Medicare Advantage in the headlines: 10 recent updates

Several insurers reported higher-than-expected medical costs in Medicare Advantage, and federal regulators predicted the program would receive billions in overpayments in 2024. 

Here are 10 Medicare Advantage updates Becker's has reported since Jan. 5. 

1. Humana reported higher medical costs and lower Medicare Advantage enrollment will hurt its year-end earnings. The company said its Medicare Advantage growth during the annual enrollment period was below its expectations, adding around 100,000 new members, representing a 1.8% growth rate. UnitedHealth Group and CVS Health also reported higher-than-expected costs in Medicare Advantage. 
   
   
2. Coding intensity and the types of enrollees who select Medicare Advantage plans will drive an additional $88 billion in payments to the program in 2024 compared with what traditional Medicare would receive, according to estimates from the Medicare Payment and Advisory Commission. 
   
   
3. Though some contract negotiations with providers came "down to the wire" last year, UnitedHealthcare executives said the payer did not see more contract splits than usual in 2023. Brian Thompson, CEO of UnitedHealthcare, told investors on a Jan. 12 call the insurer did not see more contract disruptions than in previous years in 2023. 
   
   
4. More seniors and dual-eligible individuals continue to enroll in Medicare Advantage plans, but the number of plans available decreased in 2024, according to an AHIP report. Here are 10 key updates on the program for 2024. 
   
   
5. CMS uses star ratings to determine the quality of Medicare Advantage and Part D prescription drug plans. The agency may terminate a plan sponsor's contract to administer Medicare benefits if it achieves a rating of less than three stars for three consecutive contract years. Here are four plans the agency has recently announced it plans to terminate. 
   
   
6. Newark, Del.-based ChristianaCare is out of network with Humana's Medicare Advantage plans as of Jan. 1. According to the health system's website, its four hospital campuses and all other practices and services are out of network with Humana. ChristianaCare HomeHealth is still in network with Humana, however. 
   
   
7. Alignment Health is beginning 2024 with 155,000 Medicare Advantage members. According to regulatory documents Alignment filed with the Securities and Exchange Commission, the company grew its Medicare Advantage membership 44% year over year. 
   
   
8. Louisville, Ky.-based Baptist Health has been out of network with UnitedHealthcare and Centene's WellCare Medicare Advantage plans since Jan. 1.The health system's medical group previously went out of network with Humana's Medicare Advantage and commercial health plans in September. Baptist cited routinely denied or delayed prior authorization requests or payments from the insurers.
   
   
9. Hospital and payer groups are broadly supportive of proposed changes to Medicare Advantage prior authorization and broker compensation regulations. 
   
   
10. Elevance Health and its insurance subsidiaries are suing HHS for "unlawful, and arbitrary and capricious" methodology changes to how Medicare Advantage and Part D star ratings are calculated.