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 📚 - Stars, Premium, Deductibles & MOOPs - MA Landscape 🏞 (Part 2)

3. Sponsor Snapshot 🚀 - brought to you by Medicare Market Insights - Plus

4. Compliance Chatter 📢 - final guidance from CMS regarding drugs, disaster impact on NC Medicare, also new info on WI and OR!

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

DEEP DIVE 📚

Stars, Premium, Deductibles & MOOPs - MA Landscape 🏞 (Part 2)

The 2025 Annual Enrollment Period (“AEP”) is underway.

Yesterday was the first day. And for at least part of the day yesterday the Medicare.gov Plan Finder looked like this:

😨

In some ways this is a fitting way to start. We’ve been warning you that this AEP is going to be wild.

In all seriousness, I hope this didn’t impact any seniors ability to access new plans, and I’m glad things seem to be up and running now!

In today’s deep dive we are going to look a bit closer at 4 data points that we pieced together using CMS enrollment data, Crosswalk files and Landscape files.

1. Star Rating comparisons between 2024 and 2025 for plans that are renewing in 2025

2. Monthly Premium comparisons between 2024 and 2025 for plans that are renewing in 2025

3. Drug Deductible comparisons between 2024 and 2025 for plans that are renewing in 2025

4. OOP Max comparisons between 2024 and 2025 for plans that are renewing in 2025

[Note: MMI+ subscribers will be able to download the full dataset tomorrow]

Last week MMI+ subscribers got a deep dive analyzing terminating plans. 7% of the individual MA/MAPD enrollees have plans that are terminating Jan. 1 (up from ~1% in previous years).

But, that also means that 93% of enrollees have plans that will be renewing.

This week’s deep dive is focused on these plans/enrollees. Will they be seeing changes to star ratings, monthly premiums, drug deductible and out-of-pockets maximums?

[Note: we are only looking at Individual HMO/POS, PPO, and PFFS plans.]

Star Ratings

2025 Star Ratings were released last week.

The overall enrollment weighted star rating decreased from 4.07 in 2024 to 3.92 in 2025.

This is the lowest overall star rating in recent history, and will result in continued pressure on Medicare Advantage profitability over the coming years as star ratings are a key driver of bonus revenues.

The table below looks at Star Rating changes from 2024 to 2025 (for the plans that are renewing in 2025), and includes the current enrollment in each bucket.

• 44% of current enrollees are in plans that will see a star rating decrease (everything in red above)

• 35% of current enrollees are in plans that will see no change in star ratings (everything in blue above)

• 22% of current enrollees are in plans that will see a star rating increase (everything in green above)

Premium Amount

Given the pressure on MA/MAPD plans, you might expect that premiums will be going up in 2025. But are they?

Not really.

The overall enrollment weighted average monthly premium is going from $18.07 in 2024 to $17.47 in 2025 (down 3.3%).

Currently, 60% of the individual MA/MAPD market had a $0 premium plan.

If everyone sticks with their same plans in 2025, 61% of the market will have $0 plans.

Finally, the majority of the current market will see premiums that either stay the same or decrease (82%).

18% of the market will see an increase in premiums, with the enrollment weighted average change of $11 per month.

Drug Deductible

Again, MA/MAPD plans are under pressure with the Inflation Reduction Act specifically shifting more of the Rx burden to Plans (though the “premium stabilization” program dampens that impact) with the introduction of a $2,000 max out of pocket in 2025 (down from $3,300 in 2024).

So, if Monthly Premiums are not increasing, are the Drug Deductibles increasing for MAPD plans?

Yep.

The overall enrollment weighted average Drug Deductibles is going from $176 in 2024 to $309 in 2025 (up 76%).

Currently, 60% of the individual MAPD market has a $0 Drug Deductible.

If everyone sticks with their plans in 2025 only 31% of the market will have a $0 Drug Deductible.

You can see a large decrease in the share of enrollees with $0 Drug Deductibles, with a large increase in enrollees with Drug Deductibles in the $200+ range.

The majority of the current market will see drug deductibles increase (63%).

Only 4% of the market will see an decrease in their drug deductible.

In Network Max Out-Of-Pocket (“MOOP”)

Premiums are generally not increasing, drug deductibles are increasing, what about the In Network Max out-of-pocket (“MOOP”) amounts?

Note: due to a change in the landscape file data, we can only compare the MOOP for Non SNP plans

Yes and No.

The overall enrollment weighted average MOOP is going from $4,644 in 2024 to $4,973 in 2025 (up 7%).

But, the details are a bit more important on this one.

55% of current enrollees will see either no change or a decrease in MOOP.

But, the weighted MOOP change for the 45% that is increasing is $871.

Bottom Line

So, what did we learn about Individual MA/MAPD plans as we go from 2024 to 2025?

Star Rating Down

Premiums Level/Down

Drug Deductibles Up

MOOP Mixed, though largely up

This is only scratching the surface on plan changes in 2025. A more detailed view of plan benefits will reveal changes to formularies, along with large changes to supplemental benefits.

That’s all for now. It’s time for me to head to a 9th grade volleyball match (go Mustangs)!

Happy AEP!

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)