Several Medicare Advantage plans are challenging CMS' star ratings, and a new audit from HHS' Office of Inspector General examined the widespread use of in-home visits and chart reviews in the program.
Here are seven recent updates to note:
- Low star ratings put Medicare Advantage plans at risk for a "Darwinian death spiral," according to Sachin Jain, MD, president and CEO of SCAN Group.
- Insurers are trying to maintain stability for enrollees amid a tumultuous Medicare open enrollment.
- Eighteen insurers have exited Medicare Advantage markets for 2025, with more than 1.8 million people currently enrolled in plans that will not exist next year, according to a report from OliverWyman. Market exits by Humana, Aetna and UnitedHealthcare collectively affect nearly 70% of those 1.8 million individuals.
- Medicare Advantage companies brought in billions in "questionable" payments found during in-home visits and chart-reviews, HHS' Office of Inspector General claimed in an audit. Insurer groups called the report "misleading."
- CMS lifted an enrollment suspension on a UnitedHealthcare subsidiary's Medicare Advantage plan following three years of not meeting the required 85% medical loss ratio.
- Several insurers are disputing CMS' Medicare Advantage star ratings in court. Humana, Centene and UnitedHealthcare have all filed challenges to their star ratings. For 2025, just seven plans received a five-star rating from CMS, down from 38 in 2024.
- Devoted Health, BCBS Michigan, Highmark Health and Aetna were named the best Medicare Advantage carriers for 2025 by U.S. News & World Report.