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Capping Part D Costs Could Lead to Reduced Benefits

Discussions continue to ripple through the Medicare insurance community with the recent Centers for Medicare and Medicaid Services (CMS) announcement of rules and regulations changes for 2025.

Sweeping alterations were released earlier in April that affect everything from agent commissions to Part D drug benefits. At first, the changes to Part D drug benefits were seen as a positive for consumers because enrollees could see reduced costs for prescription drugs.

For 2025, changes to Part D included capping annual out-of-pocket costs for people with Medicare Part D at $2,000 in 2025 and beyond.

This would seem to be a good development for those buying Part D plans, however, there is concern in the industry that these changes will be costly to insurance providers. In order to cope with the increased costs, providers could pass this cost to the consumer through a decrease in covered drugs.

The Part D cap isn’t the only thing affecting providers.

This change in Medicare Part D is coupled with a new payment increase of 3.7 percent for MA plans. There are concerns in the MA industry that the expected increase in payments will not cover the full rise of 2025 healthcare costs. This most likely will lead to a cut in benefits for Medicare Advantage plans, which will lead to more consumer cost share.  This will be the first time in recent memory that benefits could decrease for MA.

What Does This mean for Brokers and Agents?

While this particular announcement doesn’t mention brokers directly, the overall financial pressures on the insurers could lead to consequences that indirectly affect brokers and their clients. Agility is constantly updating our agent partners on changes in the health insurance industry so that you have the best information available to help your clients.

Look to our blog page for the latest information and perspective on how changes affect our agents.

We offer top commissions, training, administrative support and many other services to help you succeed in a changing landscape. Find out how to partner with Agility by contacting us at 866-590-9771.

This information is confidential and intended solely for broker use. Distribution to Medicare beneficiaries is not permitted.