wellness

Medicare Advantage (MA) critics like to shout about revenue overpayments and this is sure to generate headlines and ongoing controversy. But MA plans need to worry about yet another concern from the Centers for Medicare and Medicaid Services (CMS), investigatory agencies, and Capitol Hill. This surrounds supplemental benefits and whether enrollees are benefiting from the vast amount of dollars supposedly earmarked for their utilization each year. This is yet another complicated subject so let’s try to break this down a bit. Rate-setting quick primer As we have discussed on this website often, the rate-setting process in MA has helped MA plans grow considerably. Plans submit annual bids on how much it will cost to deliver traditional Medicare benefits. It then is paid out a portion of the difference between the county benchmark and the bid amount for traditional benefits. This is called the rate rebate. The amount given back to

As noted, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. Admittedly, the continuing growth is tied to remaining strong benefit packages for 2024 and appears to be isolated to a few big plans. Month-over-month growth appears to be slowing a bit, but we are so close to the Fall open enrollment season that I will keep doing these monthly snapshots for those who like to track the data. One new feature in the chart below: you may notice the percentage of MA enrollment against the total Medicare beneficiary population has changed slightly. That is because I stumbled upon a great Centers for Medicare and Medicaid Services (CMS) monthly Medicare enrollment site. It has both annual average enrollment as well as monthly enrollment. This goes all the way to the county level in each state. The site is here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment . The good

A stay issued by a federal court was not well publicized as it came out during the July 4 holiday, but the action could have major implications for the 2025 Medicare Advantage (MA) enrollment season. A federal judge suspended the implementation of the Centers for Medicare and Medicaid Services’ (CMS) MA broker and agent compensation reform changes. The move has major implications for the agency’s efforts to reform what I believe is a badly broken system. What problem did CMS identify? For the past number of years, the number of marketing related complaints have increased dramatically. CMS has attempted to force health plans to have better delegated oversight over the independent third-party marketing organizations (TPMOs) that have grown considerably because of the lucrative nature of enrolling MA members. Agents receive compensation each year a person stays with MA and even more for first-year enrollees. I value the role of agents