Health Care Matters | July 31
CMS to End Temporary Part D Premium Subsidies After 2026
The Centers for Medicare & Medicaid Services (CMS) will end the temporary Part D Premium Stabilization Demonstration after 2026. The program was introduced in 2024 to limit premium increases for stand-alone prescription drug plans as changes under the Inflation Reduction Act shifted more drug costs to plan sponsors. In 2026, the demonstration reduced the base beneficiary premium by $10 and capped monthly premium increases at $50. CMS said its review of 2027 plan bids indicated that insurers now have sufficient experience to price their plans without the additional support. Final plan-level premiums and benefit details are expected in September. Read more here and here.
Why It Matters
Ending the demonstration removes a temporary safeguard that helped stabilize premiums and enrollment during a period of significant change in Medicare Part D. The effect will vary by plan, but some beneficiaries enrolled in stand-alone prescription drug plans could face larger premium increases in 2027, particularly as plans continue to manage rising drug costs and greater financial responsibility under the redesigned benefit. The decision may also widen the affordability gap between stand-alone coverage and Medicare Advantage drug plans, which can use rebates to reduce Part D premiums. That difference could influence coverage decisions for beneficiaries who want to remain in traditional Medicare and place additional attention on the long-term stability of the stand-alone drug plan market.
Look for the Helpers: Helping Rural Older Adults Stay Home and Connected
In rural North Dakota, the Aging in Community program is helping older adults remain in their homes by organizing neighbors and local coordinators to provide practical support and companionship. From home visits and help with everyday tasks to game days and connections to local resources, the program is addressing the isolation that can make aging in rural communities especially difficult. Its expansion across 12 counties shows how simple, community-led support can help older adults feel safer, more connected, and less alone. Read more here.
New Resource
Understanding CMS’ Updates and Proposed Changes to the Accountable Care Prospective Trend (ACPT)
In the Proposed 2027 Physician Fee Schedule (PFS), CMS proposed several updates to the Medicare Shared Savings Program (MSSP), including changes to the ACPT. Separately, CMS recently issued sub-regulatory guidance detailing updates to the ACPT that are effective immediately. Coral’s new resource summarizes both the immediate updates and proposed changes to help ACOs understand the implications for their organization. Read the resource here.
What We Are Reading
Access To Community Pharmacies Associated With Reduced Racial And Ethnic Disparities In Use Of Prescription Drugs, 2010–19
A Health Affairs study examines how greater access to community pharmacies was associated with narrower racial and ethnic disparities in prescription drug use, highlighting the role of local pharmacy availability in medication access and health equity. Read here.
Aligning Medicare and Medicaid Incentives Through Accountable Care
A Center for Health Care Strategies brief outlines what states need to know about Medicare-Medicaid alignment under the Long-term Enhanced ACO Design (LEAD) Model. Read here.
Guidebook to Help Organizations Advance Patient Empowerment
A Health Care Payment Learning & Action Network guide offers practical strategies to help patients take a more active role in their health by focusing on three interconnected priorities: making care more affordable, ensuring patients can access the services they need, and helping them navigate the health care system with confidence. Read here.
CMS Serves Up Details on Medicaid Provider Taxes
A McDermott+ analysis highlights key provisions in CMS’s proposed rule implementing new Medicaid provider tax limits, including state-specific thresholds, expanded reporting, and stronger enforcement. Read here.
Pop Health Podcast
Turning Denial Appeals Into a Faster Workflow
In this episode of Bright Spots, Coral’s Kate Freeman speaks with Gretchen Heinen, Founder and CEO of Authsnap, about how AI-enabled tools can help reduce the administrative burden of insurance-denial appeals and medical-necessity documentation. The conversation explores how Authsnap supports clinics, hospitals, and health care organizations by streamlining work that has traditionally required hours of manual review, helping providers manage growing volumes of commercial-payer and specialty-drug denials with greater speed and accuracy. Gretchen shares how her experience as a utilization-management nurse shaped the development of Authsnap, what implementation looks like in real-world provider workflows, and what tools like Authsnap could mean for the future of prior authorization, revenue cycle operations, and patient access to care.