This week’s series covers:
- Medicare Advantage to Cost 20% More Than Traditional Medicare in 2025, MedPAC Reports
- Congress Extends Medicare Telehealth Waivers Until September 2025
- CMS Ends Medicare Generic Drug Discount Program
Missed Last Week’s Healthcare.com Roundup? Here’s what happened:
- March 12, 2025
- March 3, 2025
- February 25, 2025
- February 13, 2025
- February 5, 2025
- January 31, 2025
- January 22, 2025
- January 15, 2025
- January 8, 2025
Medicare Advantage to Cost 20% More Than Traditional Medicare in 2025, MedPAC Reports
According to the Medicare Payment Advisory Commission (MedPAC), which reports to Congress each March on Medicare fee-for-service (FFS) payment systems, Medicare Advantage (MA) plans are projected to cost taxpayers 20% more than traditional Medicare in 2025, resulting in an $84 billion spending difference.
Key cost drivers include:
– Favorable Selection: MA attracts beneficiaries with lower actual healthcare spending relative to their risk scores, projected to increase 2025 payments by 11% ($44 billion)
– Coding Intensity: MA plans report higher risk scores (16% above FFS beneficiaries in 2025) through methods like health risk assessments, and inflating payments.
– Structural Policies: MA benchmarks are set above FFS costs in many regions, and quality-bonus programs add costs without meaningful quality improvements.
These higher costs contribute to increased Part B premiums for all Medicare enrollees and highlight gaps in oversight, particularly regarding MA supplemental benefits.
MedPAC recommends reducing overpayments, refining risk adjustment, and improving program oversight to address these inefficiencies.
Why This Matters
For consumers, this impacts out-of-pocket costs and plan choices, as rising premiums and potential policy changes could affect affordability and coverage options.
For health insurance professionals, understanding these cost dynamics is essential for advising shoppers on plan selection and preparing for potential regulatory shifts that may impact plan structures and compensation.
Congress Extends Medicare Telehealth Waivers Until September 2025
Last week, Congress extended COVID-era Medicare telehealth waivers until September 30, 2025, as part of a spending bill to prevent a government shutdown.
These waivers, originally set to expire on March 31, 2025, allow Medicare beneficiaries to continue receiving telehealth services at home, use audio-only telehealth, and access care from a broad range of providers, including those at federally qualified health centers and rural health clinics.
The legislation also delays until October 1, 2025, the requirement for Medicare providers to conduct in-person visits before delivering telehealth services for mental health treatment.
While this extension maintains telehealth accessibility, healthcare organizations should prepare for potential restrictions and the expiration of other COVID-19-related flexibilities by the end of 2025.
Why This Matters
This extension ensures continued access to convenient, flexible, and potentially lower-cost healthcare services for individuals, especially those in rural or underserved areas.
Additionally, this allows for a more stable telehealth landscape for health insurance agents, brokers, and partners, enabling them to guide shoppers effectively while preparing for potential regulatory changes in 2025.
CMS Ends Medicare Generic Drug Discount Program
The Trump administration has ended plans for a Medicare $2 generic drug list. CMS canceled the initiative, which aimed to offer 150 generic drugs for a $2 copay, along with other Medicare updates.
The move follows the administration’s repeal of a Biden-era order directing HHS to lower drug costs. CMS estimated the program could have helped up to 32 million Medicare Part D drug plan enrollees.
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