subsidies lapse. It would drop to 15.4 million in 2030. This would send our uninsured rate up. I expect it to continue to increase now due to the Medicaid redeterminations and losses

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