Keeping you updated on the latest Medicare and Part D news

CMS Issues Final Medical Loss Ratio Rule

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The final medical loss ratio (MLR) regulations require Medicare Advantage and Part D Plan Sponsors to spend at least 85 percent of Medicare contract revenue on clinical services, prescription drugs, quality improvement activities, and direct benefits to beneficiaries in the form of reduced Part B premiums. Plan Sponsors who fail to meet the 85 percent threshold must remit payment to CMS for the product of: (1) the total revenue under the contract for the contract year, and (2) the difference between 0.85 and the contract’s MLR.

Full article here


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