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Part D Out-of-Pocket Costs to Spike in 2020

Posted by www.psmbrokerage.com Admin on Tue, Oct 15, 2019 @ 11:48 AM

Part D Out-of-Pocket Costs to Spike in 2020

Part D Out-of-Pocket Costs to Spike in 2020-1

Part D catastrophic threshold to spike in 2020, hiking out-of-pocket costs: KFF report

Kaiser Family Foundation (KFF) researchers examined how policy changes could impact the Part D market for the 2020 plan year and found that the catastrophic threshold is set to increase substantially, leading to higher out-of-pocket costs for certain beneficiaries. 

The catastrophic threshold for 2020 will rise from $5,100 in 2019 to $6,350, KFF found. That’s an increase of $1,250, or 25%.

Beneficiaries who take only brand-name drugs will pay for a quarter of that increase out of their pockets, while the rest will be covered by drugmaker discounts. Beneficiaries who take only generic drugs will pay the entire increase out of pocket, according to the report. 

 

RELATED: Part D rebates grew but not enough to offset price spikes, OIG finds 

The report projects that out-of-pocket costs for beneficiaries who take only brand-name drugs will increase from $2,275 in 2019 to $2,652 in 2020, or close to $400. The researchers said that the large increase is due to the expiration of a provision within the Affordable Care Act that slowed the growth of the catastrophic threshold. 

“In the absence of a change in law, Medicare Part D enrollees can expect to face an increase in their out-of-pocket drug costs in 2020,” the researchers wrote. 

Based on 2017 claims data—the most recent available—the report says 4.9 million Part D beneficiaries who do not receive low-income subsidies reached the coverage gap, and 1 million reached the catastrophic coverage threshold. 

Had the threshold increased in 2017, fewer than 1 million people would have qualified for catastrophic coverage, meaning more people would be paying out of pocket in the coverage gap. 

The findings are notable in part, the researchers said, because some legislators are actively seeking ways to cap beneficiaries’ out-of-pocket costs. The drug pricing plan backed by House Speaker Nancy Pelosi would do so, alongside shifting some of the liability for costs for beneficiaries who do reach the catastrophic threshold. 

“Proposed changes to the Part D benefit design would help to mitigate out-of-pocket drug cost increases for Medicare beneficiaries, particularly for those with high drug costs who currently face no limit in their annual out-of-pocket expenses—with Part D plan sponsors and drug manufacturers potentially picking up much of the additional costs,” the researchers wrote. 

Source: https://www.fiercehealthcare.com/payer/part-d-catastrophic-threshold-set-to-spike-2020-increasing-out-pocket-costs-kff-report

Additional Updates:
 

Tags: Medicare Part D

Medicare Advantage, Part D members shifting to higher-rated plans

Posted by www.psmbrokerage.com Admin on Tue, Oct 15, 2019 @ 11:07 AM

Medicare Advantage, Part D members shifting to higher-rated plans

Medicare Advantage, Part D members shifting to higher-rated plans


CMS unveiled star ratings for both Medicare Part D prescription plans and Medicare Advantage plans that show even more of the plans achieving higher star ratings.

The number of Medicare Part D prescription drug plan members who will be in plans with four stars or more in 2020 rose to 27.6%, up from just 3.5% last year, according to data released by the CMS on Friday. The percentage of four-star or greater Medicare Advantage Part C plans with prescription drug coverage grew to a whopping 81.1% of members in 2020, up from 75.3% in 2019.

The topic of lopsided star ratings toward the high end of the scale has been a sticking point with the Medicare Payment Advisory Commission, which believes $6 billion a year could be saved by revamping the way stars are awarded in the Medicare Advantage program.

Medicare prescription drug plans 2020 star ratings

The percentage of Medicare Part D prescription drug plan members in plans with four stars or more in 2020 rose sharply from the year before.

The average star rating of Part D plans, which are managed by pharmacy benefit management companies and health insurers, has bobbed up and down for years but has always hovered below four stars. The average star rating across the 54 Part D contracts in 2020 was 3.5, up from last year's average rating of 3.34.

Enrollment in Part D prescription drug plans with fewer than three stars dropped to 0.8%, compared to 6.2% last year. Just 5.6% of Part D plans received below three stars, whereas 9.6% did in 2018.

Meanwhile, more than 200 Medicare Advantage plans offering prescription drug coverage, representing 52.4% of these plans for 2020, received at least four stars. Last year, 172, or 45.7% of plans, were part of that category. The average star rating for Medicare Advantage plans with prescription drug coverage was 4.16 for 2020, up from last year's 4.06. Medicare Advantage plans with fewer than three stars dropped to 15%, compared with 21.3% in 2019.

Higher rated plans get larger share of enrollees

More people were enrolled in Medicare Advantage plans with prescription drug coverage that had 4.5- or 5-star ratings.

