Medicare Advantage in the headlines: 9 recent updates

Here are nine Medicare Advantage updates Becker’s has reported since July 17. 

1. Molina Healthcare is expecting to add $1.8 billion in premium revenue from its acquisition of Bright Healthcare’s 125,000-member Medicare Advantage business.
2. A group of lawmakers is urging the Biden administration and Congress to do more to limit Medicare Advantage overpayments, misleading marketing and prior authorizations.
3. A bill aiming to reform the Medicare Advantage prior authorization process was included in a package of healthcare legislation that passed the House Ways and Means Committee and is headed to the full House for further consideration. The legislation is similar to a bill that passed the House last year but was never called to a vote in the Senate.
4. Medicare Advantage enrollees who use supplemental benefits are more likely to live in areas with fewer resources, according to a report from the Elevance Health Public Policy Institute.
5. Physicians who serve more patients dually eligible for Medicare and Medicaid and with higher risk scores are less likely to be included in Medicare Advantage networks, a study published in JAMA Health Forum found.
6. The neighborhood an individual lives in can affect their healthcare utilization, especially in the Medicare population, according to a study in the American Journal of Managed Care.

7. Audits from HHS’ Office of Inspector General published in the first half of 2023 found over $56 million in estimated overpayments to Medicare Advantage providers. Here are five plans audited for estimated overpayments Becker’s has reported in 2023.
8. Medicare Advantage overpayments may be higher than the Medicare Payment and Advisory Commission estimates, a June study from researchers at the Los Angeles-based University of Southern California found. In an article in Health Affairs, the authors of the study proposed two short-term and one long-term fix to reduce the rate of overpayments in the program.
9. UnitedHealthcare is expecting medical costs for its Medicare Advantage members to keep rising, the company’s top executives said. A higher rate of outpatient procedures among older adults is contributing to rising medical utilization rates, executives told investors.