The Centers for Medicare & Medicaid Services (CMS) recently released a final rule with changes to the Medicare Advantage (MA) and prescription drug program (MA-PD) for Contract Year 2025 (CY2025). CMS’ stated goal for the final rule is to strengthen…

A growing number of disputes have arisen between health systems and Medicare Advantage (MA) plans, with 15 health systems finalizing terminations so far this year. Some have resulted in terminating a single plan’s MA contract, while others have terminated the…

The Centers for Medicare & Medicaid Services’ (CMS’) recently released final rule finalized changes to the Medicare Advantage (MA) prescription drug program (MA-PD) for Contract Year 2025 (CY 2025). CMS’ stated goal for the final rule is to strengthen consumer…

The Centers for Medicare and Medicaid Services’ (CMS’) recently released final rule finalizes changes to the Medicare Advantage (MA) prescription drug program (MA-PD) for Contract Year 2025 (CY 25). CMS’ stated goal for the final rule is to strengthen consumer…

Medicare Advantage Organizations (MAOs) face an inherent tension to grow despite financial constraints on margin. This pressure makes it difficult to invest in competitive benefit design elements that are known to drive growth, including supplemental benefits. Significant financial headwinds including…

Health plans are confronting significant pressure to their financial sustainability, including rising costs, new regulations, and increased competition. Rising medical costs remains an ongoing challenge, with medical expenses outpacing projections in 2023 driven by factors such as post-COVID demand, network…

CMS recently released its proposed rule for Medicare Advantage Organizations (MAOs) and Part D sponsors for contract year 2025. While the proposed rule outlines meaningful policy and technical changes to the Medicare program (e.g., behavioral health, health equity, agent/broker compensation, D-SNP…

Introduction The recent publication of 2024 Medicare Advantage (MA) Star ratings confirmed that the regulatory and operating environment for this program will challenge health plans (especially compared to past years) as the Centers for Medicare and Medicaid Services (CMS) shifts…

This brief builds upon last year’s analysis of Medicare’s Annual Enrollment Period (AEP) and highlights results from the most recent enrollment data available1 from the Centers for Medicare and Medicaid Services (CMS) that accounts for 2023 AEP. Where helpful, we’ll compare…

Studies have previously suggested that MA members are “sticky” and rarely change coverage; however, this behavior may be changing given the proliferation of product options and availability of rich benefits. For example, at the recent JP Morgan Healthcare Conference, Humana…