番茄社区

Average premiums and benefits for Medicare Advantage (MA) and Medicare Part D drug plans will remain stable in 2025, CMS officials said Friday.

"Bottom line: average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2025 just as they were in 2024," Meena Seshamani, MD, PhD, director of the CMS Center for Medicare, said on a call with reporters. "Average premiums are projected to decline in both the Medicare Advantage and Part D program from 2024 to 2025."

"CMS has taken significant steps over the last few years -- improved payment accuracy and improved protection for people with Medicare -- and the data are showing that benefit offerings are stable and premiums are decreasing," she added. "People will continue to have ample, affordable choices in both MA and the Part D markets." In addition, thanks to new CMS regulations, "the options people will be choosing from will include stronger beneficiary protection, such as better guardrails to prevent problematic prior authorization, as well as improved access to mental health and substance use disorder treatment," she said.

In specific terms, average MA premiums are expected to decrease, with the average monthly plan premium for all MA plans -- including those with drug coverage -- dropping by $1.23, from $18.23 in 2024 to $17.00 in 2025, CMS . About 60% of Medicare Advantage enrollees in their current plan will have a $0 premium in 2025, the agency said, noting that "as with previous years, access to MA plans with prescription drug coverage will remain nearly universal, with about 99% of people enrolled in Medicare having access to at least one Medicare Advantage health plan in their area."

On the Part D side, average Part D premiums are projected to decrease by $7.45 in 2025, from $53.95 in 2024 to $46.50 in 2025, according to CMS. The agency also noted that the Inflation Reduction Act made several improvements to the basic Part D drug benefit that will reduce costs for people with Medicare, including the annual out-of-pocket spending cap of $2,000 that will apply in 2025. Overall, the law's redesign of the Medicare Part D benefit will reduce enrollee out-of-pocket spending by about $7.4 billion annually among more than 18.7 million enrollees (36% of Part D enrollees) in 2025 – nearly $400 per person.

In addition, starting in 2025, Medicare beneficiaries will have the option to spread their prescription drug costs throughout the year, according to the fact sheet. Part D plan sponsors will provide their enrollees with the option to participate in the Medicare Prescription Payment Plan, which allows them to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy. Under this program, Part D enrollees won't pay anything to the pharmacy for covered Part D drugs; instead, Part D plan sponsors will bill program participants monthly for any cost sharing they incur while in the program.

Regarding MA plan marketing, "people with Medicare will also continue to have increased protection from predatory marketing, and CMS will continue to closely monitor TV ads to make sure they are not misleading for seniors," said Seshamani. "So far, we have rejected more than 1,000 TV ads that didn't meet our tightened [criteria]. We are also making ongoing improvements to Medicare plan finders designed to help consumers navigate the many choices they have."

CMS officials were asked during a question-and-answer session on the call whether they were concerned about health plans dropping out of MA regional markets. "In 2025 there will continue to be ample choice in Medicare Advantage," an official said. "Furthermore, the average number of MA plan choices per county remains robust, with about 34 plan offerings for [non-special needs MA] plans with prescription drug coverage. Plans make business decisions each year, and the majority of what we're seeing this year is plans streamlining their offerings, but not leaving regions -- meaning they may have had a handful of products in one region, and they have reduced that to less products. But it's not accurate to say that access or affordability has decreased in 2025."

Asked by 番茄社区 whether the agency was concerned about some providers dropping out of MA plans due to low reimbursement and prior authorization hassles, the official said that "all the plans that are available in Open Enrollment meet strict network adequacy requirements" but did not elaborate further. However, a CMS spokesperson said in an email that a "noninterference clause" in the law governing Medicare Advantage "prohibits CMS from requiring MA organizations to contract with specific providers or requiring a particular structure for payment from an MA organization. This means that CMS is limited in terms of what we can require of MA plans in implementing specific contract arrangements, as those are negotiated between the plans and providers themselves."

"When a provider termination occurs mid-year, MA plans must provide a notice to enrollees at least 45 days before the termination is effective for primary or behavioral health care providers, and at least 30 days before the termination [is] effective for all other providers," the spokesperson said. "This notice also must include information regarding other in-network providers that the enrollee may access for continued care."

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