Deft Research: Which MA supplemental benefits do Duals want most?

Take a Look into Duals’ Supplement Preferences

At Deft Research, we’re dedicated to uncovering Medicare insights that help carriers, agencies and marketers serve clients better. And every month, we share select insights on our blog.

 

This month, we’re exploring some of our most profound learnings about Duals and their interest in MA supplemental benefits. In our 2024 National Dual Eligible Benefit Design Study, we took a closer look at the importance of Dual’s unique needs, as well as Duals’ preferences for supplemental benefits. Our takeaway? 

 Of the eight supplemental benefits we tested, dental benefits emerged as the most important for Duals and low-income non-Duals (LINDs). 

READ THE BLOG

 

Get our Free Snapshot on Duals

Based on our 2024 National Dual Eligible Benefit Design Study, this one-page infographic offers a birds-eye view into Medicare Advantage plan design preferences among Dual eligibles and low-income non-Dual seniors.

It’s perfect for a quick overview. Plus, some of our findings may cause you to rethink your plan designs.

 

DOWNLOAD THE FREE DUALS SNAPSHOT

ADS & Devoted Health Ohio Teaming Up to Help Diabetic Clients

ADS is excited to share that Advanced Diabetes Supply has now signed a limited contract with Devoted Health in Ohio!!Agents, you can begin referring your Ohio Devoted members who need a meter and test strips to ADS starting NOW!www.northcoastmed.com/laura-clinansmithWhile ADS is now able to provide a meter, test strips and other ancillary supplies like needles and syringes, they are NOT able to serve those members who are using a CGM (Dexcom or Libre) at this time.

ADS is excited to extend their services to your members with Devoted in Ohio.

 

If you have any questions, please reach out to your CSM Rep! 614-763-2255

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

READ FULL ARTICLE

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.

CSM’s Employee Spotlight Featuring: Jaime Lebrón

Congratulations Jaime Lebrón for 7 years of service with Cornerstone Senior Marketing!

Jaime is paving the way for Medicare agents up in the Northeast corner of Ohio, as 2024 marks his 30th year in the insurance industry. Jaime plays a vital role with developing relationships with brokers and understands the value of a true partnership. He is constantly out in front of brokers educating and helping the independent agent or agency learn more on how to grow their business organically.

Cornerstone Senior Marketing wants to thank Jaime for his excellent service to our agents!

Brokers International Adds AuguStar Life to Carrier Line-Up

Brokers International is pleased to announce a dynamic addition to our carrier line-up with the partnership of A-rated AuguStarSM Life. This means you have access to a suite of life insurance choices right for a wide range of individual family needs and crucial business protection.

Our new relationship with AuguStar Life (formerly Ohio National Financial Services) is now being offered to BI’s network of agencies and financial professionals.

AuguStar is focusing on further expanding the role of life insurance in protecting the financial health of individuals, families, and businesses through life’s predictable and unpredictable events. Products include:

  • Indexed universal life—to protect loved ones, grow wealth, and create tax advantages
  • Indexed whole life—life-long insurance protection, level premiums and death benefits, and tax-smart cash value that earns interest based on an investment index
  • Term life—for death benefits guaranteed throughout a specific period, premiums based on insured’s age, health, and life expectancy, and possible renewal and conversion

Reach out to your Cornerstone Senior Marketing Sales Rep to receive more information to help you assess your existing clients’ needs and consider new market segments and people who may need your financial expertise.  614-763-2255

Medical Mutual Signs Agreement to Acquire Paramount Health

MMO Broker Update 1/29/2024:

Today, Medical Mutual announced its intent to purchase Paramount Health, a Northwest Ohio-based health insurance company. Paramount, which offers Medicare Advantage, Individual ACA, commercial group and short-term insurance plans, is headquartered in Toledo and does business primarily in Ohio and Michigan.

FULL DETAILS HERE…

Prepare for a potential shift in the Medicare Agent/FMO distribution model

Exclusively from our partners at Deft Research:

The Value of the Health Insurance Agent/FMO Model

DEFT RESEARCH SPECIAL EXECUTIVE RESEARCH BRIEF

 

CLICK HERE TO READ FULL BRIEF 

CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebate Program

December 14, 2023

Contact: CMS Media Relations
CMS Media Inquiries

FOR IMMEDIATE RELEASE
December 14, 2023Contact: CMS Media Relations
CMS Media Inquiries

 

CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebate Program 

Under President Biden’s lower-cost prescription drug law, drug companies will pay rebates to Medicare for raising prescription drug prices faster than the rate of inflation

 

As a result of President Biden’s historic prescription drug law, the Inflation Reduction Act, drug companies will pay rebates to Medicare when prices of certain prescription drugs administered or dispensed to people with Medicare increase faster than the rate of inflation. In addition, people with Medicare may pay a lower coinsurance for some Part B drugs if the drugs’ prices increase faster than the rate of inflation.

