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October 19, 2017

Recent Stories

From Medicare Advantage News - All signs point to healthy and competitive Medicare Advantage and Part D markets in 2018 as more sponsors place their bets on a growing Medicare population, according to the so-called landscape files recently posted by CMS. Gorman Health Group (GHG) estimates there will be a 12% increase in the number of plan benefit packages (PBPs) offered next year, which reflects continued growth of provider-sponsored plans, as well as an across-the-board increase in MA Special Needs Plans (SNPs) offered in 2018. Read more

As the Oct. 15 start date of the 2018 Annual Election Period… Read more

As Senate leaders returned from summer recess this month to work on… Read more

Uptake of the Medicare Advantage Value-Based Insurance Design (VBID) model that launched… Read more

From the Editor

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October 11, 2017
2018 Star Ratings Show Boost in Average Overall Score for MA-PDs, PDPs

CMS this morning posted 2018 star quality ratings data for Medicare Advantage and Part D plan sponsors, indicating a slight drop in the number of MA Prescription Drug contracts earning 4 stars or higher but a greater percentage of beneficiaries enrolled in high-performing plans and an improved average star rating for MA-PDs. Specifically, approximately 44% of MA-PDs (170 contracts) that will be offered in 2018 achieved overall ratings of 4 or above, down from 49% of plans (178 contracts) offered in 2017. Weighted by enrollment, nearly 73% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2018, compared with approximately 69% based on 2017 star ratings, CMS said. And the average star rating for MA-PDs improved from 4.02 in 2017 to 4.06 this year.

Meanwhile, the percent of PDPs receiving an overall star rating of 4 or higher rose from 49% (27 contracts) last year to 52% (28 contracts) for their 2018 Part D rating. And the average star rating for PDPs rose from 3.55 last year to 3.62 for the 2018 star ratings. Weighted by enrollment, nearly 47% of PDP enrollees are in contracts with 4 or more stars, up from 41% in the 2017 star ratings. Similar to last year, a total of 23 contracts are highlighted on the Medicare Plan Finder with a high performing (gold star) icon for achieving 5 stars; 15 of these are MA-PDs, seven are PDPs and one is an MA-only contract.

View the new data here.

September 22, 2017
CMS Considers 'New Direction' for Innovation Center

Since the arrival of the new administration and the appointment of HHS Secretary Tom Price, M.D., rumors have been swirling about the future of CMS's Innovation Center, which Republicans have criticized for operating too many demonstrations that are "experimenting" on seniors and are putting too much of a burden on physicians. So it should come as no surprise that CMS this week released an informal Request for Information (RFI) to collect stakeholder input on "a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes."

In the document, CMS said it is interested in testing models in eight focus areas, including Medicare Advantage. In addition to potential modifications to the MA Value-Based Insurance Design model to provide plans more flexibility to innovate, CMS said it is considering a demonstration that incentivizes MA plans to compete for beneficiaries, including those beneficiaries currently in Medicare fee-for-service (FFS), "based on quality and cost in a transparent manner." CMS would look at what flexibilities around supplemental benefits could be included to increase choice, improve care quality, and reduce cost, and is seeking comments on what options might exist beyond FFS and MA for paying for care delivery that "incorporate price sensitivity and a consumer driven or directed focus and might be tested as alternatives to FFS and MA."

The deadline for comments to be submitted online is Nov. 20.

View the RFI here.

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.

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