margins

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January 31, 2024

Another Flat Year For Medicare Advantage Before Risk Score Trends The Centers for Medicare and Medicaid Services (CMS) announced the 2025 rate hike for Medicare Advantage will be relatively flat. This is similar to what happened in 2024 after big increases in 2022 and 2023.  The effective growth rate was up, but the phase-in of a new risk adjustment model basically offsets those gains. The final notice may push these numbers up a bit. If you include risk score trends, MA revenue could increase by about 3.7%. So real revenue should be up, but health plans don’t like thinking of it that way as they think risk score trends tie to increased medical exposure.  I include all these articles here but read with caution as many reporters interpret things differently. In the end, this is not the worst news, but it is bad in the face of some major medical

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January 30, 2024

Health Policies To Watch In 2024 The Peterson-Kaiser Family Foundation Health Tracker has a good briefer on expected healthcare policy issues to watch in 2024.  Among the many include site-neutral policies, price transparency, drug pricing and trends, PBM reform, drug price differences around the developed world for weight-loss drugs, value-based care and payments, and anti-trust activity.  A great primer! #peterson #kff #healthcare #healthcarereform Link to Article Kaiser Family Foundation Publishes Analysis Of Medicare Advantage Enrollment Drivers The Kaiser Family Foundation (KFF) briefer on why Americans are choosing Medicare Advantage (MA) is an important read.  I do not agree with everything in it, including references to a recent MedPAC analysis, but MA proponents will have a very good understanding of the threats presented. KFF providers ten reasons. MA is expected to hit at least 60% of beneficiaries by 2030 and that payments to MA are right now about 123% higher, or

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January 29, 2024

Elevance Health Sues CMS Over Medicare Advantage Star Rating Interesting article on Elevance Health’s lawsuit against the Centers for Medicare and Medicaid Services (CMS) on Stars.  If this is anything close to true, CMS needs to relook at how it ensure fairness in calculations. How many others may have been impacted? #elevancehealth #stars #medicareadvantage Link to Article Moody’s Says Medicare Advantage Margins On Downturn Interesting analysis by Moody’s that says Medicare Advantage (MA) margins have dropped from 4.9% in 2019 to 3.4% in 2022. Margins fell in commercial too but by a smaller amount. Note that these changes occurred before the latest medical expense upswing, lower 2024 rates, and new prior authorization limitations. Today, I published a blog on the future of MA after some major regulatory changes and a major increase in medical expenses. The boom is over. What will happen? The blog is here: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ #medicareadvantage #margins #rates

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