The H.R. 5376 Inflation Reduction Act of 2022 (IRA) was signed into law on August 16th 2022. The IRA makes improvements to Medicare that will expand benefits, lower drug costs, keep prescription drug premiums stable, and improve the strength of the….continue reading
On September 29th it was announced that people with Medicare will begin seeing lower premiums for Medicare Advantage and Medicare Part D prescription drug plans in 2023….continue reading
On July 7th, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year 2023 Physician Fee Scheduling proposed rule. If finalized, the rule would….continue reading
The U.S. Department of Health and Human Services has announced that it is adding additional consumer resources to support consumers’ access to coverage….continue reading
Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year….continue reading
Starting in March 2020, through the initial provisions of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the RDS has suspended the 2% sequestration reduction for costs incurred from May 1, 2020 – December 31, 2020 to temporarily increase subsidy payments to plan sponsors. Now, through the Consolidated Appropriations Act, enacted on December 27, 2020, the suspension of the 2% sequestration reduction will be continued until March 31, 2021…continue reading
Underestimating Cost Adjustment during interim payments occurs when a plan sponsor doesn’t make changes to their cost adjustment methodology between plan years if the cost adjustment percentage has changed. During this interim cost reporting, plan sponsors are required to report estimated cost adjustments…continue reading
Medicare first started offering prescription drug coverage to its participants in 2006 through the Part D program, but it’s something that changes every year. Keeping track of what those changes are and how they affect the coverage different plans offer can be quite confusing, even for someone who deals with it each year and receives training on it…continue reading
Starting October 1st, seniors can begin to compare their Medicare coverage options for 2021. CMS has released the 2021 benefit and cost-sharing information for Medicare Advantage and Part D prescription drug plans on Medicare.gov. Additionally, seniors will be able to use the Medicare Plan Finder to identify more than 1,600 prescription drug plans. Many of these plans will offer insulin at no more than a $35 monthly copay beginning in January…continue reading
On September 3rd, the Centers for Medicare & Medicaid Services (CMS) launched Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov. Care Compare provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools…continue reading
On July 29th 2020, the Centers for Medicare & Medicaid Services (CMS) announced the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy…continue reading
As a result of these unprecedented times, there have been a number of changes made to Medicare as a response to the COVID-19 pandemic. Many of these changes are temporary and will presumably subside after the announcement of the end of the declared public health emergency. Here is a list of some of the major changes that have been made to Medicare in response to COVID-19…continue reading
Plan sponsors should take note that the COVID-19 pandemic has created an interesting situation in regards to member’s eligibility if they choose to return to work for financial or health benefit related purposes. If a member returns to work, it is the Plan Sponsor’s duty to provide the updated eligibility to CMS/RDS in a timely manner. Retirees may be eligible for subsidy, but then return to active status and lose that eligibility, multiple times per year and, as such, CMS/RDS allows Plan Sponsors to update eligibility as often as needed…continue reading
CMS’ RDS Center is pleased to announce that beginning May 8, 2020, all RDS applications’ Payment Frequency will be set to a maximum frequency of monthly interim payments, consistent with the general payment rules regarding timing set forth in 42 C.F.R. 423.888(b)(1). This enhancement will be applied to all current and active RDS applications, as well as all future RDS applications. Plan Sponsors who had previously selected the Quarterly or Annual Payment Frequency option on their current applications will now be eligible to submit interim costs and request interim payments more frequently than quarterly or annually, if so desired. No action is required on the part of the Plan Sponsor or its Vendors to implement this new feature…continue reading
Michigan Governor Gretchen Whitmer issued Executive Order 2020-42, which requires all business in the state of Michigan to temporarily suspend in person operations until at least May 1st, 2020 in order to suppress the spread of novel Coronavirus. Please rest assured that Part D Advisors will remain in operation during this national crisis. PDA staff have been thoroughly trained and our equipment is prepared to operate remotely so that our clients and partners will not see any disruption in their service…continue reading
If you’re counting on working past your 65th birthday, be sure to consider how Medicare may factor into your plans — even if you already have health insurance through your job. The share of people ages 65 to 74 in the workforce has been steadily rising for years. It’s projected to reach 30.2% in 2026, up from 26.8% in 2016 and 17.5% in 1996, according to the Bureau of Labor Statistics…continue reading
