KFF – New $2,000 Medicare Part D Cap Begins in 2025

New $2,000 Medicare Part D Cap could reduce out-of-pocket drug costs for over one million beneficiaries beginning next year, including tens of thousands of beneficiaries in most states.  Millions more will reach the spending threshold and benefit from the cap over time


Anthem Insurance Carrier Face Becoming Out-Of-Network with Reid

Ref: https://kicks96.com/local-news/727456

(Richmond, IN)–Tens of thousands of area residents who have Anthem health insurance are set to be impacted if Reid Health becomes out-of-network for Anthem.  Kicks 96 and 101.7 The Point News was informed last week by a source close to the situation that patients of Reid Health and its providers would soon receive a letter stating that Reid has been unsuccessful in reaching an agreement with Anthem and will terminate the relationship with Anthem to stand up for its healthcare providers.  The letter has now been sent and states that Reid will be out-of-network for Anthem beginning March 18 unless an agreement is reached.  More than 44,000 area patients stand to be impacted.  A website has been created to give more information.  It’s reidhealthaccess.org.

Inflation Reduction Act raises Medicare Part D prescription costs by 42-57%

Inflation Reduction Act raises Medicare Part D prescription costs by 42-57%
by Julia SpencerWed, December 6th 2023, 8:30 AM EST

Medicare will be increasing the cost of prescription drugs in Part D of their plans.

People enrolled in the Medicare Part D plan will see a 42% to 57% increase in price of their prescription drug medication, according to Healthview Services.

The increase is a result of the new Inflation Reduction Act that pans to lower out of pocket costs to $2,000 dollars in 2025 compared to $7,000 in 2023.

If a patient is enrolled in the premium Medicare plan, also known as Medicare Advantage, they will not be seeing an increase in their prescription drug plan because prescription drug costs are already embedded into the plan.

Read full article here

Overall Satisfaction with Medicare is High, But Beneficiaries Under Age 65 With Disabilities Experience More Insurance Problems Than Older Beneficiaries

While most people with Medicare are adults age 65 or older, Medicare also covers millions of younger people who qualify for Medicare based on having a long-term disability, or diagnosis with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). In 2022, 7.7 million people under age 65 with disabilities were covered by Medicare, representing 12% of all Medicare beneficiaries. Younger beneficiaries who qualify for Medicare because of disability are more likely than those who qualify based on age to have lower incomes and education levels, to be Black or Hispanic, and to be in worse health.

Medicare covers the same benefits for people of all ages, regardless of how they qualified for Medicare, and Medicare coverage options and financial assistance programs are generally the same – the main exception being that people under age 65 with disabilities do not have a guaranteed issue right to purchase Medigap supplemental policies. However, perhaps related to their different pathways to Medicare eligibility and because the program was originally designed to cover older adults, with coverage for younger people with disabilities added later, Medicare generally does not work as well for people under age 65 with disabilities. This conclusion is based on KFF analysis of surveys dating back to 2008 but not more recent than 2019. According to previous analysis, beneficiaries under age 65 with disabilities have reported worse access to care, more cost concerns, and lower satisfaction with care than those age 65 or older.

To get a more current understanding of how Medicare is working for older adults and younger people with disabilities, this brief analyzes data from the 2023 KFF Survey of Consumer Experiences with Health Insurance, a nationally representative survey of 3,605 U.S. adults with health insurance. This brief focuses specifically on the 885 adults with Medicare, including 165 adults under the age of 65 with disabilities.

This analysis provides a window into the challenges facing people with disabilities as they navigate the health insurance system by focusing on the experiences of younger adults on Medicare who qualify for the program due to having a long-term disability. The analysis highlights the ways in which beneficiaries under age 65 with disabilities may be less well served by the Medicare program than older beneficiaries. (While people with disabilities are also included among the population of Medicare beneficiaries age 65 or older, the survey sample is insufficient to focus on this group specifically.) People with disabilities who are covered by private insurance or Medicaid are likely to face similar challenges using their coverage. Insights from this analysis could help to inform efforts to strengthen the Medicare program, particularly for younger adults with disabilities.

