Industry News

Legislation Could Impact your Business

Episode Summary

Mike Smith joined the host to discuss various healthcare-related provisions within the Inflation Reduction Act and their implications. A major change is the introduction of a $2000 out-of-pocket maximum for Medicare Part D prescription drugs starting in 2025. This cap will provide substantial savings for beneficiaries with high drug costs. However, Mike notes it could negatively impact insurance companies, causing them to raise premiums or exit the Medicare Part D market entirely if their costs rise significantly.

Another key part of the Act is extending Affordable Care Act subsidies for another three years. Mike views this as moving the country closer to a universal healthcare system funded by taxpayer dollars. While helping more people afford coverage, the impacts on cost, quality, and access to care remain uncertain.

Beginning in 2026, Medicare will start directly negotiating prices on some prescription drugs. Mike points out that negotiation will initially only apply to the top 10 drugs used by Medicare beneficiaries. He believes this limited scope may not produce meaningful cost savings overall.

Mike cited accountable care organizations and value-based insurance as examples of other initiatives aimed at controlling healthcare costs. Their effectiveness is still being evaluated.

A new requirement for recording sales and enrollment calls will take effect for Medicare Advantage and Part D plans in October 2022. Mike thinks this will help agents defend themselves against consumer complaints by supplying call recordings as evidence. However, costs and data privacy are downsides to consider.

Citing government data, Mike states that with only 39,000 complaints out of 29.5 million Medicare beneficiaries last year, agents are satisfying over 99.99% of their clients. He believes this exemplary track record demonstrates most agents' commitment to ethical, customer-focused business practices.

Overall, while the Inflation Reduction Act introduces measures intended to reduce healthcare costs for Americans, particularly seniors, Mike argues the actual impacts remain uncertain. Insurance affordability, market competition, quality of care, and total system costs will need to be assessed as these policies take effect. He encourages consumers and industry professionals to closely monitor developments stemming from this landmark legislation.


(0:00:03) - Broker link brings in Mike Smith to talk about healthcare legislation
(0:01:53) - The Inflation Reduction Act is going to impact Medicare and ACA agents most
(0:09:09) - Medicare will begin to negotiate drug prices beginning in 2026
(0:16:10) - The Centers for Medicare and Medicaid Services is targeting costs through innovative initiatives
(0:18:29) - The 2023 AEP kickoff event is only a few days away
(0:27:35) - Gillan: CMS has new call recording requirements for Medicare Part C
(0:34:08) - The CMS ruling is a good thing because it helps defend the agent
(0:40:05) - Nahu is working on changes to some antiquated Medicare rules
(0:42:20) - The brokerage will continue to support its agents, educate them and help them grow
(0:43:50) - Mike Smith: We empower insurance agents to sell more, earn more

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