Today, the Centers for Medicare & Medicaid Services (CMS) released revised guidance detailing key requirements and procedures for calculating rebates and invoicing manufacturers that owe rebates to Medicare under the Medicare Prescription Drug Inflation Rebate Program for certain drugs covered under Medicare Part B and Part D. CMS also released the list of 48 prescription drugs for which Part B beneficiary coinsurances may be lower between January 1, 2024 – March 31, 2024. Some people with Medicare who take these drugs may save between $1 and $2,786 per average dose starting January 1, 2024, depending on their individual coverage.

“The Inflation Reduction Act is making health care and prescription drugs more affordable while improving the sustainability of the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “The Medicare Prescription Drug Inflation Rebate Program is an important tool to discourage excessive price increases and protect people with Medicare, and today’s revised guidance for the Inflation Rebate Program finalizes key requirements and outlines the process by which CMS will calculate and invoice inflation rebates beginning in 2025.”

When drug companies of certain drugs covered under Medicare Part B and Part D raise prices at a rate that exceeds the rate of inflation, these drug companies will pay rebates to the Medicare Trust Fund under the Medicare Prescription Drug Inflation Rebate Program. CMS will issue invoices to drug companies for these rebates starting in 2025, including for years 2022, 2023, and 2024. The Part D inflation rebate period began on October 1, 2022, and the Part B inflation rebate period began on January 1, 2023. In addition, CMS will continue to apply lower beneficiary coinsurances for certain Part B drugs if prices increase faster than inflation. Including the drugs announced today, CMS has lowered coinsurance for 64 drugs and biologicals.

CMS issued initial guidance on the Medicare Prescription Drug Inflation Rebate Program in February 2023 and voluntarily sought public comment on key topics. The agency received and analyzed more than 90 comments on the initial guidance from consumer and patient groups, drug companies, and other interested parties.

CMS gathered feedback on how best to address challenges drug companies are facing due to likely or actual drug shortages and severe supply chain disruptions, particularly for events outside of their control, and provides for appropriate reduced rebate amounts consistent with the Inflation Reduction Act. The revised guidance also includes guardrails to minimize incentives for drug companies to remain on a shortage list, delay resolving a severe supply chain disruption, or maintain a situation in which a generic drug would be at risk of shortage in order to avoid paying an inflation rebate. While the inflation rebates do not apply to multi-source generic drugs, which are the drugs most likely to be in shortage, the revised guidance provides a greater rebate reduction for Part D sole-source generic drugs as well as Part B and Part D plasma-derived products in shortage.

“Today’s guidance strikes a balance between discouraging large price increases by drug companies and providing appropriate relief to drug companies experiencing shortages or severe supply chain disruptions,” said Dr. Meena Seshamani, M.D., Ph.D., CMS Deputy Administrator and the Director of the Center for Medicare. “Our goal at CMS is to make sure drugs are more affordable and accessible, which includes helping to safeguard and ensure that the pharmaceutical supply chain can deliver critical medicines to providers and patients.”

Key dates for implementing the Medicare Prescription Drug Inflation Rebate Program include:

  • October 1, 2022: Began the first 12-month period for which drug companies will be required to pay rebates to Medicare for raising prices that outpace inflation on certain Part D drugs.
  • January 1, 2023: Began the first quarterly period for which drug companies will be required to pay rebates for raising prices that outpace inflation on certain Part B drugs.
  • April 1, 2023: Some people with Traditional Medicare and Medicare Advantage started paying a lower coinsurance for certain Part B drugs with prices increasing at a rate faster than inflation.
  • 2025: CMS intends to send the first invoices to drug companies for the rebates owed.

View a fact sheet on the Medicare Prescription Drug Inflation Rebate Program revised guidance.

Read the Medicare Part B Prescription Drug Inflation Rebate revised guidance.

Read the Medicare Part D Prescription Drug Inflation Rebate revised guidance.

The lower Part B coinsurance on the list of drugs will be in effect from January 1, 2024, to March 31, 2024. This coinsurance adjustment applies to certain drugs and biologicals paid under Medicare Part B. The Part B drugs impacted by this coinsurance adjustment may change quarterly.

More information about these 48 Part B drugs and biological products can be found in the quarterly Average Sales Price (ASP) public files, available here. A fact sheet is available here.

View an ASPE fact sheet on prescription drugs with reduced coinsurances in 2023.

 

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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