News Archive

"While this latest development is a relief, it is clear that the issues surrounding the funding of Medicare telehealth -- and telemedicine prescribing -- are not going away every time Congress kicks the proverbial can down the road.... In 2025, we know the consequences of letting the flexibilities expire -- providers do not get paid, access to quality care is diminished, and questions of retroactive payment create uncertainty."  MORE >>

"Recent analysis highlights that a man will need to have saved $191,000, and a woman will need to have saved $226,000 just to have a 90% chance of meeting their healthcare spending needs in retirement. As medical costs continue to rise faster than inflation and life expectancy is higher than ever, planning for healthcare in retirement ... should be viewed as a 'core liability' alongside housing, food, and other necessities."  MORE >>

"From 2021 to 2023, ... the CMS Innovation Center tested the Part D Senior Savings model, which lowered Medicare Part D insulin out-of-pocket costs to a maximum of $35 for beneficiaries in model-participating plans.... The goal of this article is ... to offer five design and evaluation considerations for future prescription drug models that the Innovation Center is interested in designing and testing. [The authors] discuss implications of each consideration for key stakeholders based on [their] interviews with participating plans, manufacturers, and beneficiaries."  MORE >>

"[On] October 21, 2025, CMS ... [directed] MACs to lift the claims hold for Medicare physician fee schedule, ground ambulance transport and federally qualified health center claims, including telehealth claims that 'CMS can confirm are definitively for behavioral and mental health services.' ... CMS directed MACs to continue to temporarily hold claims for nonbehavioral and mental health services telehealth claims and for acute hospital care at home claims."  MORE >>

"Before the Inflation Reduction Act (IRA) passed in 2022, drug manufacturers increased prices an average of 4.2 percent on more than 900 brand-name drugs ... To discourage such price hikes, the IRA requires manufacturers to pay inflation rebates to the Medicare program when they increase certain drug prices faster than inflation.... This year, 2025, will be the first in which drug manufacturers will be invoiced for any rebates they owe the federal government under the new policy."  MORE >>

"The market continues to consolidate, with fewer plan offerings and increased concentration among the top carriers. The increase in $0 premium basic PDPs may signal a shift in plan sponsor strategy, as some carriers focus on LI auto-enrollment beneficiaries. CMS’s PDP Premium Stabilization Demonstration has played a critical role in moderating premium increases and supporting beneficiary affordability, though its long-term impact on plan strategies and market stability remains to be seen."  MORE >>

"Fidelity Investments estimates a 65-year-old couple retiring in 2025 could face $345,000 in lifetime health care costs. Preparing for these expenses requires a proactive approach focused on what you can control and informed decisions about insurance and long-term care. Here's how to start."  MORE >>

"For this year's open enrollment period, [CMS] released a new tool on the Medicare Plan Finder that allows beneficiaries to enter up to 5 of their preferred providers to more easily view if their doctors are in a plan's network. The tool also lets beneficiaries sort available plans in their area by whether a 'must-have provider' is in the plan's network.... In previous years, beneficiaries.... would need to go to each plan's website to determine whether their preferred providers were in the plan's network."  MORE >>

"Considerations for employers on this topic include: Understanding MSP laws governing your size company Tapping into resources available from consultants and service providers Engaging with employees to understand their concerns about their next steps. Communicating with a strategy, including providing access to a third party who can individually consult with employees prior to age 65."  MORE >>

"The 2006 Tax Relief and Health Care Act created the Physician Quality Reporting System, which rewarded physicians for reporting on both quality and patient outcomes. The 2010 [ACA] added 'value' to the equation -- incorporating concepts of both cost and quality.... These well-intentioned efforts to improve quality have failed ... [The authors] describe the challenges in quality measurement, explain the financial incentives behind the system, and propose policy solutions."  MORE >>

"The 2026 changes to the Medicare Part D drug benefit passed under the Inflation Reduction Act are generally modest compared to the significant adjustments made in 2025. However, new instructions related to determining the creditable coverage status of prescription drug coverage allow plan sponsors to utilize a revised methodology for 2026. Plan sponsors should review the new methodology as they determine the most suitable one for their particular group health plan."  MORE >>

"[A] District Court invalidated the [CMS] 2023 RADV Final Rule, finding that the agency violated the notice-and-comment requirements of the Administrative Procedure Act (APA). This ruling comes amidst a recently announced aggressive agenda by the current Trump administration to catch up on five payment years of RADV audits." [Humana Inc. v Becerra, No. 23-0909 (N.D. Tex. Sep. 22, 2025)  MORE >>

