physicians

As noted last month, 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 and largely ties to a few big plans. 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

It was a little over two years ago that the brand drug makers and PhRMA, the drug lobby, were crying apocalypse – that drug innovation and the industry itself would be in tatters if the Inflation Reduction Act (IRA) passed and Medicare drug price negotiations were ushered in. Well, as is the case with almost every “Chicken Little” declaration, their world and ours did not come to an end and the public just might see some – I emphasize some — relief from high drug prices. This past week, the Centers for Medicare and Medicaid Services (CMS) announced that drug prices have been set for the first ten drugs covered by the IRA for January 1, 2026. Five of the drugs’ prices were set by mutual negotiation between the drug makers and CMS. In fact, CMS accepted the counterproposals on four of them. The remaining half were set by CMS

There was a great deal of health plan news the past month, so I decided to do an insurer news roundup blog. Of course, you can find all the details on these topics in my newsfeeds, blogs, and podcasts on this website. Here goes: Q2 2024 investor calls Q2 was a mixed bag for the publicly traded insurers. While some reported great news and others mixed, the message from many of the biggest plans was that Medicare Advantage (MA) and Medicaid rates have led to some financial uncertainty. The insurtechs – Alignment Healthcare, Clover Health, and Oscar Health – reported overall good news, showing they seem to be gaining traction against the big guys. Cigna, Elevance Health, and United reported good news, largely as they are more isolated from government program uncertainty. CVS Health, Humana, and Centene reported more mixed news and seem most impacted by government program issues. United

New Humana CEO Jim Rechtin made some waves recently when he made a compelling case on his Q2 2024 investor call that Medicare Advantage (MA) needs to transform and be more accountable to the government and the Americans it serves. Several other prominent MA executives, including Andrew Toy of Clover Health, John Kao of Alignment Healthcare, and Sachin Jain of Scan Health Group, also have signaled views that are similar. Rechtin made the case that greater collaboration with the Centers for Medicare and Medicaid Services (CMS) is needed and that the industry must better show its value and have some of it accrue back to CMS, Medicare, and Medicaid. Read closely, Rechtin is saying that MA has to be willing to allow Medicare to realize more of the savings. I think Rechtin is right. Let’s break the issue down a bit. Today, MA plans are in a cat-and-mouse game with

Many are asking whether insurers, and specifically Medicare Advantage (MA), would do better under a Kamala Harris or Donald Trump administration. Well, the answer is not so easy. There are pros and cons for each. Further, some of this could be determined by the makeup of Congress as well. But here is my quick take on the issue. I am sure we will be covering more of this as Election 2024 rolls on. The pros and cons are strictly from the standpoint of a health plan. Trump Pros Trump Cons Harris Pros Harris Cons Areas They May See Eye To Eye #election2024 #harris #trump #healthcare #coverage #medicare #medicareadvantage #medicaid #managedcare #exchanges #obamacare #aca — Marc S. Ryan