Verma Talks Up Medicare Advantage Growth at Insurance Industry Meeting

CMS Administrator Seema Verma touted the growth in enrollment in Medicare Advantage (MA) programs during an appearance at a conference run by America’s Health Insurance Plans on Tuesday. Open enrollment started this week and runs until December 7.

“Thirty-seven percent of Medicare beneficiaries now participate in Medicare Advantage, up from 15% just 2 decades ago, “ said Verma. MA enrollment grew 11.5% this year, she said.

Discussing the private plans’ approach to offer more services at lesser cost, Verma said, “the lesson here is a basic law of economics: choice increases competition, and competition drives up value.”

Verma said that so far 270 MA plans are using new 2019 rules to create flexible benefit packages, allowing services that address social determinants of health and include a broad range of other services, such as meals, nursing hotlines, transportation, adult day care services, in-home support services, caregiver support services, and home-based palliative care.

She also cited new rules that allow MA plans to use step therapy as a way to control costs.

Step therapy in MA plans can only be applied to new prescriptions, so patients who choose one of these plans will not have medications they are actively receiving be affected by the policy. However, some in the healthcare industry view step therapy, also known as "fail first," as dangerous to patients with life-threatening diseases, such as cancer.

MA premiums are down by an average of 6%, to $28, from an average of $29.81 in 2018. The number of MA plans will increase by 600 this year, she said.

Traditional Medicare premiums rose slightly. The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, a slight increase from $134 in 2018. The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1364 in 2019, an increase of $24 from $1340 in 2018.

Verma also cited agency efforts on Part D drug coverage, particularly in regard to generic drugs and biosimilars. She said Part D premiums are lower this year than they were last year, and they are projected to decline again next year. She said the administration is “working towards additional regulatory flexibility in this area.”

On Monday, CMS announced a proposed rule that calls for posting the wholesale acquisition cost of prescription drugs that cost more than $35 a month in legible type on television ads. The rule does not require the price to be included in the ad voiceover. The rule enacting the Trump administration’s plan to require drug companies to feature prices in television ads seems likely to set off a fight with the pharmaceutical industry, however.