A First Look At The 2025 Medicare Part D Risk Score Model

As stakeholders and legislators examined how to redesign the Medicare Part D program, a principal priority was protecting seniors financially by providing an annual $2,000 out-of-pocket maximum. Of equal importance was reducing the government reinsurance payments which had increased dramatically since the inception of the program in 2006. These two primary changes, in tandem with other smaller regulatory tweaks, would result in a sizeable increase in health plan liability. To avoid significant premium increases, and by virtue of the basic payment mechanics of the program, the offset to this increase in plan liability would be a substantial increase in the risk-adjusted direct subsidy payments. With the signing...