Those who grew up in the 80s recall clip shows. They included a story framework but usually consisted of clips from previous episodes. They helped reduce costs, enabling actors and crew to take additional time off.
As the end of the year nears, you’ll see a lot of retrospective looks at the past 365 days. In most cases, those writing the content – like their 80s TV show peers – want an easy piece to create as the holidays hit and they spend time away from work.
I’m no different. After 52 blog posts this year, it’s time to recap our seven most popular posts of 2024.
As you can see, the Medicare Prescription Payment Plan, a new option for Medicare Part D beneficiaries that enables them to spread out-of-pocket prescription drug costs throughout the year rather than paying them all at once at the pharmacy, dominated our most popular blog posts of 2024. Those posts accounted for five of the seven most viewed posts. Star ratings and health insurance rates also snuck in the top seven.
If you missed them, here’s a quick recap of Certifi’s 2024 most popular blog posts:
New Medicare Prescription Payment Plan Model Documents Released: What Part D Plans Need to Know
The Centers for Medicare & Medicaid Services (CMS) released several model documents to help health plans implement the Medicare Prescription Payment Plan (M3P). These documents help plans comply with M3P regulations and communicate clearly to members.
Key Model Documents and Their Purpose:
- Likely to Benefit Notice:
- This notice identifies members eligible for M3P.
- Explains the program, benefits, and how to enroll.
- Must be sent to eligible members before the plan year starts.
- Participation Request Form:
- Allows members to enroll in the M3P program.
- Members can use the form for both initial and subsequent enrollments.
- Election Approval Notice:
- Confirms a member’s enrollment in the M3P program.
- Provides details on monthly payments, potential consequences of non-payment, and how to withdraw from the program.
- Failure to Pay Notice:
- Notifies members of missed payments and the consequences.
- Provides information on how to make payments and resolve the issue.
- Termination Notice:
- Informs members that the plan terminated their M3P enrollment due to non-payment.
- Explains the reasons for termination and the steps to re-enroll.
- Voluntary Termination Notice:
- Informs members who voluntarily withdraw from the M3P program.
- Details the termination process and any outstanding payments.
2025 Medicare Advantage Star Ratings: How Insurers Fared
CMS released the 2025 Medicare Advantage Star Ratings on October 10, 2024. These ratings measure the quality of health and prescription drug services provided by Medicare Advantage (MA) and Part D plans.
Key Takeaways:
- Declining 4-Star Plans: The percentage of MA plans achieving 4-stars or higher has decreased for three consecutive years.
- Increased Cut Points: CMS has increased the performance thresholds for plans to earn higher star ratings.
- Impact of Tukey Outlier Deletion: This statistical method has affected cut-point calculations, making it more challenging for plans to achieve high ratings.
Implications for the Future:
- Increased Competition: The declining number of high-star plans will intensify competition among health plans.
- Focus on Quality Improvement: Plans should prioritize initiatives to maintain or improve their Star Ratings.
- Impact on Enrollment: Lower-rated plans may experience decreased enrollment, while higher-rated plans may attract more members.
- Financial Implications: Star Ratings directly impact Medicare payments to plans, with higher-rated plans receiving larger payments.
M3P Model Documents Update: A Breakdown of Key Changes for Plan Sponsors
CMS released the final Part 2 guidance and revised M3P model documents on July 16, 2024. These documents incorporate public feedback and clarify program details for plan sponsors and enrollees.
Key Changes:
- Financial Responsibility: Revised notices emphasize that enrollees remain financially responsible for prescription costs despite not paying at the pharmacy.
- M3P Program Information: Introductory text added to some forms briefly explains the M3P program for enrollees.
- Disenrollment Clarification: The revised text clarifies the process and options for leaving the M3P program.
- Website Link: Enrollees can learn more about the program via a new website link (medicare.gov/prescription-payment-plan).
- Removed Question: The Participation Request Form no longer asks about other prescription cost assistance programs.
Revised Documents:
- Likely to Benefit Notice: Clarifies financial responsibility and adds a program website link.
- M3P Participation Request Form: Includes introductory text about the program and removes questions about other assistance programs.
- Part D Sponsor Notice to Acknowledge Acceptance of Election: Adds information for plan sponsors, clarifies payment information, and revises disenrollment text.
- Notice of Failure to Pay: Includes a program reminder and removes language about applying M3P payments to plan premiums.
- Notice of Involuntary Termination: Adds minor text changes and plan sponsor instructions.
- Notice of Voluntary Termination: Adds optional text depending on the disenrollment type and plan sponsor instructions.
Proposed 2025 Minnesota Health Insurance Rates
In July, the Minnesota Department of Commerce released proposed 2025 health insurance rates for individual and small group markets.
