Medicare Advantage

The aging population is increasing, which means that more Medicare beneficiaries, especially those 75 and older, have considerable morbidity, diminished quality of life, and a high degree of caregiver burden. The increase of medically complex Medicare beneficiaries has created a need for developing core measures for tracking and improving the quality of care this population receives. This article discusses how to leverage Medicare Advantage to support diverse older patients, a different framework to improve quality in Medicare, and the development of a care set of measures for age-friendly care.

CMS has published this report which presents summary information on the quality of health care received by Medicare Advantage enrollees nationwide. The report highlights racial, ethnic, and gender differences in health care experiences and clinical care. The report highlights data regarding patient experiences and compares enrollees responses to national averages.

On Wednesday, April 5th, CMS issued a final rule that revises the Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, and network adequacy. Additionally, the final rule also makes permanent the Limited Income Newly Eligible Transition (LI NET) Program and expands eligibility for the full low-income subsidy benefit to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria.

CMS released the Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). CMS will phase-in certain updates, and on average, CMS anticipates a payment increase for MA plans of 3.32% from 2023 to 2024, which is approximately a $13.8 billion increase in MA payments for next year. The Rate Announcement finalizes updates to MA payment growth rates and changes to the MA and Part D payment methodologies. These include technical and clinical updates to the MA risk adjustment model to keep it up to date and improve payment accuracy.

The CMS Innovation Center announced that the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model will be extended for calendar years 2025 through 2030. Changes intended to address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness will be announced by the Innovation Center when available.

This past Wednesday, February 1st, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.

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.

This report from CMS presents information on disparities in health care received by people using Medicare Advantage. The report looks at differences in quality of care based on race and ethnicity and sex as well as the intersections of race/ethnicity and sex. CMS uses data from the Consumer Assessment of Healthcare Providers and Systems and the Healthcare Effectiveness Data and Information Set in this report.

Medicare Advantage (MA) plans have gained flexibility to offer a wide range of new supplemental benefits and to target benefits to members with specific conditions and individual need. This data insight provides an analysis of non-medical supplemental benefit growth since 2020, and focuses on the following: Special Supplemental Benefits for the Chronically Ill (SSBCI), which first became available in 2020 through the passage of the CHRONIC Care Act and a set of five Expanded Primarily Health-Related Benefits (EPHRB), which first became available in 2019 after the Centers for Medicare and Medicaid Services (CMS) expanded the definition of what could be considered “primarily health-related."