CMS Increases Part D 2016 payments by an average of 1.25 percent and finalizes policy updates for Medicare Health and Drug Plans

Medicare Advantage and Part D plans will see an average of a 1.25 percent rise in payments next year compared to the 0.9 percent decline that was initially proposed by The Centers for Medicare & Medicaid Services (CMS) in February.

“The Rate Announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans. On average, the expected revenue change is 1.25 percent without accounting for the expected growth in coding acuity that has typically added another 2 percent. The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015. Medicare per capita spending in 2014, 2015, and 2016 is still expected to be below historical standards.” 

The final policies require Medicare Advantage plans “to maintain accurate provider directories in a timely manner and make those directories widely available.” In addition, “clear and accurate access to information on preferred cost sharing pharmacies in their networks” must be provided to enable all beneficiaries to make educated decisions on their coverage.

View a fact sheet on the 2016 Rate Announcement and final Call Letter.

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