Here is what you’ll find in this week’s newsletter!

1. Important links 🔗 - the best articles we found this week about the Medicare Market along with links to Jared’s recent LinkedIn posts.

2. Deep Dive 📚 - A look at the 8 Trends You Can’t Ignore

3. Sponsor Snapshot 🚀 - brought to you by Modivcare

4. Compliance Chatter 📢 - Several new regulations to review!

It’s only a 5 minute read, but it will make you 10x smarter.

DEEP DIVE 📚

March Medicare Madness: 8 Trends You Can’t Ignore 🏀 

For many of us, March = madness. 

Usually that’s 🏀 basketball related, but you may also feel spun around by the whirlwind of results, headlines, and possible changes related to Medicare dominating market conversations these days.

This week’s newsletter wades through Medicare market happenings from early 2025 and what we’re watching for throughout the rest of the year. We’ll look at what we learned from 2024, what regulatory signals we’re seeing, and what else may be on the horizon.

What did 2024 show us – AEP Results and 2024 Financials

1) MA/MAPD Slowdown in Enrollment Growth

There was a significant slowdown in enrollment growth across the total Medicare Advantage market this past AEP compared to other recent AEP years. (link)

The numbers:

_{source: CMS enrollment data}

2) AEP ‘25 Switching Up

While overall growth slowed, the percentage of MA enrollees switching carriers or plans continued upward. 

Whether driven by carrier withdrawals, plan terminations, service area reductions, supplemental benefit changes, or simply savvier plan shoppers – beneficiaries were on the move. (link, link)

The numbers:

 _{source: Deft Research Study}

3) Increased Medical Loss Ratios

Carriers continued to feel the pressure of higher medical loss ratios (MLRs) – citing rising utilization, Medicaid redeterminations, Medicare Advantage funding cuts, and higher pharmacy costs as drivers of the higher levels. (link)

The numbers:

_{source: Company 10-Ks and 10-Qs}

4) Higher Medicare Supplement Rate Increases

In the Med Supp market, this loss ratio pressure resulted in sustained higher rate increase levels seen during 2024 for many carriers. (link)

The numbers:

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CMS Proposals & Increased State Legislative Activity

AEP results and carrier year-end financial reporting gave us a sense of where we ended 2024. As we rolled into 2025, federal and state regulators started signaling their priorities for the near term.

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5) 2026 Proposed MA/MAPD Rule

The proposed rule covering MA policy and technical changes for 2026 was issued in late 2024. (link)

It reads like a mini-course in Medicare hot topics, touching on-

• Anti-obesity medications (link)

 The numbers:

_{source: OIG Report}

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• Prior authorization/coverage decision guardrails & limiting the use of AI algorithms

The numbers:

_{source: KFF - Medicare Limited data set}

_-

• Behavioral (Mental) health care access

The numbers:

25% - Estimated % of Medicare beneficiaries with behavioral health conditions

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• The proposed rule also included more expected items like –

  • Star Rating formula revisions

  • Consumer protections focused on marketing and transparency

  • Prescription drug affordability & generic drug access

  • MLR reporting changes

It’s worth noting that the proposed rule was issued by the Biden administration, and the final rule will be issued by the new administration very soon.

6) Medicare Supplement State Regulation Changes

There’s also been steady activity across state legislatures related to Medicare Supplement plans. Several states have pending bills to create annual open enrollment windows. Other states are looking at expanding Medicare Supplement plan availability to individuals under age 65 who qualify for Medicare. See a list of states’ regulatory activity here. (link)

7) The Great Unknown - The New Administration

There are headlines everywhere about the new administration’s efforts to reduce spending and increase efficiency across many areas of government.  For Medicare, the talking points indicate benefit cuts aren’t on the table but there is a serious interest in clamping down on waste and fraud issues. (link)

What’s changed so far?

→ Leadership changes include:

• Robert F. Kennedy, Jr confirmed as Secretary of Health and Human Services (HHS)

• Dr. Mehmet Oz nominated as Administrator of the Centers for Medicare & Medicaid Services (CMS).  Dr. Oz has long been an advocate for Medicare Advantage but in his first confirmation hearing, he did point out concerns he’d like to tackle as head of the CMS – upcoding and prior authorizations, in particular.

→ Efforts by the Department of Government Efficiency (DOGE) to cut spending and optimize government efficiency related to Medicare to date have primarily impacted workforce staffing. 

Some federal workers with the HHS department were offered buyouts and some probationary workers with CMS were terminated. 

The DOGE team is signaling its intent to find and rectify significant waste and fraud areas within Medicare and Medicaid. There’s sure to be more to come on this topic in the months ahead!

The numbers:

100% - Probability DOGE will investigate Medicare overspending and fraud

Light-heartedness aside, some specific actions related to Medicare taken by the administration thus far include:

→ Hospice industry oversight paused (link)

→ Prescription drug price caps reversed (link)

Speculation on the administration’s next moves are rampant and varied. 

Maybe it’s a sweeping change, like Medicare Advantage for All, or maybe a flurry of smaller directives. This administration has shown a willingness to part decisively with how things have been, in efforts to streamline government work. 

Negotiating the administration’s appetite for change with the existing CMS policy initiatives will be no small challenge for the new CMS and HHS leaders.

8) Looking Ahead - what to anticipate in 2025 and 2026

• Continued carrier focus on profitability over growth, along with more MA plan revisions and benefit changes

• Another heavily shopped AEP this fall

• Disruptions to the status quo from the administration/DOGE/new agency leadership

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That’s all for this week. 

We hope you get to take a break from the Medicare madness and enjoy a 🏀 game or two.

We’ll be cheering on our local men’s and women’s teams - Go Jays! Go Mavs! Go Huskers!  

If you’re ready, here are some ways we can help you:

• Newsletter Sponsorship opportunities: Promote your product or services to leaders in the Medicare space. Let’s discuss. (link)

• Market Research: Reports that help you wrap your arms around the Senior focused insurance markets. (link)

• Consulting: We can help you develop new insurance products for the Medicare market, appraise your books of business, and keep you compliant. Let’s discuss. (link)