After Last Year’s Shock, CMS Predicts Modest MA Pay Increase for 2025

February 2

Industry analysts reacted with a shrug on Jan. 31 when CMS released the much-anticipated 2025 Advance Notice of Medicare Advantage and Part D payment changes, which said that health plans can expect to receive a 3.7% average increase in risk-adjusted revenue next year.

The 3.7% figure factors in a 2.45% revenue decline related to fee-for-service normalization and a major risk adjustment model revision that CMS is phasing in over three years, as well as an effective growth rate of 2.44% and a Star Ratings bonus impact of -0.15%. CMS estimated the revenue change from the combination of those proposed policies is -0.16%. After also factoring in an average risk score increase of 3.86%, CMS arrived at its net expected revenue change of 3.7%.

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Health Plan Weekly

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.