Payers urge 'stability' from CMS on Medicare Advantage

CMS needs to do more to account for rising utilization rates in Medicare Advantage, the Better Medicare Alliance argued. 

In a Feb. 15 news release, the insurer-backed advocacy group said the agency should use more "recent and complete" data in its rate proposals for 2025. 

Better Medicare Alliance President and CEO Mary Beth Donahue said in the news release the rate notice should be adjusted to ensure stability in the program. 

"There has been a notable increase in seniors using health care services from their doctors and providers, which makes sense given an increasingly aging population and the pent-up demand after the COVID-19 pandemic," Ms. Donahue said. "At the same time, the Medicare Advantage program continues to adjust to significant policy changes, including the implementation of major changes to Part D."

CMS published its proposed Medicare Advantage rates for 2025 on Jan. 31. The proposal would cut benchmark payments by 0.2%. CMS said insurers should expect to see 3.7% higher revenue overall, with an MA risk score trend of 3.86% — the average increase in risk adjustment payments year over year — offsetting risk model revisions and a projected decline in star rating bonuses.  

The agency will also continue phasing in coding adjustment changes, which will be implemented between 2024 and 2026. 

Insurer executives called the proposed rate insufficient in the face of rising costs in the program. 

A bipartisan group of lawmakers also urged "payment and policy" stability in Medicare Advantage in a Jan. 29 letter to CMS. 

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