Opinions on what is expected with the final rule for Medicare

[somarco]

But please tell me more about how to run a business when you haven’t even read up on the changes that passed 2 years ago.

(I actually don’t care if you can read or not. I DO care when you make idiotic statements about things you clearly know nothing about and confuse newbies)

ROFL!!

It’s “sort of 6%”

My understanding is the 6% applies only to the BASE Beneficiary Premium

Inflation Reduction Act (IRA): Changes to Medicare Part D prescription drug coverage 2023 and beyond.

A number of changes are included in the Inflation Reduction Act of 2022 impacting future Medicare Part D prescription drug plan coverage.

q1medicare.com

More details here . . .

What are the Medicare Part D abbreviations: EA BA DS AE in the plan benefit type?

Medicare Part D plans are categorized as defined standard (DS), actuarially equivalent (AE) standard, or basic alternative (BA) - and benefits are actuarially equivalent to the CMS defined standard Part D benefit. Enhanced alternative (EA) plans exceed defined standard coverage.

q1medicare.com

 

[kgmom219]

They could roll out a new plan, or like mutual, could they just sit it out for year, then re-enter in the following year?

Don’t ask me the details yet but

ROFL!!



My understanding is the 6% applies only to the BASE Beneficiary Premium

Inflation Reduction Act (IRA): Changes to Medicare Part D prescription drug coverage 2023 and beyond.

A number of changes are included in the Inflation Reduction Act of 2022 impacting future Medicare Part D prescription drug plan coverage.

q1medicare.com

More details here . . .

What are the Medicare Part D abbreviations: EA BA DS AE in the plan benefit type?

Medicare Part D plans are categorized as defined standard (DS), actuarially equivalent (AE) standard, or basic alternative (BA) - and benefits are actuarially equivalent to the CMS defined standard Part D benefit. Enhanced alternative (EA) plans exceed defined standard coverage.

q1medicare.com

Agreed on both.

Now explain it to a client. I am wide open to a better script.

 

[somarco]

Now explain it to a client. I am wide open to a better script.

Your current plan renewal will probably increase. The formula is a secret and complicated . . . even Congress doesn't understand it . . . and none of them read the bill before voting on it.

If you need more detail, ask me in October . . .

 

[kgmom219]

Your current plan renewal will probably increase. The formula is a secret and complicated . . . even Congress doesn't understand it . . . and none of them read the bill before voting on it.

If you need more detail, ask me in October . . .

 

[Yagents]

Your premium will fluctuate. It could fluck down or it could fluckUP

 

[Duaine]

So Part D plans.

No cost for Part D formulary drugs after reaching $2,000 out-of-pocket cap

Medicare Part D beneficiaries will have a $2,000 maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP). In 2025, the $2,000 RxMOOP should be reached when a person purchases Medicare Part D formulary drugs with a retail value totaling $6,230. In other words, starting in 2025, Medicare Part D beneficiaries will not spend more than $2,000 out-of-pocket for formulary drugs.

The $2,000 RxMOOP or out-of-pocket spending limit can increase every year like other Medicare Part D parameters*.

Also it's my understanding that the Part B drugs are excluded from this $2,000 threshold . So we are seeing large increases in the Medigap plans as a result. This perhaps will also drive up the MOOPs along with the payer cuts. Less goodies added into the MAPD plans.

 

[somarco]

Also it's my understanding that the Part B drugs are excluded from this $2,000 threshold . So we are seeing large increases in the Medigap plans as a result.

I don't see how the $2k cap will impact Medigap plans at all.

As it stands now, more B drugs are now self injected . . . no need for infusion therapy as these meds move from B to D.

MAPD has been a runaway train for some time. The carriers created that problem and now they will have to make adjustments and learn to live on less money like the rest of us.

 

[Surancedawg]

You must have been sleeping in 2014 and later when Obama and friends decided to take the regulation of individual health insurance away from the states and make it the purview of CMS, et al.

Carriers rolled over and said scratch my belly one more time.

Mandated coverage. No underwriting. No pre-ex.

Carriers and agents alike thought they were going to get rich.

Didn't quite work out as DC planned. Damn near killed the under 65 health insurance market.

Nope, I was working the under-65 Individual health insurance market before Obamacare came along. The justification for regulating individual health insurance by the Federal gov't was that since it was now being federally subsidized (at least the on-Exchange plans) - just like with MA, PDP plans, Federal flood insurance, etc - the Feds should be responsible for regulating the industry.

But since STMs get NO federal subsidies, how can the Feds justify regulating it? This sets a bad precedent. What's next, HIP plans, Cancer-CI plans.....life insurance?!

 

[Ron Van D]

Don't give them any ideas!

 

[aheff]

This is what my crystal ball shows. All cheap Part D plans will go away, no longer offered. They will be migrated into other plans. The cheapest Part D plan will be at least $20/month, Probably $30/month.
Gonna be a fun fun fun AEP.