Webinar Highlights
Medicare Advantage
- Payments from the government to MA plans are expected to increase on average by 5.06% from 2025 to 2026; this Expected Average Change in Revenue more than doubled from +2.83% since the CY 2026 Advance Notice
- The effective growth rate is 9.04%, higher than the estimated 5.93% in the Advance Notice
- CMS is NOT finalizing these provisions from the proposed rule: Enhancing Health Equity Analyses and Guardrails for Artificial Intelligence
- Third-year completion of the phased-in approaches for removing medical education costs and MA risk adjustment model changes
- Plus, MA risk score trend, closing MA appeals loopholes, and more…
Part D
- CMS is NOT finalizing the provision from the proposed rule to include Anti-Obesity Medications (AOMs) under Part D coverage—which would have substantially increased access to GLP-1 drugs for weight loss
- The CY2026 annual out-of-pocket costs for enrollees will be capped at $2,100
- The annual deductible will increase to $615 from $590 in 2025
- A cap on a month’s supply of insulin will be the lesser of $35, 25% of the Medicare Drug Price Negotiation, or 25% of the plan’s negotiated price
- There will be no cost sharing for adult vaccines that are covered under Part D and recommended by the Advisory Committee on Immunization Practices
- The selected drug subsidy program created by the IRA will be established; Part D sponsors will receive a government subsidy for selected drugs (drugs that are part of the Medicare Drug Price Negotiation Program) equal to 10% of the drug’s negotiated price until the $2,100 cap is met
- Plus, the M3P program, creditable coverage, and more…
Recognition for Educational Initiatives
Our Growth team has been recognized for making a meaningful impact on the group health benefits industry with educational initiatives and timely resources. We are a 2025 Silver Stevie® Award Winner for Best Use of Thought Leadership in Complex Sales and a 2024 BenefitsPRO Luminary in the Education & Communication category.
