2025-MAPD & PDP what does your Crystal Ball say?

[Duaine]

Had a recent conversation with an agency owner who attended a BCBS agency owners meeting. In that meeting the Blues stated that with the new rules they will have to pay 67% or the cost of prescription drugs.

Obviously that along with the new Medicare cuts is going to cut into their profits making them cut benefits or raise deductibles and co-pays in some matters. Also BCBS doesn't have a PBM to help them on the costs.

So, what are your predictions on plan changes and the impact also on PDP plans?

 

[StevenjKSU]

I think UHC, Humana and Aetna are going to lay people off to offset the costs (which they are already doing). I think some of the supplemental benefits are going to bite the dust. Smaller regional carriers like bcbs are going to have to make some tough decisions and really hope that their local customer service and brand loyalty hold up when they start charging a premium for their plans. They would really like to move to an HMO model, but that won't be tolerated in our region. They could raise MooP, but that only effects a very small fraction of the member base.

George Brett may have to get a new part time job at Whataburger.

 

[Duaine]

Medicare Advantage members could see $396 benefit cut in 2025​

Medicare Advantage beneficiaries could see their supplemental benefits reduced or cost-sharing increase by $33 a month on average in 2025, according to an analysis from the Berkeley Research Group.

The analysis, published Feb. 26, was commissioned by the Better Medicare Alliance, a pro-MA group backed by insurers.

CMS' proposed rates for Medicare Advantage plans in 2025 will not offset rising medical costs, the research group found. Every major insurer has indicated medical costs in the program are on the rise.

The analysis projected medical costs will rise between 4% and 6% in 2025. CMS' proposal would cut benchmark payments to plans by 0.16%, according to the agency's estimates.

Plans could offset some of the difference between CMS' payments and rising medical costs through various measures, including administrative savings, analysts wrote.
[EXTERNAL LINK] - Medicare Advantage members could see $396 benefit cut in 2025

 

[DonP]

I’ve intently followed the earnings reports of all carriers this qtr. I can see co pays rising significantly and benefits falling . Unfortunately for many agents Humana the golden child of the last 4 yrs sounded the most pessimistic . They even acknowledged they’ll sacrifice loss of members for margin and pull out of some areas . Many agents wrote a ton of Humana the last 4 yrs . It means an agent might be moving a large portion of his book this aep . Humana was one of the few carriers to cut benefits big in 2024 . They’re already on thin ice. If they cut big again agents will move mass clients in 2025 me included .I think 2025 has chaos written all over it as we’ve plateaued in mapd and are starting a decent .

 

[kgmom219]

Which BCBS doesn't own a PBM???

 

[Duaine]

KC

 

[Fisher]

WTF?

 

[Special Agent]

I am kind of looking forward to telling entitled seniors in 2025 what are you crazy you think health insurance pays for personal trainers, Uber rides and Poligrip?

 

[somarco]

Financing for Part D comes from general revenues (74%), beneficiary premiums (14%), and state contributions (11%). The monthly premium paid by enrollees is set to cover 25.5% of the cost of standard drug coverage. Medicare subsidizes the remainder, based on bids submitted by plans for their expected benefit payments. Higher-income Part D enrollees pay a larger share of standard Part D costs, ranging from 35% to 85%, depending on income.

For 2024, Medicare’s actuaries estimate that Part D plans will receive direct subsidy payments averaging $383 per enrollee overall, $2,588 for enrollees receiving the LIS, and $1,153 in reinsurance payments for very high-cost enrollees; employers are expected to receive, on average, $591 for retirees in employer-subsidy plans. Part D plans also receive additional risk-adjusted payments based on the health status of their enrollees, and plans’ potential total losses or gains are limited by risk-sharing arrangements with the federal government (“risk corridors”).

In 2024, as in previous years, Medicare’s reinsurance payments to plans subsidize 80% of total drug spending incurred by Part D enrollees above the catastrophic coverage threshold. (This share will drop to 20% for brand-name drugs and 40% for generic drugs, beginning in 2025, due to a provision in the Inflation Reduction Act.) In the aggregate, Medicare’s reinsurance payments to Part D plans now account for close to half of total Part D spending (48%), up from 14% in 2006

An Overview of the Medicare Part D Prescription Drug Benefit | KFF

This fact sheet includes the latest information and data about the Medicare Part D prescription drug benefit, including current plan information, the standard benefit parameters, low-income assistance, the latest available enrollment data, and Part D program spending and financing. It also...

www.kff.org

Uncle Sam will print the money to shore up Part D . . .

Voodoo magic!

 

[Special Agent]

I’ve intently followed the earnings reports of all carriers this qtr. I can see co pays rising significantly and benefits falling . Unfortunately for many agents Humana the golden child of the last 4 yrs sounded the most pessimistic . They even acknowledged they’ll sacrifice loss of members for margin and pull out of some areas . Many agents wrote a ton of Humana the last 4 yrs . It means an agent might be moving a large portion of his book this aep . Humana was one of the few carriers to cut benefits big in 2024 . They’re already on thin ice. If they cut big again agents will move mass clients in 2025 me included .I think 2025 has chaos written all over it as we’ve plateaued in mapd and are starting a decent .

I see this a boon for the call centers because as MA members get their ANOC they will not be aware that all the MA plans will not be better for 2025 and they will be more likely to start calling the medicare help lines and be fed lies to get them to switch.

I think UHC will be even stronger in 2025 mostly at Humana's and Aetna's expense since they already pulled back some benefits in 2024 compared to most other carriers.I hope they keep their HMO plans Open Access