Medicare Advantage in the headlines: 7 recent updates

A New York City plan to implement Medicare Advantage for retirees is being challenged in court again, and federal lawmakers are pressing the largest Medicare Advantage insurers on claims denials. 

Here are seven updates about the program Becker's has reported since May 22.  

  1. A group of retired New York City employees are suing Mayor Eric Adams and other city officials in an attempt to block the city's planned switch to an Aetna Medicare Advantage plan for the 250,000 retired city workers and dependents the city provides health coverage for. 

  2. Medicare Part D beneficiaries who don't receive low-income subsidies spend 2.5 times more out-of-pocket on "ultra-expensive" drugs than those with commercial insurance, a study in JAMA Health Forum found. Medicare Advantage beneficiaries paid less than standalone Part D plan members, paying $4,301 out-of-pocket for ultra-expensive drugs, compared to $4,575 for Part D beneficiaries. 

  3. Eight states have at least 1 million residents enrolled in Medicare Advantage plans, according to a health coverage report published by insurance trade group AHIP in April. Here is each state ranked by total Medicare Advantage members. 

  4. CVS Health is expecting Aetna's operating income to decrease by up to $1 billion next year because the number of its Medicare Advantage members in four-star plans has dropped significantly since last year. 

  5. Individuals who are dually eligible for Medicare and Medicaid had lower scores on many clinical care measures than their counterparts only eligible for Medicare, a new report from CMS found

  6. Medicare Advantage and traditional Medicare can differ on clinical quality and costs, but most enrollees are equally satisfied with their coverage, studies published in the last few months have found. Here's what six recent studies on Medicare Advantage found. 

  7. Lawmakers are seeking more information about claims denials from the largest Medicare Advantage insurers. The Senate Permanent Subcommittee on Investigations sent letters to CVS Health, Humana and UnitedHealth Group seeking internal documents detailing how the companies decide to approve or deny claims, including how the payers use artificial intelligence in the process. 

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