Medicare Advantage plans could face mounting pressures in 2024 as medical utilization increases, and payers should prepare for shifts in the market, analysts say.
Here are 10 updates about the program Becker's has reported since July 6.
- Payers should start evolving their strategies to be digital first and streamline administration to respond to headwinds in the Medicare Advantage market, McKinsey and Company analysts said.
- Excellus BlueCross BlueShield received an estimated $5.4 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit from HHS' Office of Inspector General.
- Gold Kidney Health Plan, a Medicare Advantage insurer offering chronic special needs plans, is expanding to Florida in 2024.
- A New York judge temporarily blocked New York City's plan to switch 250,000 retired city employees from traditional Medicare to an Aetna Medicare Advantage plan. Judge Lyle Frank sided with a group of retirees challenging the plan, issuing a temporary injunction on July 6 that prevents the city from requiring retirees to switch from their current insurance to Medicare Advantage.
- Nearly half of Medicare Advantage beneficiaries report having at least one health-related social need, a survey of over 300,000 Humana Medicare Advantage enrollees found.
- There are several demographic and socioeconomic differences between individuals who select traditional Medicare coverage versus Medicare Advantage plans before they turn 65 and who have commercial insurance, according to a new study from researchers at Harvard Medical School and software firm Inovalon.
- The Medicare Advantage star rating system and its quality bonus payment program is failing to achieve its two main goals of helping beneficiaries select a plan and incentivizing payers to improve plan quality, according to a report from the Urban Institute.
- "Look-alike" dual eligible Medicare Advantage plans — which primarily enroll people eligible for Medicare and Medicaid but are not regulated as D-SNP plans — grew significantly from 2013 to 2020, according to a study in the July issue of Health Affairs.
- Many Medicare Advantage plans have narrow networks for psychiatrists when compared to Medicaid managed care and ACA plans, a study published in the July issue of Health Affairs found.
- Medicare Advantage profits will likely be stable in 2023 but could face pressure from rising utilization rates in 2024, according to commentary from AM Best. UnitedHealthcare and Humana, the two largest Medicare Advantage insurers, recently warned of rising medical utilization rates as beneficiaries access care delayed during the COVID-19 pandemic.