Description: In this session, Deana Bell, FSA MAAA provides a comprehensive introduction to the Medicare Risk adjustment Program. Deana is a Principal & Consulting Actuary in the Seattel office at Milliman. She has been working with Medicare Advantage throughout her career as an actuary. Her expertise includes actuarial opinions, pricing, rating, reserving, medical underwriting, benchmarking, and risk adjustment projects. IN this session she sheds light on how Medicare Advantage health plans are compensated by the Centers of Medicare and Medicaid Services (CMS) through risk adjusted revenue. She highlights the significance of risk adjustment in ensuring financial stability for Medicare Advantage plans. Contributors: Deana Bell, FSA MAAA ; David Koenig, FSA, MAAA, John Dawson, FSA, MAAA, Jon Forster, ASA, MAAA

Description: Hear from Kevin Pierce, FSA MAAA on the key components on the Inflation Reduction Act as it relates to Medicare Part D. Kevin is a Senior Consulting Actuary at Milliman and a top industry speaker on this subject. Kevin has extensive industry experience in actuarial, finance, and strategic projects, providing market intelligence and strategy support for clients across the health care industry. He outlines key provisions of the act, such as a complete redesign of the benefit, inflation rebate payments from pharmaceutical manufacturers,, and Medicare’s ability to negotiate drug prices. Kevin touches on the changes in costs and complexities for beneficiaries, pharmaceutical manufacturers, the federal government, and health insurers. Contributors: Kevin Pierce, FSA MAAA, Mitchell Momanyi, FSA, MAAA, Deana Bell, FSA, MAAA, Jon Forster, ASA, MAAA

Description: In this video Mitchell Momanyi, FSA MAAA presents an informative breakdown of Medicare Advantage plans, delving into the intricacies of this alternative to traditional Medicare. Covering the inception of Medicare Advantage and its evolution, Momanyi explores the managed care companies offering Part C coverage, emphasizing the role of provider networks coordinated care. Concluding with key considerations for beneficiaries, Momanyi stresses the importance of weighing the pros and cons between Traditional Medicare and Medicare Advantage, while also emphasizing the evolving nature of the Medicare landscape and the regulatory nuances influencing enrollment decisions. Conributors: Mitchell Momanyi, FSA, MAAA, Deana Bell FSA, MAAA, Matt Emery, FSA, CERA, MAAA, Jon Forster, ASA, MAAA

Description: In this video led by Mitchell Momanyi, FSA, MAAA, the types of Medicare products available is discussed. This two major types are traditional Medicare and Medicare Advantage. It discusses how traditional Medicare encompasses Parts A and B, covering various inpatient and outpatient services but not long-term care or prescription drugs, which fall under Part D. The video details deductibles, cost-sharing structures, and options like Medigap plans that assist with Traditional Medicare’s out-of-pocket expenses. Mitchell emphasizes clarity and understanding while sharing his expertise in this comprehensive overview.

Description: In this video Scott Allen, FSA, MAAA discusses the Medicare Advantage Part C bid template. The template helps Medicare Advantage plans estimate costs and premiums, comparing their bids to CMS benchmarks. It’s a complex process involving worksheets that project costs, calculate revenue requirements, and determine rebates, ultimately influencing the plan’s benefits, premiums, and competitiveness in the market. Contributors: Scott Allen, FSA, MAAA, Eric Milner, ASA, MAAA, Danica Turner, FSA, MAAA, Jon Forster ASA, MAAA

Description: Kevin Pierce, FSA MAAA divesinto the Inflation Reduction Act’s impact on US drug pricing. He discusses two key provisions: Inflation rebates, where pharmaceutical manufacturers must pay rebates to the government if drug prices rise faster than inflation, and drug price negotiation by Medicare, set to commence in 2026 for selected drugs. Contributors: Kevin Pierce, FSA, MAAA, Deana Bell, FSA, MAAA Mitchell Momanyi, FSA, MAAA, Jon Forster, ASA, MAAA