Participating Insurers:
- Individual Market: HealthPartners, Blue Plus, Medica, Quartz Health Plan, UCare
- Small Group Market: Blue Cross, Blue Plus, HealthPartners, Medica, Quartz, Sanford, UnitedHealthcare (2 companies)
Reasons for Rate Increases:
Insurers cited several factors driving these increases, including:
- Increased Utilization and Costs: This was a common theme across all insurers, with some experiencing higher claims costs or increases in high-cost members.
- Medical Trend: Health plans mentioned rising medical care costs and utilization rates as key drivers, with trends ranging from 5.2% to 11.3% depending on the insurer.
- Morbidity: Plans noted changes in the overall health of the insured population as a factor.
- Regulatory Requirements: Some insurers also noted that adjustments to plan benefits and cost-sharing due to regulations.
Comparison to National Trends:
These proposed rates appear consistent with national trends. A KFF report found that ACA marketplace insurers nationwide projected rate increases of around 7% in 2025, with similar reasons cited for increased costs.
Medicare Prescription Payment Plan Member Communication Provisions of the M3P Part 2 Draft Guidance
CMS released Part 2 of the M3P guidance on February 15, 2024, focusing on member communication, outreach, and operational requirements.
Key Points:
- M3P Enrollment: Plans must include information about M3P and an enrollment form in member ID cards and EOCs.
- Targeted Outreach: Plans must identify and proactively reach out to members likely to benefit from the program.
- Communication Channels: Plans must use various channels, including mail, email, and phone, to communicate with members about M3P.
- Model Documents: CMS will release model documents for various communications, such as enrollment forms, notices, and explanations of benefits.
- Website Information: Plans must provide detailed information about the M3P program on their websites, including eligibility, benefits, and how to enroll.
- Financial Responsibility: Enrollees are responsible for paying monthly bills, even if they don’t pay at the pharmacy.
- Termination and Re-enrollment: Plans must provide information about termination procedures and the possibility of re-enrollment.
Conquering Medicare Prescription Payment Plan Billing: Essential Questions for Choosing the Right Solution
The Medicare Prescription Payment Plan (M3P) introduces a new, complex billing model for Medicare Advantage plans. Health plans should carefully evaluate potential billing solutions based on the following key factors:
- Billing Accuracy: Ensure the solution can handle variable billing, retroactive adjustments, and complex calculations.
- Payment Options: Support various payment methods, including cash payments, and offer an integrated payment portal.
- Delinquency Management: Automate delinquency processes, generate timely notices, and provide clear instructions for payment.
- Configurable Invoices and Communications: Customize invoices and communications to comply with M3P requirements and maintain brand consistency.
- Robust Reporting: Generate detailed reports on payment history, aging, and other key metrics to monitor performance.
- Data Integration: Seamlessly integrate with existing systems to capture prescription data and other relevant information.
- Scalability: Ensure the solution can handle increased volumes and evolving requirements.
- Security: Protect sensitive member data with robust security measures.
- Compliance: Adhere to HIPAA and other regulatory requirements.
- Implementation Timeline: Select a solution to implement quickly and efficiently.
- Member Experience: Provide a user-friendly payment portal and clear communication to enhance the member experience.
- Vendor Expertise: Choose a vendor with a proven track record in healthcare billing and a deep understanding of M3P regulations.
- Support and Maintenance: Ensure the vendor offers reliable support and maintenance services.
Medicare Prescription Payment Plan Part 1 Final Guidance
CMS released the final Part 1 guidance for M3P in February 2024. This guidance provides crucial details for health plans to implement the M3P program effectively.
Key Points from the Final Guidance:
- Likely to Benefit Threshold: CMS has set a specific threshold of $600 for identifying members likely to benefit from the M3P program.
- Payment Methods: Cash payments have been removed as a payment option, emphasizing electronic payments.
- Financial Reconciliation: CMS has clarified the financial reconciliation process, including handling overpayments and underpayments.
- Automatic Re-enrollment: CMS will provide further guidance on automatic re-enrollment in future updates.
- Grace Periods and Terminations: The final guidance details grace periods, termination procedures, and reinstatement criteria.
- Pharmacy Fees: CMS clarified that pharmacies cannot impose additional fees on participants due to the M3P program.
Key Communication and Outreach Requirements:
- Likely to Benefit Notices: Plans must identify and notify eligible members before and during the plan year.
- Membership ID Cards: Plans must include M3P information on member ID cards.
- Evidence of Coverage (EOC): EOCs must contain information about the M3P program.
- Annual Notice of Change (ANOC): ANOCs must include M3P information.
- Explanation of Benefits (EOB): EOBs must include M3P details.
- Plan Websites: Plans must provide comprehensive information about the M3P program on their websites.
Certifi’s health insurance billing and payment solutions help payers improve member satisfaction while reducing administrative costs.
