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CMS Announces the Rates for Medicare Health and Drug Plans

On Monday CMS issues the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit programs. Key changes and updates that are included in the finalized Rate Announcement and final call letter include:

  • Lower Out-of-Pocket Drug Spending: As a result of the Affordable Care Act, in 2015, enrollees who reach the prescription drug coverage gap will receive coverage discounts of 55 percent on covered brand name drugs and 35 percent on generic drugs. This is a significant increase in savings compared to 2014, on prescription drugs.
  • Greater Protection for Beneficiaries: For the 2015 contract year, the permissible amount of increase in total beneficiary cost for Medicare Advantage enrollees will be $32 per member per month. In the 2014 contract year, the cost is $34 per member per month.

  • Increased Protection for Beneficiaries: The final call letter strengthens tools to ensure compliance with established provider access requirements and establishes best practices for Medicare Advantage Organizations to follow when significant changes are made to their provider networks.

  • Payments to Medicare Advantage Plans: CMS will implement a new phase in the schedule for the Part C risk adjustment model introduced in 2014. The risk adjustment methodology has been refined to account for the impact of the influx of baby boomers. In 2015, CMS will not finalize the proposal to exclude diagnoses from enrollee risk assessments.

According to Jonathan Blum, CMS principal deputy administrator, “the policies announced today will provide improved benefits in Medicare Advantage and the Prescription Drug Plans while keeping costs low for Medicare beneficiaries.”

Since 2010, Medicare Advantage premiums have fallen by 10 percent, with a 38 percent increase in enrollment, to more than 15 million beneficiaries. 30 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan.

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