"The largest year-over-year jump is expected between 2025 and 2026, with a projected increase of $21.50, setting the 2026 Part B premium at $206.50, up from $185.00.... The [2025 Medicare Trustees Report] estimates that the standard monthly premium for Medicare Part B will potentially reach almost $350 by 2034. If the estimates are accurate, the Part B premium is expected to increase by 188% by 2034."  MORE >>

"This white paper examines trends in actual out-of-pocket (OOP) costs among Medicare Part D beneficiaries from 2023 through early 2025, to understand the net impact of the key forces outlined above. [The] analysis summarizes the proportion of beneficiaries reaching the catastrophic coverage phase each year, their associated OOP costs, and the timing of these events."  MORE >>

"While [CMS] extended many of the flexibilities introduced during the COVID-19 Public Health Emergency (PHE) multiple times over the years, many of these policies are set to expire ... September 30, 2025 -- and others will expire on December 31, 2025. Several bills are pending ... [h]owever, to date, no long-term legislation has offered a solution to make a broad range of telehealth services a permanent benefit under Medicare."  MORE >>

"Strategic investments in disease prevention, early detection, and other proactive measures could save the U.S. health care system up to $2.2 trillion a year by 2040 -- more than $7,000 per person ... These investments could also help save Medicare more than $500 billion a year on medical and prescription drug claims, strengthen the program's long-term financial outlook, and expand the number of years beneficiaries live in good health.... [L]owering Medicare spending in this way could delay potential insolvency and ease the need for benefit reductions or tax increases to maintain the program as it currently exists."  MORE >>

"The Inflation Reduction Act (IRA) has significantly enhanced Medicare Part D benefits, lowering out-of-pocket costs and raising the standard for creditable coverage. These changes may make it more difficult for some employer-sponsored prescription drug plans, particularly high-deductible health plans, to meet creditable coverage standards."  MORE >>

"Relative to [the] 2024 estimates, [Milliman projects a] hypothetical couple retiring in 2025 will need to save approximately $7,000 less if they have Original Medicare plus Medigap and Part D coverage, and $1,000 more if they have Medicare Advantage plus Part D coverage, all else being equal."  MORE >>

"[T]his issue brief ... examines the findings of the Medicare Trustees Report with respect to program solvency and sustainability.... The longer that corrective measures are delayed, the worse the financial challenges will become and, in turn, the greater the burden that is likely to be imposed on beneficiaries, providers, and taxpayers."  MORE >>

"For 2025, with the Inflation Reduction Act lowering the out-of-pocket maximum to $2,000 (from $8,000 in 2024), many employer prescription drug plans -- and especially those with High Deductible Health Plans -- may find that their plans are no longer creditable.... [N]ew changes for 2026 may also impact these notices."  MORE >>

"This case arose from Caremark's failure to comply with a change in Medicare's policies intended to curtail opaque pricing practices.... This case and Judge Goldberg's judgment further demonstrate to PBMs the consequences of failing to keep up with changes in the law and the increased scrutiny PBMs are now facing from federal agencies." [U.S. ex rel Behnke v. CVS Caremark Corp, No. 14-0824 (E.D. Penn. Aug. 19, 2025)]  MORE >>

"What is the purpose of the notice? ... Who should receive the notice? ... When does the notice have to be provided? ... Can it be sent electronically? ... Does the notice have to be in a separate document? ... Does the notice have to be mailed/provided separately? ... Do we need to send a separate copy to spouses and dependents? ... Are model notices available? ... Is this the same as the annual reporting requirement?"  MORE >>

"How does employer size affect Medicare requirements? ... What about employees with dependents? ... Why should employers care about Medicare education? ... What employers can do: [1] Add a dedicated Medicare resource to your benefits package ... [2] Provide employees access to one-on-one guidance who can walk them through eligibility, enrollment, and dependent coordination ... [3] Communicate early and often[.]"  MORE >>

53 pages. "The budget reconciliation law commonly known as the One Big Beautiful Bill Act (PL 119-21) ... includes a number of health provisions that impact Medicaid, the State Children's Health Insurance Program (CHIP), Medicare, private health insurance, and rural hospitals and providers.... This report provides descriptions of [those] provisions ... These descriptions are followed by abbreviated summaries of the health provisions ... details about implementation funding ... and a list of the abbreviations used throughout the report[.]" [R48633 Aug. 18, 2025]  MORE >>

"While previous research showed Part B increased launch prices, [the authors] estimate its effect on later prices (net of rebates). Drugs more exposed to Medicare have lower price growth. A drug with above median Part B exposure has a 10% lower price after 3 years than a below median exposure drug that launched at the same price, with a larger effect for newly approved molecules."  MORE >>