This is Emerson with the Becker's Payer Issues
podcast.
Here's your biweekly industry news briefing for September
30th.
Average Medicare Advantage premiums and Medicare part d
premiums will decrease in 2024
according to CMS on September 27th.
The average Medicare Advantage monthly premium in 2025
will be $17.
That's down from
$18.23
this year.
The average total part d premium will decrease
by
$7.45 next year to a total of $46.50.
The average stand alone part d plan premium
will decrease slightly to $40.
The average part d premium for MA plans
with prescription drug coverage will decrease,
to $13.50.
A provision of the Inflation Reduction Act can
capping out of pocket prescription drug costs of
$2,000
a year for Medicare beneficiaries
takes effect in 2020
5. CMS has offered plans a voluntary demonstration
program to stabilize premiums as planned to implement
the out of pocket cap. The vast majority
of plans opted into the demonstration.
The agencies $5,000,000,000
to keep part a premiums stable, and it
projects 35,700,000
people will enroll in Medicare Advantage Plans in
2025.
Well, Centerra Health in Norfolk, Virginia is cutting
about 200 jobs, with the majority of those
cuts coming from its health plan division.
Other cuts are corporate shared service positions that
function in support of health plan operations.
Cuts span at multiple levels with 40% being
in leadership positions. A final number of job
cuts has not been determined as the system
works to find affected employees other roles
within the system. Sentara said that Medicaid redeterminations
have resulted in its health plan losing
115,000
members, which is approximately 16%
of its membership.
Said the cuts align staffing levels with its
health plan membership.
The cuts themselves, though, represent less than 1%
of Sentara's 34,000
total employees across the health system side as
well. The impacted positions span 10 states with
a majority residing in Virginia.
Well, CVS has struggled financially this year, and
investors are now taking action. According to a
new report from the Wall Street Journal,
shares in the company have fallen around 24%
this year, and CVS plans to lay off
29 100 employees,
which is less than 1% of the company,
and those are roles primarily corporate roles.
The health care company cut its earnings guidance
multiple times in the last 12 months, primarily
due to rising costs within Aetna's Medicare business.
The company's pharmacy benefit unit also has issues.
The FTC is scrutinizing CVS Caremark over alleged
insulin price inflation.
Senior executives from CVS are meeting with the
leaders of Glenview Capital Management, a hedge fund
investor this week.
They are discussing ways to improve operations at
the company. The meeting could launch,
an activist stance from the hedge funds.
One of the leaders of the hedge funds
told the Wall Street Journal that he intends
to present ways to energize the company, but
not break up the company.
Back in August, CEO Karen Lynch unveiled plans
for $2,000,000,000
in cost cuts and parted ways with Aetna's
president.
She, along with CBS CFO, Tom Cowhey, are
managing the insurance company now.
Well, a new bill will require some forms
of insurance in California to pay for IVF.
Governor Gavin Newsom signed that legislation September 29th.
The bill requires large group insurers to cover
the diagnosis and treatment of infertility, including in
vitro fertilization,
which can be a very expensive service, often
costing up to $20,000
per round of treatment.
The legislation applies to large group plans, which
cover around 9,000,000 people in California.
Legislation does not apply to Medicaid enrollees or
people who receive coverage from religious employers. The
law goes into effect in July of next
year for private sector employees and in 2027
for California state employees.
The University of Vermont Health Network and MVP
Health Care will no longer offer their joint
Medicare Advantage Plans in Vermont in 2025.
MBB Healthcare is based in Schenectady, New York.
It said it will no longer offer UVM
Health Advantage, which is a co branded plan
offered with the University of Vermont Health with
and it will no longer be offered in
the state of Vermont.
UVM Health Advantage will still be available in
5 upstate New York counties in 2025.
The company said it could know Medicare Advantage
was no longer sustainable in Vermont given sharply
increasing post pandemic surges in care utilization
and difficult regulatory changes on the horizon in
2025.