As most Group Health Plans are likely already aware, they are required to notify the CMS every year as to whether their drug coverage is “creditable” or “non-creditable” for Medicare Part D purposes. This notice must be mailed to all Medicare Eligible plan participants annually before Oct 15. However, in addition to the mailing, the CMS requires a separate online disclosure notification for the Plan…continue reading
Even though Medicare Open Enrollment ended in December, the Medicare Advantage Open Enrollment Period is going on right now. This is an opportunity for those who are currently enrolled in Medicare Advantage to change plans….continue reading
The Centers for Medicare and Medicaid Services (CMS) announced that about 220,000 Medicare beneficiaries’ card numbers have been compromised by an unknown person or organization. It is unknown how this data breach occurred, but CMS is taking steps to remedy the situation and prevent its re-occurrence in the future…continue reading
The Trump administration is delaying a rule that would require hospitals to share negotiated rates because officials said they are working to expand the plan to include insurers.The Centers for Medicare and Medicaid Services had proposed making hospitals next year share the rates they negotiate with insurers, with a possible fine of up to $300 a day for failing to comply. The mandate would have covered all the more than 6,000 hospitals that accept Medicare, as well as some others…continue reading
Ahead of Medicare Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) announced today that, on average, Medicare Advantage premiums in 2020 are expected to decline 23 percent from 2018 while plan choices, benefits and enrollment continue to increase…continue reading
For the first time in a decade, the Centers for Medicare & Medicaid Services (CMS) recently launched a modernized and redesigned Medicare Plan Finder, allowing users to shop and compare Medicare Advantage and Part D plans. The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer. …continue reading
The U.S. Department of Health and Human Services (HHS) recently announced that HHS and the U.S. Food and Drug Administration (FDA) are publishing a Safe Importation Action Plan that outlines two potential pathways that would lay the foundation for the safe importation of certain drugs originally intended for foreign markets…continue reading
In late May, Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) unveiled a plan that they say will lower healthcare costs and remove surprise bills. One major part of that plan could radically change PBMs in the future. The proposed bill, S 1895, moved through the Senate Health Committee with a vote of 20 to 3 and could hit the senate floor by the end of July…continue reading
Part D Advisors, Inc. (PDA), the nation’s largest administrator of Medicare’s Retiree Drug Subsidies (RDS), announced the purchase of select assets from Health Decisions, Inc. (HDI) in Plymouth, Michigan. The assets are related to Health Decisions’ Dependent Eligibility Audit and other eligibility verification services…continue reading
The Centers for Medicare & Medicaid Services’ (CMS) Retiree Drug Subsidy (RDS) Center has begun cracking down on users that are caught sharing or transferring user accounts or logins and passwords, which is a violation of Federal Law. If CMS’ RDS Center detects suspicious activity with a user account, the account will be deactivated until the issue is resolved…continue reading
The CMS’ Center for Medicare and Medicaid Innovation (CMMI) announced a new model to try to shrink skyrocketing Medicare Part D drug spending. It also expanded the scope of its value-based insurance design (VBID) model for Medicare Advantage plans. …continue reading
There seems to be no end in sight for the current partial government shutdown, but for the vast majority of the federal government’s public health efforts, it’s business as usual. Congress has already passed five of its major appropriation bills, including funding for the Department of Health and Human Services (HHS) through September 2019. As a result, flagship government health programs such as the Affordable Care Act, Medicare and Medicaid remain insulated…continue reading
The Retiree Drug Subsidy (RDS) recently held a Website Modernization webinar about upcoming program changes that will affect all RDS Plan Sponsors and all users of the RDS Secure Website. The session provided an overview of the RDS Secure Website Modernization project and highlighted some important changes that will be coming in 2019…continue reading
The 2018 midterm elections panned out as predicted: Republicans kept the Senate majority and Democrats now have control of the House. With these results, the partisan divide in Congress continues to widen. According to several recent polls, healthcare was the #1 issue for voters heading into the election, with Rx prices, single-payer coverage and Medicare and Medicaid funding topping the list of concerns…continue reading
