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August 10, 2017

Recent Stories

From Medicare Advantage News - Despite the return of the health insurer fee (HIF), which may be reflected in pricing for some 2018 Medicare Advantage products, publicly traded plan sponsors that recently posted second-quarter 2017 earnings appeared confident in their ability to compete for new enrollees and retain existing customers during the 2018 Annual Election Period (AEP) this fall. In addition, several said they were exploring mergers and acquisitions (M&A) to boost their MA footprint. Cigna Corp., finally out of a protracted audit resolution process that excluded it from the 2017 AEP *(MAN 1/28/16, p. Read more

After a week of debating various Republican-led efforts to repeal and replace… Read more

Building on recent modifications to its review of Medicare Advantage organizations’ provider… Read more

Recognizing a wide variation in the performance of its skilled nursing facilities… Read more

From the Editor

Welcome to your Medicare Advantage News subscriber-only Web page

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

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August 3, 2017
For 2018, Basic Part D Premium Is Projected to Drop for First Time in Five Years

CMS this week released the Medicare Part D payment benchmarks and other bid-related information for the 2018 plan year, and, once again, the national average monthly bid amount for Part D plans continued to decline. At the same time, the projected average basic Part D premium will experience a slight drop for the first time in five years, which may reflect lower expected spending above the catastrophic coverage phase.

While the average monthly premium for basic Part D coverage has steadily risen since 2013, the basic Part D premium for 2018 is projected to be $33.50 per month, which is 50 cents less than the prior-year estimate and approximately $1.20 below the actual average premium of $34.70 in 2017, reported CMS. This figure takes into account the effect of enrollees switching from higher-premium plans to lower ones. The base beneficiary premium before such switches is $35.02, down 1.7%, compared with a 4.4% increase between 2016 and 2017.

Avalere Health LLC suggests that the slight decrease in premiums is likely driven by two factors: (1) lower expected costs for individuals who will not reach catastrophic coverage and (2) slightly lower predicted costs for individuals whose spending will exceed the catastrophic threshold.

In an Aug. 2 announcement accompanying the release of the bid data, CMS Administrator Seema Verma hailed the projected drop in premiums as “a step forward in fulfilling the Trump Administration’s promise to lower the cost of prescription drug coverage, particularly for Medicare beneficiaries.” CMS pointed out that this decline comes “despite the fact that spending for the Part D program continues to increase faster than spending for other parts of Medicare, largely driven by spending on high-cost specialty drugs.”

View the annual notice from the CMS Office of the Actuary and other bid-related information here.

July 31, 2017
Whistleblower Suit Targets UnitedHealth

New whistleblower suit alleges UnitedHealth hid MA enrollment complaints and misconduct from CMS. http://tinyurl.com/y8erczmq

July 14, 2017
CMS's Updated 2017 Star Ratings Data Includes Boost for Cigna

CMS this week posted updated 2017 star quality ratings data, showing that Cigna Corp. now has an estimated 57% of Medicare Advantage members in plans with four or more stars, which qualifies the insurer for a 5% performance bonus next year, according to a July 11 research note from Evercore ISI. When the 2017 ratings were posted last fall, only 20% of Cigna’s MA enrollees were expected to be in a plan with a star rating of 4 or higher for 2018, which it partly attributed to a comprehensive program audit. Cigna revealed last month that CMS had lifted its MA marketing and enrollment sanctions, and said it expected 60% of its MA customers to be enrolled in 4-star or higher plans for next year. Stars improved in nine of Cigna’s 20 contracts, comprising 61% of its enrollment, estimated Evercore. Meanwhile, Anthem, Inc. saw a half-point improvement in a 3-star regional PPO contract accounting for 14% of Anthem’s overall MA membership that will keep it below the bonus threshold but provides the company a “step up in rebate percentage,” observed securities analyst Michael Newshel.

View the updated file by clicking on Part C and D Performance data under the Star Ratings section on our page of useful MA guidance and resources.

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