New CMS Ruling will help lower drug cost at the counter and require insurance companies to be more transparent
In the new rule passed by CMS the key takeaways are lower Part D cost (drug cost) and transparency into spending. There are many moving parts to the new ruling. Lets cover some of the basics that take effect January 1, 2024:
- Requires Part D plans to apply all price concessions they receive from network pharmacies to the negotiated price at the point of sale.
- This means the beneficiary can share in the savings.
- Will improve price transparency and market competition to Part D plans.
Where’s the money going?
Prior Authorizations denials and denied payments to providers with Medicare Advantage plans have been on the rise and are higher in comparison to Original Medicare. In both cases, it seems reporting had met the rules and requirements of Original Medicare and plan billing rules.
To promote sustainability and provide transparency, CMS is reinstating medical loss ratio reporting requirements and expanding reporting requirements for Medicare Advantage Supplemental benefits.
In short, CMS wants more visibility into the supplemental benefits Medicare Advantage plans offer that are not covered by Original Medicare. There needs to be accountability to make to ensure the benefits these plan propose are actually being utilized.
Joe Namath Medicare Commercial
If it’s October 1st and you’re seeing Joe Namath, it’s not because he is coming out of retirement to play football. No, instead he has teamed up with the Medicare Coverage Helpline to smother your TV screen.
But in all fairness, it’s not just Joe. There are plenty of ex-sports stars and celebrities’ that are now fighting to have you call the agency that pays them the big bucks.
The good news, relief may be around the corner. Part of the new bill revises marketing requirements to strengthen oversight on TPO’s (third party marketing organizations) from potentially misleading activities to enroll members.
Stronger Networks for New Service Area’s
Under the new rule, Medicare Advantage plans must provide and demonstrate they have a sufficient network of contracted providers. If the plan can’t prove the network, CMS reserves the right to deny the new or expanded service area.
What is Medicare Part D
Medicare Part D is your drug coverage. Drug coverage is not required, but Medicare can penalize you for not having creditable drug coverage. Some examples of creditable drug insurance are having group or retiree insurance or having VA coverage. Otherwise, Part D Medicare can be obtained one of two ways:
- Enroll in a stand-alone Part D plan when you are on Original Medicare
- Enroll in a Medicare Advantage plan that includes drug coverage
Cost of Medicare Part D can vary depending on where you live, medications you are taking, frequency, pharmacy and much more.
How you can start lowering Part D Cost today
There a few things to start saving on your Part D prescription cost today.
- Be sure you are using a preferred pharmacy
- Use generics when possible and as advised by your physician
- Consider the mail-order option through your insurance carrier
- If you do not like the mail-order, try a 90-day fill at the pharmacy
- Use discount cards (There are a couple we recommend). Be careful when choosing a discount plan, some sell your information or will solicit you.
Medicare Part D Cost / Medicare Part D Donut Hole
Compare Medicare Part D Cost
We make it easy to compare Medicare Part D plans.
- Use our online quote tool and find the Best Medicare Part D Plans for 2022
- Schedule an appointment for your free Medicare benefits review
- Call us today, 866-633-4427
We represent over 25+ top-rated insurance carriers, like Humana Medicare, Aetna Medicare, WellCare Part D and many more.
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Resource: Susan Morse, HealthCare Finance
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