Federal and State Policy
As the largest US healthcare payer, the federal government plays a dominant role in shaping the healthcare marketplace, while states take center stage when it comes to developing novel policy approaches. Our experts track, interpret, and model policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Avalere Analysis on Recently Released 2017 Medicare Advantage Landscape Files
The Centers for Medicare & Medicaid Services (CMS) just released the annual Landscape Files containing data on plan participation, beneficiary premiums, and benefit designs for the 2017 Part D and Medicare Advantage (MA) markets. Avalere offers the following observations on key trends in the MA and Part D programs that are likely to influence the 2017 market.
Webinar: Navigating the Exchange Market: Policy Updates and Strategies for Mitigating Risk
Earler this month, the Obama Administration released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year. Meanwhile, the exchange market faces instability. Recent Avalere analysis finds that more than one-third of rating regions may have only one insurance carrier participating on the exchange in 2017.
Avalere Analysis on MedPAC’s Proposed Part D Reforms to Modify Beneficiary Cost Sharing
Avalere recently analyzed two different Part D policy proposals outlined in The Medicare Payment Advisory Commission (MedPAC) June 2016 report to Congress.
CMS Takes on Risk Adjustment in Latest NBPP Proposal
In late August, CMS released its proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year.
What are the ACA Enrollment Figures for 2016?
Recently, Avalere worked with the Council for Affordable Health Coverage to examine enrollment trends for the Affordable Care Act (ACA).
Experts Predict Sharp Decline in Competition across the ACA Exchanges
Avalere experts predict that one-third of the country will have no exchange plan competition in 2017, leaving consumers with few options for coverage.
The Inpatient Prospective Payment Systems (IPPS) FY 2017 Overview
Last Tuesday, August 2, the Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS final rule
Outpatient Services Are the Largest Driver of 2017 Premium Increases
Prescription drugs are not outsized contributors to rate increases.
Interview: E2 – What the Elections Might Mean for the Drug Pricing Debate
Our experts provide a quick glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail.
UPDATE: Early Analysis Finds 2017 Proposed Exchange Premiums for Low Cost Silver Plans Increasing 8 Percent on Average
Rates vary widely by state; popular low cost options see smaller increases.
Snapshot of Gubernatorial Elections and Outlooks
Recently, Avalere took a look at the gubernatorial elections happening this year, their outlooks, and where they stand on the Exchanges and the Medicaid expansion.
Interview: E1 – An Introduction to the 2016 Election Series
Between now and November, Avalere will to bring election content to the public dialogue. Our experts provide a glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail.
MedPAC Proposes Changes for 42 Million Medicare Beneficiaries Enrolled in Part D
Cost-sharing changes could increase costs for many beneficiaries.
CORRECTION: Early Analysis Finds 2017 Proposed Exchange Rates Exceed 2016 Increases But Vary Widely By State
Popular low cost options see smaller increases.
Medicare Advantage: 2016 National Snapshot
In 2016, more than 18 of 56 million Medicare beneficiaries receive their benefits from Medicare Advantage (MA) plans. MA plans are private managed care organizations that contract with the federal government to coordinate care for Medicare beneficiaries.
13 Million Adults Could Be Eligible to Purchase Medicare Coverage Under Proposed Clinton Plan
A new Avalere analysis finds that nearly 13 million Americans age 50 or over who are currently uninsured or have individual coverage purchased through the private market-inside and outside the exchange- could be eligible to buy-in to the Medicare program under a plan proposed by Democratic presidential candidate Hillary Clinton.
A Conversation on Prescription Drug Pricing
As the discussion intensifies, one of Avalere's experts provides keen observations on what you need to know about this topic.
2016 Exchange Plans Improve Access to Medicines Used to Treat Complex Diseases
An analysis from Avalere shows that more health insurance plans offered through the Affordable Care Act exchanges are making some drugs used to treat complex diseases—such as HIV, cancer, and MS—more accessible to patients in 2016 than in the previous years. Specifically, plans were less likely to place all drugs in a class on the highest cost-sharing tier.
Medicare Beneficiaries Will Pay More for Biosimilars than for Their Biologic Reference Products in Part D
Two Potential Policy Changes Would Reduce Out-of-Pocket Costs for Consumers
Proposed Medicare Part B Rule Would Reduce Payments to Hospitals and Some Specialists, While Increasing Payments to Primary Care Providers
Rule Would Decrease Medicare Reimbursement for Drugs That Cost More than $480 per Day; Seven of the 10 Most Affected Drugs Treat Cancer