Major Medicare Advantage Advocacy Group Launches Ad Campaign
Better Medical Alliance (BMA), a prominent Medicare Advantage (MA) advocacy group, has launched a seven-figure digital ad campaign in an effort to avoid MA cuts and boost the proposed 2026 rate increase. Not counting risk score trends, MA rates saw a decline in 2024 and 2025. The Biden administration proposed just a 2.3% hike for 2026. This would lead to a third year of benefit cutbacks and geographic footprint reductions. The reductions have been caused by a new risk model that takes about 7% out of rates overall (it is being phased in over three years through 2026) as well as reductions in medical education funding.
BMA notes that both Milliman and PwC estimated medical cost trends in MA increased by 8% from 2023 to 2024. The trend continues into 2025 with the return of utilization. Plans are also facing higher costs in Medicare Part D due to the Biden administration’s and Democrats’ misguided and unfunded reduction in out-of-pocket costs in the Inflation Reduction Act (IRA).
The final rate hike is now at the Office of Management Budget (OMB) for approval and should be released publicly by April 7. MA plans are hopeful that rates are increased despite the spending cut push. This could come in a few ways: an increase in the cost trend, pushing out the final year of the risk model phase-in, and forestalling the phase-in of medical education funding reductions.
The ad campaign could also influence the potential reductions to MA in a budget reconciliation bill. Pressure is mounting to curb overpayments and reform risk adjustment in the program. This is due to commitments to avoid major Medicaid coverage reducions and the sheer size of spending cut targets. I feel like carefully phased-in and targeted risk adjustment reforms are not unreasonable, but also think rate relief is needed in 2026.
Additional articles: https://bettermedicarealliance.org/news/better-medicare-alliance-launches-new-ad-urging-trump-administration-to-protect-medicare-advantage-for-seniors/ and https://insidehealthpolicy.com/daily-news/ma-allies-launch-ad-campaign-cy-2026-ma-rate-notice-hits-omb
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#medicareadvantage #overpayments #riskadjustment #rates
https://www.modernhealthcare.com/medicare/better-medicare-alliance-ads-medicare-advantage
Report Says About 5 Million Could Lose Medicaid If Work Requirements Implemented
A new Urban Institute and Robert Wood Johnson Foundation analysis says that about 5 million people could lose Medicaid coverage if work requirements are adopted. The researchers find that losses would occur not because they fail to meet work criteria, but due to bureaucratic hurdles and reporting challenges. Evidence from states who have adopted work requirements seems to prove this and also shows the requirement to be very expensive to implement and operate.
According to researchers, more than 9 in 10 adults with Medicaid expansion coverage work or are otherwise meeting requirements to stay enrolled.
In other news, a Health Affairs Forefront Blog predicts that the GOP will not reduce Medicaid by a lot because the program is popular, it is efficient, and it is helping improve health.
Additional article: https://www.healthaffairs.org/content/forefront/five-reasons-republicans-won-t-cut-medicaid-much
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#medicaid #budgetreconciliation #congress #trump #coverage #workrequirements
— Marc S. Ryan
