Medicare Advantage in the headlines: 7 recent updates

More hospitals are cutting ties with Medicare Advantage plans, and some insurers are bracing for membership losses in 2025. Here are seven Medicare Advantage updates Becker’s has reported since May 8. 

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By: Rylee Wilson
  1. Medicare Advantage is the dominant form of Medicare, and questions loom for payers, providers and policymakers alike in the year ahead. Here are 10 key questions that will define the future of the program.
  2. North Platte, Neb.-based Great Plains Health plans to stop contracting with Medicare Advantage plans in 2025. Narayana Koduri, MD, the system’s chief medical officer, said to put patient care first, the system could “no longer be under contract with a plan that causes significant delays in care, longer hospital stays and outright denials of care.” Great Plains Health is one of a handful of health systems that have stopped contracting with Medicare Advantage plans in the past year. 
  3. Hospitals and payers are grappling with the implementation of the two-midnight rule. CMS’ expansion of the two-midnight rule could affect more than 20% of Medicare Advantage patients this year and has led to increased inpatient volumes and revenue growth for hospitals in the first quarter, according to a recent report by Strata Decision Technology. Read more about the report and seven other two-midnight rule updates here. 

  4. CVS Health could lose up to 10% of its Medicare Advantage membership in 2025, executives told investors. The insurer is expecting its membership to drop as it cuts back benefits and exits some counties to account for higher medical spending and lower reimbursements from CMS. UnitedHealth Group executives had a different view. Brian Thompson, CEO of UnitedHealthcare, told investors that medical cost trends and rates from CMS are in line with the company’s expectations, and he is “really comfortable with what we’ll put into the marketplace for next year.”
  5. Centene’s Wellcare and value-based physician enablement company Wellvana inked a multi-year primary care partnership for Wellcare Medicare Advantage members in Georgia, Tennessee and Texas.
  6. The average Medicare Advantage beneficiary can choose between dozens of plans. With so many options, Clever Care is trying to set itself apart with a grassroots approach. The company, one of the fastest-growing Medicare Advantage startups, is carving out a niche, offering plans tailored to Asian-American Pacific Islander Medicare beneficiaries in Southern California.
  7. Limiting the use of health risk assessments in Medicare Advantage could save the federal government billions each year, a study published in Health Affairs found.
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