Winners And Losers From 2025 Medicare Advantage Star Year Announcement
I reported yesterday that there was overall bad news for the Medicare Advantage (MA) industry when 2025 Star Years came out. The percentage of contracts obtaining a 4 Star or greater rating dropped to about 40%. Just 62% of all Medicare Advantage Part D (MA-PD) enrollees will be in a 4 Star or greater contract. These are big drops from even a sluggish 2024 Star year.
There is always good news and bad news. Insurtechs Alignment Healthcare and Clover Health are celebrating their high-performing ratings.
The big plans have a mix of stories: Humana, Elevance Health, and United Healthcare saw declines. Aetna and Cigna held steady. Centene’s performance was still sub par. Kaiser Permanente now has all of its members to 4 Star or greater.
There were just seven 5-Star MA-PD contracts. There were 24 contracts that scored below 3 Star.
In other news, a 14-hospital system in Alabama and Tennessee is terming United Healthcare commercial and MA products.
Additional articles: and https://www.beckerspayer.com/payer/24-medicare-advantage-plans-rated-below-3-stars-2025 and html https://www.beckerspayer.com/contracting/14-hospital-system-splits-with-unitedhealthcare.html
#cms #stars #medicareadvantage #partd
https://www.fiercehealthcare.com/payers/star-ratings-2025-who-are-winners-and-losers
MedPAC Wants Medicare Brokers Paid For Both MA and FFS
MedPAC commissioners are saying that Medicare enrollment brokers and agents should be paid whether they enroll beneficiaries in Medicare Advantage (MA) or traditional fee-for-service (FFS). I am not sure why agents would be paid for enrolling in FFS. I think the crying need is to stop the steerage of beneficiaries based on compensation agreements in MA as opposed to what is in the best interest of a senior. CMS and Congress must resurrect the now-struck broker reform law.
In addition, MedPAC commissioners took great issue with spending $83 billion a year on rebates for supplemental benefits, arguing some are not reasonable in the program and it is hard to determine utilization. The Centers for Medicare and Medicaid Services (CMS) has initiated reform in some areas of supplemental benefits.
Additional article: https://www.medpagetoday.com/publichealthpolicy/medicare/112366
#marketing #medicareadvantage #medicare #supplementalbenefits
https://www.medpagetoday.com/publichealthpolicy/medicare/112370
Twenty States Sue Biden Over Nursing Home Staffing
Twenty states are suing the Biden administration over a new minimum staffing level mandate in nursing homes. The states argue it will result in a mass shutdown of nursing homes and senior care across the country. There is no question the rule would at the very least lead to a massive consolidation of independent homes into major corporations. The rule is a political sop to friendly unions of the Biden administration. It is very impractical.
#nursinghomes #staffing #medicare #medicaid
KFF Briefer On Harris Medicare Home Care Proposal
While not a lot is known about her proposal, the Kaiser Family Foundation (KFF) has prepared a briefer on Kamala Harris’ Medicare home care plan. The proposal would bring chronic care home care to the program. Medicare right now largely covers acute home care and limited chronic needs. KFF says 14.7 million – about a fifth – of Medicare enrollees would be eligible.
#homecare #medicare #harris #election2024
KFF Briefer On Medicaid Drug Trends
The Kaiser Family Foundation (KFF) has prepared a briefer on trends in Medicaid prescription drugs. While the program has very aggressive rebates, Medicaid drug spending is rising. The number of prescriptions are increasing and spending has gone up from $30 billion in FY 2017 to $51 billion in FY 2023, a 72% increase. Growth in rebates is also slower than growth in spending.
#drugpricing #branddrugmakers #medicaid
— Marc S. Ryan