The CMS star rating system for Medicare's private insurance coverage is meant to hold insurers accountable for the care provided to their members.

Health plans have a financial incentive to provide better quality care for their members, because those that garner four or more stars receive a 5% boost to their monthly per-member payments from Medicare.

Twenty-three individual plans scored five stars for 2020. Twenty of those were Medicare Advantage plans offering prescription drug coverage, including nine new contracts that had not earned the high performing indicator last year. Two of the plans were stand-alone prescription drug plans and one was a Medicare Advantage-only plan.

CVS Health, Humana, UnitedHealth Group and Kaiser Foundation Health Plan were among companies offering five-star plans.

Five individual plans covering more than 73,000 people received a warning from the CMS for consistently low quality ratings. Those plans—owned by QHP Financial Group, Delaware Life Insurance Co., Centers Plan for Healthy Living, Universal Health Services and Magellan Health—have earned ratings of 2.5 stars or fewer for a Medicare Advantage or Part D contract since at least 2018.

CMS Administrator Seema Verma said in a statement that the star ratings in the Medicare Advantage and Part D programs indicate that "seniors will have access to more high-quality plans," and pointed to projections the agency released last month suggesting that in 2020 Medicare Advantage average monthly premiums will hit their lowest point in 13 years.

Source: https://www.modernhealthcare.com/medicare/medicare-advantage-part-d-members-shifting-higher-rated-plans


Additional Updates:
 

Tags: Medicare Advantage, Medicare Part D, star ratings

Scheduled Maintenance For HealthCare.gov

Posted by www.psmbrokerage.com Admin on Thu, Oct 10, 2019 @ 01:37 PM

Scheduled Maintenance For HealthCare.gov


CMS released its
scheduled maintenance windows for HealthCare.gov for the impending open enrollment period. As in recent years, open enrollment is 45 days long; from November 1 to December 15.

Maintenance for HealthCare.gov is scheduled for pre-dawn on November 1 (final prep ahead of  open enrollment) and each Sunday from midnight to noon, EST, except on December 15.

Federal officials selected Sunday mornings because it’s when the website receives the least amount of traffic. During any website downtime, HealthCare.gov will be unavailable.

As in prior years, CMS anticipates actual maintenance periods will be much shorter. Despite the allocation of 60 hours for maintenance last year, the website was down for only 
34.5

Photo by Freepik

 
 

Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D

Medicare Pays for 1/3 of U.S. Prescription

Posted by www.psmbrokerage.com Admin on Tue, Oct 08, 2019 @ 03:02 PM

Medicare Pays for 1/3 of U.S. Prescription

The majority of Medicare voluminous prescription drug spending is for drugs covered under Part D, although Part B also covers medicine; this spending accounts for 30 percent of national retail spending on drugs, and nearly $1 out of every $5 in total Medicare spending. 

medicare drug spending chart


Prescription drugs are an important component of health care for Medicare beneficiaries, which includes more than 60 million older adults and people with long-term disabilities.

The majority of Medicare prescription drug spending is for drugs covered under Part D, the outpatient prescription drug benefit. Medicare Part B also covers drugs that are administered to patients in physician offices and other outpatient settings.


A majority of Americans favors allowing the federal government to negotiate prescription drug prices on behalf of Part D beneficiaries;
the practice is prohibited under current law.


View Full Article

 
 

Annual Enrollment Period (AEP) Checklist

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Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D

It's Time to Help and Guide Beneficiaries

Posted by www.psmbrokerage.com Admin on Tue, Oct 08, 2019 @ 10:32 AM

It's Time to Help and Guide Beneficiaries

are you ready for aep-1


The Annual Enrollment Period (AEP) is the time of year when your clients may switch between original Medicare and Medicare Advantage and when they’re able to re-evaluate their prescription drug coverage – whether it’s a stand-alone Part D or wrapped into an Medicare Advantage plan.

Research by the Kaiser Family Foundation found just 11% of Medicare Advantage beneficiaries voluntarily switch plans annually; another study found only 13% of Part D beneficiaries switch voluntarily, yet nearly half (46%) of those who did cut their premiums at least 5%.

For 2019, most Medicare Advantage beneficiaries (88%) are in plans including drug coverage, and more than half (56%) pay no drug premium beyond the Part B premium.

And don’t forget those who prefer Medicare Supplement plans: they vary by design greatly by region – but often it’s possible to cap out-of-pocket costs at a lower level than what’s available in Medicare Advantage plans.

What‘s best for each client? That’s your job, your challenge, your knowledge and expertise in action. And, as always, we are here to assist our agents with any challenges they may have during this time.

AEP Resources:

☛  Welcome to your 2020 AEP Headquarters
☛  Sell Med Advantage and PDP Plans online
☛  Solution to Medicare.gov Drug Finder changes
☛  Get your Med Advantage apps issued faster
☛  Co-op marketing dollars available for AEP
☛  2020 AHIP link with $50 discount
☛  14 Ways to Generate Medicare Leads

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Our goal is to provide agents in the senior insurance market with the information they need to inform their most important business decisions. We picked a handful of our most helpful articles and placed them all on one page for your convenience.

