Payers Spend Big to Protect Lucrative Medicare Advantage Business

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.

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