The final 2027 Medicare Advantage Rate Announcement provided some relief to a still displeased industry.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the final 2027 Medicare Advantage Rate Announcement. It provided some relief to a still displeased industry.

Key Takeaways:

Medicare Advantage (MA) plans got a bit of relief from CMS initial proposal of a 0.09% rate hike in 2027.

The final adjustment will be 2.48%.

CMS gave in a bit to the industry and pulled back on another proposed risk adjustment model change.

It will follow through on some risk adjustment reform by barring unlinked charts (those not connected to an actual provider encounter) in most cases.

The rate hike is far below what has been seen in terms of utilization.

The hike will mean about $13 billion in new dollars to MA plans, up from under $1 billion proposed.

But because most plans do not have aggressive risk adjustment practices, most plans will see an increase closer to 4%.

Big plans will bear the burden of most of the unlinked chart reform.

The 2027 modest hike is yet another sign that CMS will be stingier on rate dollars in the future.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

The final 2027 Medicare Advantage and Part D rule cemented some major changes in Star Ratings that will have far-reaching revenue impacts.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the final 2027 Medicare Advantage and Part D rule. It cemented some major changes in Star Ratings that will have far-reaching revenue impacts.

Key Takeaways:

The 2027 Medicare Advantage and Part D rule was finalized with major Star Ratings changes.

The EHO4all health equity reward was retroactively rescinded, and the Reward Factor will be kept.

Thirteen of 14 measure retirements were finalized, most of which are easy-to-hit operational measures.

A new Depression Screening measure was adopted as well.

The effect of the measure changes means clinical measures now are weighted almost half of overall star ratings, with CAHPS and HOS measures over a third.

At least 25% of contracts are expected to lose a half Star rating, with others seeing their performance drop to put higher ratings out of reach.

Other reforms adopted include repealing many health equity mandates, reining in and reforming supplemental benefits, and codifying many Part D changes.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Since the feds won't act, states are increasingly passing healthcare reform legislation to control costs.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses a series of state healthcare laws and bills. Since the feds won't act, states are increasingly passing healthcare reform legislation to control costs.

Key Takeaways:

Trump 47 has pushed forward on a series of healthcare regulatory reforms. Kudos, but Congress refuses to truly act.

Therefore, states are increasingly getting into the healthcare reform game.

While states are preempted on self-insured and Medicare coverage, they are getting creative to impact price and reduce costs.

Many are pushing through hospital price caps in various forms.

Other states have set up statewide accountability costs to limit overall healthcare cost growth.

Many states have passed transparency laws.

Reform at the state level is in progressive as well as conservative states.

Increasingly states see the problem and do not view controlling price negatively.

But Congress must act to have true impact and so we don't have a patchwork system.

Site neutral payments, uniform pricing, and addressing consolidation are among the reforms I view as crucial.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

While some may disagree with the strategies, there is little question Dr. Oz is carrying out a revolution at CMS. Change is needed.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses how there is little question Dr. Oz is carrying out a revolution at CMS. While some may disagree with the strategies, change is needed.

Key Takeaways:

There is little question that the Trump 47 CMS is very different than Trump 45 and Biden.

If Trump 45 tested ideas, Trump 47 is executing on them.

Leveraging technology in healthcare is top of mind for CMS Administrator Dr. Oz.

Quality is poor in healthcare and Oz wants to change that so as to reduce costs.

Oz rightly notes that people who do not seek care can be the most expensive.

Oz is very focused on reducing drug prices and the Trump administration has made remarkable progress.

CMS also continues with value-based care and there is a proliferation of models.

Aspects of the CMS initiatives are controversial and will have fallout. But it is hard to argue change is not needed.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

The 2026 midterms will be about affordability, especially regarding healthcare. The Democrats almost assuredly will win back the House. The GOP's hold in the Senate could be in question.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses how the 2026 midterms will be about affordability, especially regarding healthcare. The Democrats almost assuredly will win back the House. The GOP's hold in the Senate could be in question.

Key Takeaways:

Affordability will dominate the 2026 midterms.

Healthcare affordability is very much on Americans' minds according to polls.

Even popular presidents' parties usually lose seats in Congress during midterms. There are just a few exceptions.

The generic congressional ballot—a key measure of national sentiment—currently favors Democrats by about five points.

With affordability dominating the headlines as it did in 2024, the GOP looks very vulnerable.

The House almost assuredly will fall to the Democrats, with either a tight margin or a more comfortable one.

Several months ago, the GOP seemed to have a lock on maintaining their hold of the Senate. But that is now somewhat in doubt.

If the Democrats take even one house, Donald Trump immediately becomes a lame duck.

To effect change, he would have to go even more in on regulations, executive orders, and government fiat.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Yes, Medicare Advantage is struggling, but it remains a key social safety net program. It just needs less biased assessments and better advocates.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses that Medicare Advantage is struggling, but it remains a key social safety net program. It just needs less biased assessments and better advocates.

Key Takeaways:

Medicare Advantage turned 25 recently and is facing great financial troubles.

CMS has proposed tight rates, restrictions on prior authorizations, risk adjustment reforms, and Star rating changes.

This has led to major retrenchment, with reduced benefits, products, and footprints.

MA growth has slowed but it still grew year over year and during open enrollment.

MedPAC has been arguing MA is overpaid for years but relies on outdated data and dubious assumptions. This has undermined MA.

Some overpayments existed, but much of it went to the biggest health plans that used aggressive coding.

A bipartisan duo of former HHS secretaries came to the defense of MA recently, saying CMS and Capitol Hill have gone too far.

Let's hope the defense of MA messages sink in The MA program is an important safety net and its death is greatly exaggerated.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Trying to make sense of the recent PBM reforms and their significance? I map them in this podcast and what it really means? It is game-changing.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc maps all the recent PBM and drug price reforms and tells you about their significance? It is game-changing.

Key Takeaways:

The recent FFY 2026 Appropriations Bill had major PBM reforms.

They included 100% rebate pass-through and transparency and reporting in the employer market.

In Medicare Part D, PBMs must adopt flat-fee compensation that is de-linked from rebates and utilization.

Important reporting and transparency in Part D as well.

Group purchasing reform could be next on lawmakers' list.

A Federal Trade Commission settlement with Cigna's Express Scripts PBM has many similar reforms.

Express Scripts is also adopting a brand net pricing model that will run in parallel with a traditional rebate model.

Various initiatives from the Trump administration will also dramatically impact drug price. These include reforms of the drug channel and most-favored nation pricing.

The developments are game-changing, but it will take time for reforms to set in and impact every line of business.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Showing Medicare Advantage's value, the sky did not fall on MA, but the earth shifted on the program.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the 2026 Medicare Advantage open enrollment. Showing Medicare Advantage's value, the sky did not fall on MA, but the earth shifted on the program.

Key Takeaways:

Many analysts predicted a major contraction during open enrollment, but the Medicare Advantage program still grew.

It grew 874K year over year and about 115K during open enrollment.

MA has grown almost 50% — 11.9 million lives – since 2020.

This shows the overall value of MA compared with traditional Medicare fee-for-service (FFS).

Still growth has come way down in 2025 and 2026, which shows the financial stress in the program.

Big plans did not fare well in open enrollment, losing 328K lives. Except for Humana, which grew about 1.2M, most big MA plans wanted to contract.

Non-Big MA plans added 443,000 lives during open enrollment, including the insurtechs by 320K lives.

SNPs grew 647,000 lives year over year -- 259,000 of that during open enrollment.

PPOs saw major contraction in terms of offerings and enrollment. PPOs were down year over year by 103K, while HMOs grew 937K.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance