Elizabeth Lippincott

The Inflation Reduction Act Part D redesign was not intended to boost enrollment in Medicare Advantage plans, but that is a likely outcome of the IRA’s changes to Part D. The IRA statutory language capped increases in a Part D premium benchmark at 6% per year, but did not cap the actual premium that members would have to pay. We suspect that legislators did not understand that actual member premiums could go up much more than 6% annually under the IRA’s Part D provisions as a result of benefit enhancements, including capping out-of-pocket costs at $2,000 annually.

The pendulum of the Medicare plan regulatory environment—which grew increasingly stringent under the Biden administration—probably reached its amplitude in the last few weeks and began to swing in the opposite direction. Having seen several oscillations of this political pendulum, I wanted to share some insights about what these changes mean for Medicare plans, as well as what lawyers and business teams can count on to stay constant.

Elizabeth Lippincott will be speaking at the AHLA Institute on Medicare and Medicaid Payment Issues on March 21, 2024 I Baltimore, Maryland.

Elizabeth Lippincott will co-chair and speak at ACI’s 2nd annual Legal, Regulatory and Compliance Summit on Medicare Advantage from November 2-3, 2023 in Nashville, Tennessee.  Elizabeth’s co-chairs are Karen Lam of Kaiser Permanente and Annie Shieh of Bright Health Group. 

The Inflation Reduction Act provisions mandating adjustments to cost sharing for Part B drugs subject to inflationary rebates were silent on the question of whether Medicare Advantage (MA) plans would need to adjust coinsurance for drugs subject to inflationary rebates for the previous quarter. On November 7, 2022, however, CMS released a memorandum titled, “Inflation Reduction Act Changes to Cost Sharing for Part B Drugs for Contract Year 2023 Medicare Advantage and Section 1876 Cost Plans.”

Last Friday, CMS took a three-month extension to finalize the 2018 proposed rule that would have revised Risk Adjustment Data Validation (RADV) regulations to make it easier for the government to recoup overpayments to Medicare Advantage (MA) organizations, including use of extrapolation based on the error rates in audit samples.

On October 19, 2023, CMS released FAQs on the updated marketing requirements that are in place this annual open enrollment season. CMS clarified its expectations under the regulations for third party marketing organizations (TPMOs).

October 12- 13, 2022 Nashville, Tennessee Elizabeth Lippincott will co-chair and speak at ACI’s Legal, Regulatory and Compliance Summit on Medicare Advantage from October 12-13, 2022, in Nashville, Tennessee.  Elizabeth’s co-chair is Karen Lam of Kaiser Permanente.  Elizabeth will be presenting alongside Teresa A. Mason of Epstein Becker Green and Julie Nielsen of Berkeley Research Group discussing "Risk Adjustment: Forecasting the Future of Enforcement and the Implications for the Compliance and Legal Landscape." 

In 2005, the year I started focusing my practice on Medicare plans, fewer than 14% of Medicare beneficiaries, or roughly 6 million people, were enrolled in Medicare managed care products.  By the end of 2021, more than 26 million people, or 42% of Medicare beneficiaries, were in Medicare Advantage, and more than 46% of Medicare spending flows through this program.  Basically, in the last 17 years, Medicare Advantage transitioned from being a niche managed care option towards becoming the standard way that Americans receive their Medicare benefits.