There have been other health systems this year
that have scaled back their Medicare Advantage plans.
Well, 2 US democratic senators have introduced the
Health Care Affordability Act, which aims to permanently
extend the Affordable Care Act's enhanced premium tax
credits for marketplace coverage. The credits were originally
extended through the Inflation Reduction Act and are
set to expire at the end of 2025.
If they're not renewed, over 20,000,000 Americans
will see higher health insurance costs with an
estimated 3,000,000 losing coverage and about 9,000,000 paying
more.
Identical legislation was introduced in the house as
well. The tax credits increased the subsidies for
individuals earning between 104100%
of the federal poverty level and expanded eligibility
for those earning above 400%
of the federal poverty
level. Debates surrounding the ACA have shifted recently
from repeal and replace to discussions on the
impending expiration of those subsidies.
Former president Donald Trump has said he would
consider changing the ACA only if a less
expensive alternative is proposed.
And while the Republican Party has moved away
from repeal efforts, lawmakers have expressed concerns about
fraud on the state exchanges.
Marketplace enrollment reached a record high of more
than 20,000,000
in 2024,
partly due to those subsidies.
Making those subsidies permanent would also add $335,000,000,000
to the national deficit between next year and
2034,
according to the congressional budget office. Public support
for making those credits permanent remains high with
78%
of Americans in favor.
Well, in a reversal,
a quick reversal, Maryland has said it will
contract with Kaiser
Permanente as a Medicaid managed care organization in
2025.
Just a few days before this decision, the
Maryland Department of Health told local media that
it would drop Kaiser as a Medicaid MCO
in 2025 after lengthy contract negotiations.
Maryland had also recently temporarily suspended new enrollment
in Kaiser's Medicaid plan, citing a failure to
meet contractual obligations related to financial operational
reporting requirements.
Kaiser has held a Medicaid contract in Maryland
for over a decade,
and it maintains the highest rated in terms
of quality Medicaid plan in the state, by
the NCQA's
national standards.
The state will also renew its existing managed
care contracts with 8 other organizations
that includes both insurers and a few health
system backed companies.
That contract,
appears to more than a 113,000
residents in the state of Maryland.
And finally, a jury has determined that Blue
Cross
and Blue Shield of Louisiana shortchanged a New
Orleans based surgical center by more than $400,000,000.
That was, late September.
The jury determined the payout following a 7
year legal fight between the insurance company
and
St. Charles Surgical Hospital and Center for restorative
breast surgery, which is a privately owned surgical
center that provides breast surgery reconstructions to cancer
patients. BCBS
Louisiana was accused of shortchanging
the center on thousands
of breast reconstruction surgeries.
The jury jury determined that BCBS committed fraud
when it authorized around 78 100 surgeries from
2015 to 2023
and then paid only about 9% of the
related claims.
The Safe Civil Court verdict was the surgery
center's 3rd attempt to seek payment. That's after
2 previous cases were dismissed in federal court.
BCBS denied that it had acted fraudulently,
and it's important to note here that because
the hospital is not a member of BCBS's
provider network, BCBS argued it had no contractual
obligation to pay any of it. In Louisiana,
about 93% of all physicians and hospitals belong
to the Blue Cross network.
A spokesperson for Blue Cross told Becker's that
while the company appreciates and values the legal
process, it strongly disagrees with the jury's verdict,
and it will quickly appeal and expects to
be successful.
That hospital was founded in 2003 and had
been a part of the Blue Cross network
until about a decade ago when it dropped
out alleging that reimbursement rates were not,
high enough.
It continued to treat Blue Cross patients though
because the surgeries were authorized by the insurer,
but the surgeons only received a fraction of
the charges they billed.
BCBS had argued that authorizing a treatment does
not guarantee guarantee payment.
That $421,000,000
award, though, it's one of the largest ever
in Louisiana, which is known for large jury
awards.
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