Are there differences in access to healthcare—specifically for Medicare Advantage (MA) plans—for racial and ethnic minorities? MA plans are offered in almost every county throughout the U.S., and the plan options available are specific to each county. Anyone living in one of those counties who is eligible for Medicare can enroll regardless of race or ethnicity. What is the impact of geography on the number and average characteristics of plans available to each ethnic and racial group?
This paper by Milliman’s Adam Barnhart and Mary Yeh evaluates the general enrollment MA plans available to individuals for different racial and ethnic groups in the United States. They examined plan options available to individuals aged 65 and over belonging to five different racial or ethnic groups (white, Black, Hispanic or Latino, Asian or Pacific Islander, or American Indian or Alaska Native) from 2016 to 2020.
In February, the Center for Medicare and Medicaid Innovation released a Request for Applications (RFA) for the Medicare Part D Payment Modernization Model (PMM). The PMM is a voluntary program whose goal is to reduce Part D federal reinsurance costs by adding new program flexibilities and introducing a two-sided risk-sharing arrangement around federal reinsurance costs. Interested Part D plan sponsors were required to submit an application to the Centers for Medicare and Medicaid Services (CMS) by March 15 in order to participate in the 2020 plan year.
There are many unknowns and questions regarding the PMM RFA. Some of these questions are:
• Who is eligible to participate (and who would want to)?
• What types of formulary or other program flexibility might be offered?
• What costs are associated with participating?
• Will this really result in Part D savings?
• How should plans determine information required for the application without insight on key program aspects?
• How would the benchmark be calculated?
• How could this be affected by the U.S. Department of Health and Human Services (HHS) proposal to move drug rebates to point of sale?
• What are the financial implications to the bid?
• What are the potential risks with participating?
In this article, Milliman’s actuaries discuss the answers to these questions.
The Bipartisan Budget Act of 2018 enacted key changes to Medicare Part D that will affect the program’s coverage gap—the “donut hole”—starting in 2019. The changes to the coverage gap have several financial implications for Part D stakeholders. In this article, Milliman consultants Adam Barnhart, Gabriela Dieguez, and David Mike explain the financial impact the bill will have on beneficiaries, employers, pharmaceutical manufacturers, the federal government, and plan sponsors.