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What You Need to Know About Changes to Medicare Part D in 2025
Two important changes are coming for Medicare Part D beneficiaries in 2025 as a result of the Inflation Reduction Act: Annual out-of-pocket (OOP) cap of $2,000 for prescription drugs. Medicare Prescription Payment Plan (MPPP), which will allow beneficiaries who opt in...
Comparing Plans is Especially Important This Open Enrollment Season Due to Changes in Part D Protections and New Options
Key components of the Inflation Reduction Act’s Part D reforms will be fully implemented for plans offered in 2025. These changes, including the total elimination of the “coverage gap” coverage period, the establishment of a $2,000 cap on beneficiary out-of-pocket...
Millions See Cost Savings Under the Inflation Reduction Act
The Inflation Reduction Act (IRA) made significant improvements to Medicare prescription drug access and affordability, including by restructuring the Part D benefit to limit enrollee expenses. Those changes began in January 2024, when the IRA eliminated cost sharing...
Medicare benefits in 2025: 4 big changes every enrollee should know
Big changes are coming to Medicare in 2025, and they could make a major difference in your prescription drug costs. Thanks to the Inflation Reduction Act, Medicare beneficiaries will see the most significant updates to the program’s drug coverage since it was first...
CMS Finalizes Payment Rule, Including Update to the Custody Definition
Medicare payment rules prohibit coverage for a service if a beneficiary is not financially responsible for the care or if another government entity is obligated to provide or pay for the item or service. For years, the Medicare rules interpreting and implementing this...
Healthcare.gov Now Open for 2025 ACA Plan Shopping
Now is the time for people who need health insurance in 2025 to shop for coverage. For those without employer, Medicare, or Medicaid coverage, Healthcare.gov or their state exchange is the place to shop for Affordable Care Act (ACA) plans. Most shoppers will be able...
CMS Announces 2025 Premiums and Deductibles for Medicare Parts A and B
Last week, the Centers for Medicare & Medicaid Services (CMS) released information about Medicare costs in 2025, including the 2025 premium, deductible and coinsurance amounts for Medicare Part A and Part B. The agency also announced the income-related monthly...
Health Care Access Improving in Rural Areas, Challenges Persist
A new report from the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) examines trends in health care access and outcomes in rural America. While insurance rates in these areas are improving,...
Watchdog Estimates $7.5 Billion Medicare Advantage Overpayment from “Questionable” Health Risk Assessments
When the Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage (MA) organizations, they increase the payments when plans enroll sicker people. This is called risk adjustment, and it is an important guardrail to ensure that all people with Medicare...
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