Medicare Advantage plans are set to receive $12.8 billion in bonus payments from CMS in 2023, and representatives are introducing new legislation aimed at reforming prior authorization in the program.
Here are 10 updates about Medicare Advantage Becker's has reported since July 31.
- Half of Medicare Advantage beneficiaries say they don't fully understand their plan, a survey from Retirement Living found.
- UnitedHealthcare had the highest percentage of Medicare Advantage enrollees in 2013 and 2023, but its market share grew by 7 percentage points over that span. Here is how UnitedHealthcare and other payers' Medicare Advantage market share has changed over the past decade.
- CMS will pay Medicare Advantage plans $12.8 billion in bonus payments in 2023, a nearly 30 percent increase from 2022. Kaiser Permanente will receive the highest bonus payments per Medicare Advantage enrollee in 2023 of major payers.
- Brookings (S.D.) Health System will no longer be in-network with any Medicare Advantage plans in 2024. The system told the Brookings Register the decision was made to protect the financial sustainability of the organization.
- Changes in CMS' risk model for Medicare Advantage and rising medical costs among the Medicare population could lead to changes in benefits design, payer executives told investors in second-quarter earnings calls.
- Humana had the largest Medicare Advantage membership growth in the second quarter of 2023, and UnitedHealthcare continues to have the largest member base, according to the companies' earnings reports. Here's how major payers compared on Medicare Advantage membership at the end of the first half of 2023.
- Higher utilization is putting pressure on Medicare Advantage medical cost ratios and will likely continue through the end of 2023, executives from CVS Health and Humana told investors.
- Two U.S. representatives introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans.
- Portland, Maine-based Martin's Point Health Care agreed to pay $22.5 million to resolve allegations that it knowingly submitted inaccurate diagnosis codes for Medicare Advantage Plan enrollees to increase reimbursements from Medicare.
- Centene could end 2023 with no four-star rated Medicare Advantage contracts, CEO Sarah London told investors. The company has been working to improve its Medicare Advantage star ratings. The percentage of Centene members with four-star or higher plans dropped from 48 percent to 3 percent in 2022.