Payers Spend Big to Protect Lucrative Medicare Advantage Business

  • Mar 31, 2023

    Industry groups and Medicare Advantage insurers have mounted a public fight against a CMS proposal that they contend would reduce payments to MA plans. But even before that proposal, their lobbying expenditures reached record highs.

    On Feb. 1, CMS released the 2024 Advance Notice for Medicare Advantage and Part D plans — the agency’s annual proposed update to methodologies used to calculate payments to the plans — and estimated a 1.03% pay hike for MA plans, on average, when accounting for an underlying risk score trend of 3.3%. However, insurers argued that the rule would result in a cut to plans due to technical changes in how risk scores are calculated, leading to higher premiums and fewer enrollee benefits. Just prior to releasing the Advance Notice, CMS also finalized a long-dreaded final rule that will allow the government to claw back billions of dollars’ worth of overpayments to MA organizations. Read more
    © 2024 MMIT
  • Jinghong Chen

    Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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