I’d like to make a prediction. The next big political focus (after PBMs, if we give up on PBMs?) is going to Medicare Advantage. There is a lot of money flowing through managed care and scrutiny feels inevitable. It is just that if you’re following the dollar, a lot is going that way.

A few weeks ago, I did a dive into Part D enrollment and was planning on talking about Part D premiums today but really got struck by the current dynamics of premiums and the program(s). I had noted that a lot of the Part D enrollment has moved from standalone prescription drug plans (PDPs) to the Medicare Advantage plans that offer Part D plans (MA-PD plans.) Almost 30 million beneficiaries are in MA-PD plans in 2023.

As I compared my local options* for PDPs and MA-PD plans for 2023 versus 2024, I had a few observations:

• The number of PDP options in 2023 was 22, in 2024 it dropped to 19. Still plenty of choice but wonder how much that will drop in 2025 with the Part D benefit redesign which will increase plan liability.
• The number of MA-PD plan options increased to 28 from 24.
• The lowest premium PDP plan in 2023 is SilverScript Smart Saver at $7.60, in 2024 it goes up to $12.40. BUT there will be a Wellcare Value Script plan with a premium of $0.40/month. For less than a latte, you can have a PDP for the year.
• The highest premium PDP plan in 2023 was AARP MedicareRx Preferred with a premium of $112. That plan is $103 in 2024. The most expensive 2024 PDP in my area is a SilverScript plan at $113.40.
• On the MA-PD side, most plans have no premium beyond the $174.70 Part B premium. So pay for Part B and get Part D thrown in as a bonus. For the plans that do charge a premium, most are less than $50 but, on the highest end, Hopkins Premier was $301 in 2023 but dropped to $291 in 2024. This is on top of the Part B premium.

From a policy perspective, MA-PD plans make sense. They maintain financial responsibility for the whole patient so they can balance pharmaceutical and medical costs. Presumably they are motivated to keep the patient alive and well. PDPs are only paying pharmacy costs. I could speculate about what this means towards their coverage and access decisions, but I’ll leave that to you.

I’m just struck (again) by the significance of having no premium for most MA-PD plans, not even for Part D. Plus extra benefits in many of the plans like gym memberships, etc. Each beneficiary in MA plans has the potential for way more profit than in PDP plans. And where there is profit like that, scrutiny is likely to follow.

*Looked in Bethesda, Maryland