medsupp

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

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