Policy & Regulation News

Will Medicare Advantage Plan Enrollment See Record Highs?

By Jacqueline DiChiara

- Both the stabilization of Medicare Advantage premiums and improved accessibility of top-notch care plans are on the healthcare horizon, says the Centers for Medicare and Medicaid Services (CMS) in yesterday’s announcement. Enrollment is expected to reach record highs following six consecutive years of growth, CMS confirms. Because of the Affordable Care Act (ACA), says CMS, affordable healthcare and drug discounts are something millions of Medicare beneficiaries and individuals with disabilities now have greater widespread access to.

Medicare Advantage enrollees premium

According to CMS, the average Medicare Advantage premium will drop by thirty-one cents next year from an average of about $32. Over half of Medicare Advantage enrollees will not experience an increase in premiums, CMS adds. Additionally, Medicare Prescription Drug Program (Part D) premiums are also expected to stabilize next year, says CMS.

As RevCycleIntelligence.com reported, contradictory reports confirm Part D costs per capita increased by nearly 11 percent last year, due to the effect high cost specialty drugs had upon healthcare spending. Although premium growth for total Medicare payments to reinsurance plans has tripled, per-Medicare enrollee spending growth is “historically low,” according to CMS. 

Strength in numbers for the Medicare Advantage program

  • CMS Issues 2018 MACRA Implementation, Quality Payment Program Rule
  • Safety-Net Hospitals Lose $2.2M from 340B Drug Discount Limits
  • AHIMA Reviews Top ICD-10 Implementation, Coding Challenges
  • According to yesterday's announcement, ninety-nine percent of beneficiaries have access to a plan. Medicare Advantage program accessibility will “remain strong,” CMS says. A series of supplemental benefits — i.e. dental, vision, and hearing benefits — will be available to Medicare Advantage enrollees in 2016.

    Nonetheless, stability is king, says CMS. “Medicare Advantage and prescription drug plans remain affordable and provide high quality care,” states Sean Cavanaugh, CMS Deputy Administrator and Director of the Center for Medicare. “Seniors and people with disabilities continue to experience stable premiums in Medicare health and drug plans while benefiting from a transparent and competitive marketplace,” Cavanaugh adds.

    According to CMS, “Between 2010, when the Affordable Care Act was enacted, and 2016, premiums are expected to decrease by nearly 10 percent and enrollment is projected to increase by more than 50 percent to approximately 17.4 million enrollees, which represents about 32 percent of the Medicare population.”

    Higher quality healthcare is becoming a tangible reality for Medicare Advantage enrollees. About 65 percent of Medicare Advantage enrollees are currently enrolled in plans with four or more stars for 2016. This is a significant increase from an estimated 17 percent of enrollees back in 2009.  

    “Since the passage of the Affordable Care Act, which closes the prescription drug ‘donut hole’ over time, more than 9.8 million people with Medicare have saved over $17.6 billion on prescription drugs through July 2015 as a result of the discounts in the donut hole and rebates in 2010, for an average of $1,796 per beneficiary,” CMS states.

    “Quality in Part D continues to be robust, with close to 50 percent of prescription drug plans receiving four or more stars. These plans serve about one-third of prescription drug plan enrollees, compared to 27 percent of enrollees in plans with four or more stars in 2009,” CMS continues. “Because of the Affordable Care Act, people with Medicare are seeing reduced costs through both savings on covered brand-name and generic drugs and access to certain preventive services at no cost sharing,” CMS adds.