Medicare Advantage (MA)

On February 28, Justice in Aging released an issue brief titled “Dual Eligible Special Needs Plans (D-SNPs): What Advocates Need to Know.” This issue brief provides advocates with basic information about D-SNPs, whom they serve, and their structure. It also identifies specific areas where advocates can engage with their states to ensure that D-SNPs work effectively to coordinate care and benefits for dually eligible individuals, including strategies in centering equity from the outset in the design of D-SNPs...

On January 31, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Advance Notice for the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs that would update payment policies for these programs. The Advance Notice proposes annual updates to MA payment growth rates and changes to the MA and Part D payment methodologies to improve payment accuracy. For calendar year 2025, CMS proposes an MA payment increase of 3.7 percent, or over $16 billion; however, the agency also proposes a 3.9% risk coding adjustment. The CY 2025 Advance Notice also includes the continued phase-in of the updated MA risk adjustment model and updates to the calculation of growth rates related to medical education...

The Center for Medicare Advocacy (CMA) recently released a tip sheet providing guidance to Medicare Advantage (MA) enrollees facing difficulty obtaining in-network care. This article addresses the complexities of MA plans, which can restrict enrollees to contracted networks of healthcare providers. Despite strengthened regulations by the Centers for Medicare & Medicaid Services (CMS) requiring MA plans to cover necessary care outside the network under specific circumstances, recent reports indicate issues with network adequacy. CMA emphasizes the importance of MA enrollees and advocates utilizing consumer protections, reporting difficulties in obtaining necessary care, and urging CMS to publicize and enforce these rights.

On November 8, KFF released the issue brief, “Medicare Advantage 2024 Spotlight: First Look”, detailing the organization’s analysis of Medicare Advantage (MA) plans and Part D prescription drug plans (PDPs) available in 2024. The analysis revealed that nationwide the typical beneficiary has a choice of 43 Medicare Advantage plans as an alternative to traditional Medicare for 2024; the same number available as in 2023, but more than double the number of plans offered in 2018. Of the 43 MA plans, 36 plans offer Part D drug coverage, on average. Additionally, individuals with traditional Medicare have a choice of 21 Medicare stand-along PDPs for 2024.

This brief describes Medicare Advantage (MA) plan offerings in 2023. Of note, the average number of MA plans available to Medicare beneficiaries in 2023 is 43 compared to an average of 38 plans in 2022. Beneficiaries in 27 counties in the U.S. can choose from 75 or more MA plans.

The Kaiser Family Foundation's new report, “Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature,” details their findings from an analysis of 62 studies published since 2016 comparing traditional Medicare to Medicare Advantage. The analysis reviewed beneficiary experience, affordability, service utilization, and quality measures. According to the report, the review “found few differences between Medicare Advantage and traditional Medicare that are supported by strong evidence or have been replicated across multiple studies. Both Medicare Advantage and traditional Medicare beneficiaries reported similar rates of satisfaction.

On July 19, 2022 MedPAC released its July 2022 Data Book on Health Care Spending and the Medicare Program. This publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries’ access to care, and Medicare program quality. Section 4 (pages 31-38) covers dually eligible individuals and includes information on the percentage of Medicare spending for this population, demographic data, health status, and service use. Within this section, states may be specifically interested in Chart 4-4: Demographic differences between dual-eligible beneficiaries and non-dual-eligible beneficiaries, 2019.

This report, written by RTI International and the Center for Health Care Strategies, combines information gathered from an environmental scan and case studies to provide an overview of the current landscape of Medicare Advantage Organizations (MAOs) that provide expanded supplemental benefits. It includes their initial experiences and challenges with developing and administering the benefits to their members.