CMS reins in Medicare Advantage plansis a new online resource designed to meet the evolving needs of physicians. It brings together elements from Advanstar's trusted healthcare journals along with powerful tools, resources, decision support and advisory functions.Reid Paul...
On November 26, 2024, Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule revising the Medicare Advantage (“MA”) Program (Part C), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, and Programs of All-...
据报道,在联邦法院对保险公司Scan Health Plan和Elevance Health提起的案件做出裁决后,美国政府计划重新计算Medicare Advantage计划的质量评级。 《华尔街日报》周四报道,重新计算预计将在明年给保险公司带来数亿美元的额外奖金。 《华尔街日报》称,医疗保险和医疗补助服务中心最早可能在周四宣布,它打算重新计算这些计划。 这...
4月4日,美国医保局(CMS)发布了2025年的Medicare Advantage和Medicare Part D的最终版规则,其中对生物类似药替代的要求明显降低,Medicare Part D的所有生物类似药替换不再明确要求CMS的提前批准,而此前这一原则仅适用于可互换的(interchangeable)生物类似药。 在此之前,任何生物药处方的变更中,CMS规定保险公司、PBM或...
Medicare Advantage plans in 2019 will be able to provide coverage for a wider variety of non-medical benefits as CMS moves to provide better coverage forsocial determinants of health. Social determinants of health are the conditions in places where people live, learn, work and p...
It would be optional for Medicare Advantage plans, which enroll about 19 million beneficiaries (a third of all beneficiaries). It would apply only to new prescriptions starting in January. Medicare enrollees would have the choice to go to an Advantage plan that did not use step therapy or to...
Ahead of the Medicare Open Enrollment Period, CMS has announced that Medicare Advantage premiums, benefits, and plan choices will remain relatively stable in 2024.
On December 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule with technical changes for the Medicare Advantage (MA) Program and the Medicare Prescription Drug Benefit Program for Calendar Year 2026 (Proposed Rule). Citing the growing ...
For Medicare Advantage plans, the average monthly premium will decrease from $18.23 in 2024 to $17 in 2025, continuing a trend of declining premiums over recent years, said CMS. This reduction, the agency said, reflects not only its payment policy updates, but also the sustained competit...
Medicare Advantage plans must still incur a non-zero direct medical cost for supplemental benefits. CMS stated that, for SSBCI, such incurred cost should be a non-administrative cost even if it is not necessarily paid to a medical provider. For example, a plan may contract with a community-...