Medicare Advantage in the headlines: 10 recent updates

CMS is proposing a slate of Medicare Advantage policy updates for 2025, and lawmakers are eyeing marketing and networks in the program. 

Here are 10 Medicare Advantage updates Becker's has reported since Oct. 24. 

1. CMS is proposing a set of new Medicare Advantage rules.The agency's proposed updates for 2025 include new standards that would impose more limits on plans' payments to brokers and limit the role of third-party marketers, and an audit appeal process for MA plans. The agency also pitched health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. 
   
   

2. A group of lawmakers is asking CMS to increase its oversight of artificial intelligence used in Medicare Advantage prior authorization. 
   
   

3. Increasing Medicare Advantage enrollment in rural areas did not increase rural hospitals' financial distress or risk of closing, a study published in the American Journal of Managed Care found.
   
   

4. The Cigna Group is exploring a potential sale of its Medicare Advantage business, Reuters exclusively reported. 
   
   

5. Medicare Advantage enrollees have 70% lower hospital readmission rates than their counterparts in fee-for-service Medicare, a white paper from researchers at Boston-based Harvard Medical School and software firm Inovalon found.
   
   

6. SCAN Health Plan boasts the country's first Medicare Advantage plans built around the needs of older adults who are women or part of the LGBTQ+ community. Becker's sat down with SCAN Group CEO Sachin Jain, MD, to discuss how these plans are developed and the business case for why other insurers should do the same in an increasingly competitive Medicare Advantage market.
   
   

7. Lawmakers are introducing a bill to crack down on inaccurate provider directories in Medicare Advantage. Sens. Thom Tillis, Ron Wyden and Michael Bennet introduced the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, which would strengthen requirements for Medicare Advantage plans to maintain accurate directories. 
   
   

8. A group of senators said CMS actions to crack down on misleading marketing of Medicare Advantage plans do not go far enough. Fourteen Democrats on the Senate finance committee sent a letter to CMS Administrator Chiquita Brooks-LaSure, urging more action from the agency on misleading marketing. 
   
   

9. A former executive of Elevance-owned HealthSun Health Plans has been charged for allegedly orchestrating a multimillion-dollar Medicare fraud scheme.
   
   
10. Gone are the days when the grocery store was just for food — now it can provide your health insurance, too. Jason Worthen, Select Health's vice president of government markets, sat down with Becker's to discuss the payer's partnership with Kroger.