On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
The Centers for Medicare and Medicaid Services (CMS) have taken the next step on the Medicare Prescription Payment Plan draft guidance, which is required by the Inflation Reduction Act of 2022 to advance President Joe Biden's plan to lower drug costs for seniors.
The draft guidance provides communication and education requirements for...CMS Rules
Low-income Medicare beneficiaries are expected to see some much needed relief as a result of a new rule issued by the Centers for Medicare and Medicaid Services (CMS) this week. The rule seeks to simplify the enrollment and renewal processes for Medicare Savings Programs (MSPs), as many beneficiaries are currently encumbered from...Arizona News
Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...
Set to begin in 2025, the option to pay out-of-pocket costs for Part D drugs in monthly payments over a year was ratified in the Inflation Reduction Act (IRA).
CMS is releasing the guidance in two parts, this week the focus across 56 pages is on helping Medicare Part D plan sponsors and pharmacies prepare for the new program and...
The Medicare Payment Advisory Committee (MedPAC) submitted its
March 2023 Report to Congress which included its 2024 payment recommendations for Medicare fee-for-service (FFS), Medicare Advantage (MA) and the Medicare prescription drug program (Part D). This year's report is likely to please no one as the committee took aim at claims of...
While the Centers for Medicare and Medicaid Services (CMS) are moving forward with tighter regulations on the Medicare Advantage (MA) program, the Heritage Foundation argues that freeing MA from the constraints of Medicare Fee-For-Service (FFS) payment rates and making it the default Medicare enrollment system would offer a solution to...
Medicare-eligible seniors face more options than ever when considering Medicare Advantage (MA) and supplemental coverage. This year, the average beneficiary has nearly 70 different MA and Medicare Part D stand-alone plan options, with a litany of supplemental benefit offerings including many related directly to primary care.
According...
The Centers for Medicare and Medicaid Services (CMS) have heard beneficiary complaints about predatory marketing tactics by Medicare Advantage (MA) companies and is taking action.
In August, Senator Ron Wyden (D-Ore.), Chair of the Senate Finance Committee, began an investigation into deceptive marketing practices . Last week, the...
Every year, ahead of the Medicare Advantage open enrollment period, the Centers for Medicare and Medicaid Services (CMS) publish Medicare Part C and Part D Star Ratings to give Medicare beneficiaries a metric by which to assess plans. Last week, CMS released the 2023 Star Ratings for qualifying MA plans.
Medicare Advantage plans are...
The Medicare Advantage lobby is leaping into action to defend MA plans from the wave of scrutiny and proposed regulation with two separate studies published last week that demonstrate the benefits to MA enrollee pocketbooks and federal spending over traditional Medicare.
The first study, which was sponsored by the nation's largest...Arizona News
This week in Medicare Advantage news, prior authorization reform garners the support of the Better Medicare Alliance, Puerto Rico offers insight into the future of the MA program, a CMS rule on third-party marketing goes into effect and we share some acquisition news.
Last week, the Better Medicare Alliance, the largest lobby for...National News
Talks between Sen. Joe Manchin (D-W.Va.) and Senate Majority Leader Charles E. Schumer (D-N.Y.) laid the groundwork for a new drug pricing proposal that may be advanced during a budget reconciliation process; the proposal also includes a cap on annual out-of-pocket prescription drug costs for beneficiaries, limits the amount drug...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
This week in Medicare Advantage (MA), the program is on track to account for 54% of Medicare spending by 2030 and the Centers for Medicare and Medicaid Services (CMS) finalized the plan rates for 2023. Also, Humana takes a look at social needs in Medicare Advantage before COVID and eHealth looks at the rise in premiums and deductibles...
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the final 2023 Medicare Advantage (MA) Part D rate announcement, which includes an 8.5% rate increase for MA and Part D plans. The agency will not adjust the MA star rating system but will be soliciting solutions to the system that incorporates a path to the Biden...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
The Medicare Payment Advisory Commission (MedPAC), the panel that advises Congress on Medicare policy, released new findings last Friday that demonstrate a surge in popularity for the Medicare Advantage program but raises alarms about upcoding practices that have spiked Medicare spending.
Over 50% of Medicare beneficiaries are...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that takes aim at prescription drug costs in Medicare Advantage (MA) and Medicare Part D plans. The agency said the rule would reduce out-of-pocket costs for beneficiaries and improve price transparency as well as "market competition in the Part D...National News
Following months of tense negotiations between moderate Congressional Democrats and the White House, Senator Joe Manchin (D-WV) ended any hopes for passing President Joe Biden's Build Back Better Bill on Sunday. This leaves many of the sorely needed healthcare spending and reform initiatives in limbo, although some Democrats hope to pass...