Key Takeaways

  • Overall, people with Medicare are more satisfied with their health insurance coverage than adults with other types of insurance, but among people with Medicare, those under age 65 with disabilities are less likely than those age 65 or older to give positive ratings to the overall performance of their insurance coverage (79% vs. 92%) and some features of it, such as the quality and availability of providers.
  • Overall, a majority of Medicare beneficiaries under age 65 with disabilities say they experienced a problem with their health insurance in the last year (70%), compared to half (49%) of those age 65 or older. This includes a larger share of those under age 65 with disabilities who say they experienced denials or delays in getting prior approval (27% vs. 9%) or insurance not paying for care they received that they thought was covered (24% vs. 8%).
  • A relatively small share of all Medicare beneficiaries who said they had a problem with health insurance in the past year reported difficulty accessing care as a direct result of these problems, but access problems were more likely to be reported by Medicare beneficiaries under age 65 with disabilities than those 65 or older. At least one in five Medicare beneficiaries under age 65 with disabilities who reported problems say they were unable to receive recommended treatment (24%) or experienced significant delays in receiving medical care or treatment (21%), compared to very small shares of those 65 or older who said the same (6% for both).
  • Medicare beneficiaries under 65 with disabilities were more likely to experience difficulty with the health insurance enrollment process and comparing insurance options compared to beneficiaries age 65 or older, including figuring out if their income qualifies them for financial assistance (30% vs. 11%).
  • Cost concerns related to insurance are an issue for Medicare beneficiaries of all ages, particularly when it comes to monthly premiums and out-of-pocket costs for prescription drugs, but a larger share of people with Medicare under age 65 with disabilities than those age 65 or older report certain problems. More than one in three people with Medicare under age 65 with disabilities report they had a problem paying a medical bill in the past 12 months (35%), compared to one in ten (9%) of those 65 or older. People with Medicare under age 65 with disabilities were also more likely to report delaying or going without specific health care services due to cost, such as dental care (42% vs. 24%), prescription drugs (18% vs. 10%), and doctor visits (14% vs. 4%).
  • About half of people with Medicare under age 65 with disabilities self-report fair or poor physical health, compared to 19% of those age 65 or older, since, by definition, people under age 65 qualify for Medicare based on having a long-term disability. The higher rate of poorer self-reported health among beneficiaries under age 65 could contribute to a higher rate of health insurance problems.
  • Three in 10 people with Medicare under age 65 with disabilities self-report fair or poor mental health status, compared to 1 in 10 (9%) of those age 65 or older, and a larger share also report problems related to mental health care availability and access, including reporting that there was a mental health therapist or treatment they needed that wasn’t covered by insurance (27% vs. 7%), and being unable to receive mental health services or medication in the past year they thought they needed (18% vs. 5%).


NAIFA-FSP-Life Happens Announce Intent to Merge

Organizations Unite to Better Serve the Industry

The three organizations have publicly announced their intent to integrate operations to better serve the industry and the American people. The respective boards of all three organizations voted to move forward with merging together pending an overall vote by the membership.

View full article

KFF Release – 30% Increase in Bonus Payments to MA Insurers

Medicare Advantage insurers will collect at least $12.8 billion in Federal Bonus Payments in 2023—a nearly 30% increase from 2022

New KFF analyses highlight trends in enrollment, benefits and cost-sharing, and bonus payments for Medicare Advantage Plans

Federal spending on bonus payments to insurance companies that offer Medicare Advantage plans will reach at least $12.8 billion in 2023, according to a new KFF analysis. That is a nearly 30% increase from 2022, and more than quadruple the spending in 2015.

These data come from one of three analyses released today by KFF that examine various facets of the Medicare Advantage program, which provides health insurance coverage to nearly 31 million Americans. KFF examined trends in enrollment, premiums, out-of-pocket limits, cost sharing, supplemental benefits, prior authorization, star ratings and bonus payments.


Merck Sues Over Drug Price Negotiation Law

The pharmaceutical company Merck on Tuesday sued the federal government over legislation that empowers Medicare for the first time to negotiate prices directly with drugmakers.

