RADAR on Medicare Advantage

News Briefs

✦ CMS’s 2019 Medicare Parts C and D program audits resulted in civil monetary penalties amounting to nearly $1.2 million imposed on six organizations, according to CMP notices posted at www.cms.gov. The agency...

For 2021, MAOs Face Small Pay Boost, ESRD Uncertainty

With an estimated pay boost just under 1% and the continued increase of encounter data used in determining Medicare Advantage plans’ risk scores, MA reimbursement in 2021 isn’t looking as robust as it has in rec...

MA, Part D Rule Contains Many Highlights for Health Plans

In lieu of a draft Call Letter attached to its annual rate notice for the coming year (see story, above), CMS on Feb. 5 issued a 900-page proposed rule containing a slew of non-rate-related changes to the Medicare A...

Proposed MA Rule Floats Many Star Ratings Changes — Can Plans Keep Up?

In addition to codifying previous policy changes and extending some new flexibilities to Medicare Advantage organizations, a recent 900-page proposed rule (85 Fed. Reg. 9002, Feb. 18, 2020) from CMS contains some si...

Medicaid MCOs Use Resource Centers to Aid Member Health

From engaging members in cooking and self-defense classes to coaching them on specific health conditions, Medicaid managed care organizations are building out brick-and-mortar centers to better serve their enrollees...

Proliferation of $0 Premium PPOs, Supplemental Benefits Drive Continued MA Switching

A new report from Deft Research finds that switching among Medicare Advantage members during the recent Annual Election Period (AEP) was steady at 13%, compared with last year’s rate of 14% after switching among M...

News Briefs

✦ Medicare Advantage enrollment reached nearly 24.7 million members as of the Jan. 1, 2020, payment date, according to the February enrollment report from CMS, which includes final figures from the Annual Electi...

CMS Invites States to Innovate With Fixed Medicaid Funding

After months of languishing at the Office of Management and Budget, CMS’s long-awaited state Medicaid director letter addressing so-called block grants appeared on Jan. 30. But the revised 56-page “Healthy Adult...

CMS Proposes 1% Rate Increase for MA Plans in 2021 and New Program Flexibilities

CMS on Feb. 5 released Part II of the Advance Notice proposing payment changes for Medicare Advantage and Part D plans for 2021, but at press time did not include the draft Call Letter. The agency also posted a prop...

MAOs Mull ‘Memory Fitness’ in Crowded Supp Benefit Market

Surveys have shown that cognitive decline is a chief concern among aging adults, yet brain health and “memory fitness” remain largely untapped areas as Medicare Advantage insurers experiment with new benefit des...