MedPAC’s ‘Rebalancing’ Policy Would Mean Lower MA Pay

July 1

Aiming to ensure that Medicare Advantage payments are more equally distributed across geographies and that the federal government can share in the “efficiency” of MA plans, the Medicare Payment Advisory Commission (MedPAC) in its June report to Congress envisioned a “rebalancing” of the current MA benchmark policy used to calculate payment rates. Although the proposal would not translate to a complete overhaul of the current rate structure, it would mean a pay cut for many MA plans if authorized by Congress.

In the first of 10 chapters in its June 2021 Report to the Congress: Medicare and the Health Care Delivery System, MedPAC estimated that Medicare payments to MA plans this year will average about 104% of fee-for-service (FFS) spending. Meanwhile, plan bids were at 87% of FFS Medicare spending and approximately 91% of MA plans submitted bids “below the amount FFS Medicare would spend for similar beneficiaries,” stated the report.

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Radar on Medicare Advantage

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.