☛  Check out our PSM Agent Guides page

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Email: info@psmbrokerage.com

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Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D

Medicare Changes for 2020

Posted by www.psmbrokerage.com Admin on Tue, Oct 08, 2019 @ 09:29 AM

Medicare Changes for 2020

businessman with dominoMedicare and You for 2020 just came out and while we’re still waiting for the updates on any cost changes, here’s are a couple of notable changes coming for 2020.

Medicare Supplement Plan Changes – No More First Dollar Coverage.

As of January 1, 2020, Plans C & F will be not be available for newly eligible Medicare beneficiaries. However, if a beneficiary is enrolled in Medicare Part A by December 31, 2019, they will retain the option to purchase these plans in the future.

Effectively, if a beneficiary aged into Medicare prior to January 1, 2020 nothing changes in regards to Medigap plan availability for them.

Those who enroll in Medicare on or after January 1, 2020, will not be able to purchase a Medigap Plan C or F, and thus will have no Medigap Plans available that cover the Part B deductible.

Plan G will then have the most benefits available, functioning much like a Plan F once the Part B deductible is covered. Guarantee Issue rights once applied to Plans C & F will now migrate to Plans D & G for this second group of beneficiaries.

Additionally, High Deductible Plan F (HDF) is being replaced by a new Medigap Plan, High Deductible Plan G (HDG) which currently includes the same $2300 annual deductible as the previous HDF. Medicare beneficiaries can begin enrollment into HDG on January 1.


The Donut Hole Will Close by 2020

Closing the donut hole 200That’s right, pictures of donuts on Medicare related posts will be a thing of the past in 2020. The Medicare Part D Donut Hole is closing. The percentage beneficiaries will pay in the coverage gap will decrease as the Donut Hole closes.

If they’re in the Donut Hole, they will now get a discount on brand-name drugs and additional savings on generic and brand-name drugs until it’s officially closed in 2020.

The gap is closing because the manufacturers will continue paying large percentages of the drug, while Medicare drug plans will increase the amount they cover. Currently, Medicare pays 56% of the price of your generic drugs while they’re in the Donut Hole.

They are responsible for the remaining 44%. In 2020, the number they will be responsible for is only 25% of the cost. This results in big saving for Part D beneficiaries in the Donut Hole. 

For more information, check out the full Medicare and You 2020 PDF.

 

Annual Enrollment Period (AEP) Checklist

How To Decide what To Write On Your Insurance Blog

14 Ways To Generate Medicare Leads

Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D

10 Medicare FAQs You Should Know

Posted by www.psmbrokerage.com Admin on Wed, Oct 02, 2019 @ 10:32 AM

10 Medicare FAQs You Should Know


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Tags: Medicare Advantage, Medicare, Medicare Part D

Trump Administration Drives Down Medicare Advantage and Part D Premiums for Seniors

Posted by www.psmbrokerage.com Admin on Wed, Oct 02, 2019 @ 10:20 AM

Medicare Advantage premiums projected to go down to their lowest level in 13 years


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Tags: Medicare Advantage, Medicare, Medicare Part D

Med Supp Market Survey Results

Posted by www.psmbrokerage.com Admin on Fri, Sep 27, 2019 @ 01:26 PM

 Med Supp Market Survey Results

Gen Re released results of this year’s Medicare Supplement Market Survey, and found:

  • Across all participants, $24.2 billion in total Med Supp in-force premium was reported for 2018, a growth rate of 6.6% over 2017;
  • For companies selling/reporting premium and lives for both 2017 and 2018, sales premium and lives declined by 3.2% and 3.7%;
  • Lapse rates averaged 9.8% for open blocks of business and 14.7% for closed blocks in 2018;
  • Over half of the active companies report selling Med Supp plans on a direct-to-consumer basis (via phone, mail, online or a combination of these methods where a traditional agent receiving traditional paid compensation is not involved), and 10% are looking to develop this capability.

    survey results-1

    In 2018, Plan F was the most widely sold plan. Excluding two companies that sell only in waiver states, all participating companies sold Plan F. Plans G and N were also popular with over 80% of participants selling those plans. 



    survey results-2

    Read The Full Report Here -  Med Supp Market Survey


Additional Updates:

Annual Enrollment Period (AEP) Checklist

How To Decide what To Write On Your Insurance Blog

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Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D

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For Agent use only. Not affiliated with the United States government or the federal Medicare program. B08291902

Additional Updates:

Annual Enrollment Period (AEP) Checklist

How To Decide what To Write On Your Insurance Blog

14 Ways To Generate Medicare Leads

Tags: Medicare Advantage, Medicare, Medicare Supplement, Medicare Part D, AgentXcelerator

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