Both the Medicare Advantage and the Part D prescription drug programs continue to grow and provide high quality care and services to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) announced that, on average, Medicare Advantage premiums will decline in 2019 while plan choices and new benefits will increase…continue reading
After months of hard work and dedication, Part D Advisors is proud to announce that we have successfully completed our annual SOC 1, Type 2 audit. The culmination of this audit of PDA’s systems and controls means we are the nation’s only AICPA SOC certified Retiree Drug Subsidy (RDS) administration firm…continue reading
The Centers for Medicare & Medicaid Services (CMS) is delivering on President Trump’s promise to negotiate better deals for Medicare patients and create competition between drugs used to treat the same conditions. This action is an important step towards providing patients with more choices when picking a Medicare Advantage plan that best meets their needs….continue reading
Amazon has agreed to buy the small online pharmacy PillPack in a deal that will further the retail giant’s ambitions in healthcare. The deal is expected to close in the second half of 2018, helping set up a showdown between Amazon and pharmacy benefit managers…continue reading
The Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that gag clauses that keep patients from knowing how to get the best deal are unacceptable…continue reading
The Centers for Medicare & Medicaid Services (CMS) announced that it may require that hospitals post charge information as part of the proposed 2019 Inpatient Prospective Payment System rule…continue reading
To better protect the 60 million people enrolled in Medicare from identity theft, the government has begun the process of sending out new, more secure Medicare cards. Click here to learn more about when to expect your new Medicare card, what to do with your old Medicare card, as well as how to protect yourself from potential scams…continue reading
The Centers for Medicare & Medicaid Services (CMS) is required to remove social security numbers from all Medicare cards by April 2019. Starting next month, CMS will begin mailing the new Medicare cards in phases based on geographic location and other factors. Click here to learn when new Medicare cards will be rolled out in your area….continue reading
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality…continue reading
The deduction that allows people with very high medical costs to shrink their taxable income by subtracting some out-of-pocket medical expenses was a hot topic during the congressional debates this fall. But with the recent passing of the new tax bill, the deduction will continue to be preserved and even expanded upon…continue reading
The Department of Labor (DOL) has officially delayed full implementation of the fiduciary rule by 18 months, with the expected implementation of the rule’s Best Interest Contract Exemption now pushed back until July 1, 2019…continue reading
The Centers for Medicare & Medicaid Services (CMS) finalized two Medicare payment rules that move the agency in a new direction by putting patients first and ensuring that payments support access to high-quality, affordable care. The Hospital Outpatient payment rule will also help lower out-of-pocket drug costs for people with Medicare…continue reading
The Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number…continue reading
The Centers for Medicare & Medicaid Services (CMS) announced that the average basic premium for a Medicare Part D prescription drug plan in 2018 is projected to decline to $33.50 per month…continue reading
A federal advisory committee called on the U.S. Department of Health and Human Services (HHS) to rescind a 2012 rule that established a standard unique identifier for health plans…continue reading
Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring…continue reading
The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card…continue reading
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that the Centers for Medicare & Medicaid Services (CMS) remove Social Security Numbers (SSNs) from all Medicare cards by April 2019…continue reading
It has come to our attention that many plan sponsors participating in the Retiree Drug Subsidy (RDS) program may have recently received information from another firm regarding the RDS reopening appeals process. The information being mailed is misleading, inaccurate, and potentially dangerous for RDS plan sponsors…continue reading)
On March 13, 2017, the Congressional Budget Office (CBO) released their report estimating the budgetary effects of President Trump’s proposed alternative to the Affordable Care Act – the American Health Care Act. Here are some of the COB’s estimates…(continue reading)
One month into President Trump’s administration, many questions are being posed about the future of the ACA. While there is no definitive plan in place yet to either repeal, replace or reform the ACA, Republicans have proposed a number of alternative options…(continue reading)
Throughout his campaign, Donald Trump vowed to quickly repeal and replace the Affordable Care Act, marking it as a high priority for his first 100 days in office. In his health care reform letter, he wrote “On day one of the Trump administration…(continue reading)