Merck’s lawsuit, filed in federal court in Washington, is the drug industry’s most significant move so far to fight back against a substantial change to health policy, which will go into effect starting in 2026. Democrats pushed through the Medicare-negotiation program last summer as a provision of the Inflation Reduction Act, framing it as a way of lowering drug prices.


CSG Actuarial: New Data shows Med Supp Market Premium Grows to $36.1 Billion

Based on data compiled information from the NAIC and other sources, CSG Actuarial is reporting total earned premiums in the Medicare Supplement market in 2022 totaled $36.1 billion, a 1.4% increase over 2021.

 Report Highlights:

The total Medicare Supplement lives covered in 2022 decreased slightly to 14.3 million. CSG Actuarial believes this decrease was due to increased competitive pressures from Medicare Advantage plans and a decrease in the overall Medicare growth rate due to Covid deaths in 2020, 2021, and 2022.

Top 12 Carriers in terms of 2022 Medicare Supplement Premiums:

The 2022 overall Medicare Supplement market loss ratio of 80.4% returned to normal historical levels due to a rebound in utilization of non-Covid medical care the past two years.

Fifteen of the top 20 Medicare Supplement carriers reported a decrease in in-force Medicare Supplement lives in 2022.

*Data Source: National Association of Insurance Commissioners, by permission. The NAIC does not endorse any analysis or conclusions based upon the use of its data.



Free Statewide “Welcome to Medicare”

News Release – Ohio Department of Insurance

April 3, 2023

Free Statewide “Welcome to Medicare” Educational Events Available to Ohioans New to Medicare

COLUMBUS – The Ohio Senior Health Insurance Information Program (OSHIIP), the state’s official Medicare educational and counseling program, is holding free in-person and virtual “Welcome to Medicare” events across Ohio from April through June for Ohioans new to Medicare, Ohio Department of Insurance director Judith L. French announced. OSHIIP is a department program.  

“Medicare is complicated and there are different health insurance approaches along with health care and budgetary considerations for Ohioans new to Medicare to evaluate,” French said. “OSHIIP’s Medicare representatives narrow the scope while still thoroughly educating Ohioans about Medicare so they can make informed health insurance decisions best suited for their needs.”

During the events, OSHIIP representatives provide an overview of Medicare, Part A and B benefits, Part D prescription drug coverage, Medicare supplemental insurance plans, Medicare Advantage plans, eligibility, enrollment, financial assistance, and important deadlines. One-on-one follow-up counseling sessions can be scheduled.

Last year, OSHIIP through its different engagement services counseled and educated nearly 600,000 people and saved Ohioans on Medicare $46 million by helping them identify suitable coverage options and financial assistance.

To access the in-person and virtual Welcome to Medicare events schedules, visit insurance.ohio.gov. OSHIIP representatives are also available at 800-686-1578 and oshiipmail@insurance.ohio.gov to answer Medicare questions.

For Medicare information and tips, answers to frequently asked questions, and insight into how to avoid Medicare scams visit insurance.ohio.gov and medicare.gov


Biden Administration Releases Timeline IRA Medicare Provisions

Biden Administration Releases Timeline for Implementation of Inflation Reduction Act Medicare Provisions

The administration released a timeline for implementation of certain Inflation Reduction Act (IRA) provisions, including provisions related to Medicare drug price negotiations.

As we have mentioned previously, the IRA grants the secretary of HHS the ability to negotiate the prices of certain drugs for the Medicare program with new prices beginning in 2026. Ten Part D drugs will be negotiated in 2026, with an additional 15 Part D drugs in 2027, 15 Part B or D drugs in 2028, 20 Part B or D drugs in 2029, and 20 more drugs each year beyond that. The bill dictates that the secretary can only negotiate prices on costly single-source drugs, those among the highest-spend products in Part B or Part D that do not have competing small-molecule generics or biosimilars that are both FDA-approved and marketed. The legislation also exempts “small biotech drugs” from negotiation until 2028….