Medicare Advantage Plans Receive a Disappointing Pay Increase for 2021

Yesterday CMS issued a proposed rule and the Advance Notice Part II related to the Medicare Advantage and Part D prescription drug programs. Like most proposals, it presents a mixed bag for patients and providers.

On the positive side, CMS says the proposed changes would “lower beneficiary cost sharing on some of the most expensive prescription drugs, promote the use of generic drugs, and allow beneficiaries to know in advance and compare their out-of-pocket payments for different prescription drugs.”

Unfortunately, the proposed changes described in the Advance Notice are expected to increase Medicare Advantage plan revenue by a meager 0.93%. Providers are unlikely to see any of that small increase.

Medicare Advantage plans are increasingly popular with beneficiaries, and it’s easy to understand why from their perspective. Plans are offering supplemental benefits that make a big difference in a beneficiary’s quality of life and social determinants of health. Providers are forced to come on board, as that’s where their patients are, but often find that the cost of compliance is high and reimbursement is lower than expected.

Click here to read the press release about this proposal from CMS, and stay tuned for more updates.