Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

Medicare Advantage Premiums Drop 13% Due to Affordable Care Act

CMS announced last week that Medicare Advantage premiums are expected to remain steady in 2017.

By Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced in a press release late last week that the average Medicare Advantage monthly premium will be 13 percent lower in 2017 than before the Patient Protection and Affordable Care Act was passed. Medicare Advantage beneficiaries should see their monthly premiums remain stable in 2017 and have access to more quality health plans.

Affordable Care Act

The baby boomer population will lead to 18.5 million beneficiaries enrolling in Medicare Advantage, which is a 60 percent rise since 2010. Despite the surging enrollment numbers, average premium costs are expected to decline slightly and Medicare Advantage plans will incorporate dental, vision, and hearing benefits.

Additionally, the Medicare Advantage program has already saved $23.5 billion on prescription drugs for more than 11 million seniors and disabled citizens since the enactment of the Affordable Care Act.

Ever since the ACA was passed through July 2016, seniors and people with disabilities eligible for Medicare have saved an average of $2,127 per beneficiary on prescription drugs, CMS reported. The open enrollment period begins on October 15 for Medicare beneficiaries and will end on December 7, 2016.

“Medicare Advantage and the prescription drug benefit continue to be a great option for seniors and people living with disabilities,” Andy Slavitt, CMS Acting Administrator, said in a public statement. “Medicare enrollees will continue to have access to predictable premiums and high quality care.”

As more baby boomers enter retirement age, data from CMS shows that the number of seniors enrolled in Medicare Advantage plans has gone up. While in 2010, only 24 percent of enrollees had chosen Medicare Advantage plans, this number is expected to reach 32 percent of all Medicare enrollees in 2017.

Even with larger numbers of enrollees, the average Medicare Advantage monthly premium is supposed to drop by $1.19 or 4 percent next year when compared to 2016. The average premium is expected to be $31.40 in 2017, which is a decrease from this year’s average of $32.59. Out of all Medicare beneficiaries, 99 percent will have access to Medicare Advantage plans and its increase of benefits from dental to hearing and vision insurance.

With Medicare beneficiaries saving billions on prescription drugs, the Medicare Part D program has remained stable as well, CMS reports in the press release. In 2017, the average monthly premium for a Medicare prescription drug plan will cost beneficiaries about $34 per month, according to CMS. Access to prescription drug plans will remain open for Medicare beneficiaries with 100 percent access in the individual market and better access through employer-sponsored plans as well.

According to a fact sheet from CMS, the Medicare Advantage program has the following benefits: “The average number of Medicare Advantage plan choices per county is approximately unchanged from 2016, and access to supplemental benefits, such as dental and vision benefits, continues to grow. Over 94 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan. 100 percent of Medicare beneficiaries – including Medicare Advantage enrollees – have access to recommended Medicare-covered preventive services at zero cost sharing.”

Due to provisions within the Affordable Care Act and fact that the the “donut hole” was capped, Medicare beneficiaries have seen reduced costs of brand-name and generic prescription drugs as well as a rise in access to some preventive care with no out-of-pocket costs. The Affordable Care Act has required payers to cover the costs of preventive medical services such as immunizations and diagnostic screenings for disease.

When looking at Medicare Advantage and the Part D Prescription Drug Program, it is important to remember that CMS announced earlier this year that new payment adjustments will be made for these health plans. More stable reimbursement procedures are expected due to these changes.

The revenue change that will impact the Part D program will be 0.85 percent. The growth in revenue will align with some of the increases seen in Medicare’s fee-for-service payment structures. In 2017, a new Risk Adjustment Model will also be rolled out, which is expected to improve accuracy and precision in payments to Medicare providers.

With regard to next year’s Medicare benefits among seniors, CMS remains optimistic that coverage is improving and premium costs remain steady.


Dig Deeper:

35 Audits Find Medicare Advantage Plans Overbilling CMS

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies


Sign up for our free newsletter:

Our privacy policy

no, thanks