CMA Alert | January 6, 2022

Study Published in Health Affairs Finds that Medicare Advantage Quality Bonus Program Has Not Improved Quality

Health Affairs recently published a research article titled “The Medicare Advantage Quality Bonus Program Has Not Improved Plan Quality” by Adam A. Markovitz, John Z. Ayanian, Devraj Sukul, and Andrew M. Ryan (December 2021). As noted in the abstract of the report, “[i]n 2012 Medicare introduced the quality bonus program, linking financial bonuses to commercial insurers’ quality performance in Medicare Advantage (MA). Despite large investments in the program, evidence of its effectiveness is limited.”

As noted in an Inside Health Policy article by Bridget Early (Jan. 4, 2022) discussing the report, “[w]hile higher star ratings have been found to correlate with increased beneficiary enrollment, the study found that they did not improve quality of care.”

This report joins the growing evidence demonstrating that the MA quality bonus program is fundamentally flawed. As previously noted by the Center for Medicare Advocacy, including in an October 2021 Special Report on the Medicare annual enrollment period, the Medicare Payment Advisory Commission (MedPAC) has “in recent years ‘discussed the flaws in the 5-star system and the [quality bonus program] and the continuing erosion of the reliability of data on the quality of MA plans’ as noted in their March 2021 report to Congress. As a result, the Commission notes, ‘[t]he current state of quality reporting is such that the Commission’s yearly updates can no longer provide an accurate description of the quality of care in MA.’”  

In addition, as discussed in a previous CMA Alert, a September 2021 Health Affairs report titled “Medicare Advantage Plan Double Bonuses Drive Racial Disparity In Payments, Yield No Quality Or Enrollment Improvements” found that double bonuses for MA plans are not an efficient mechanism to improve the program, and are not equitable in allocation of those dollars, disproportionally benefiting White beneficiaries relative to Black beneficiaries, without improving quality or enrollment.

The Inside Health Policy article analyzing the December 2021 report quotes the Center: “‘The fact 9 out of 10 MA enrollees are in plans that receive 4 or 5 stars, combined with MedPAC’s finding that quality ratings are unreliable, means that the ratings, which are promoted as a tool for consumers to compare plans, is largely unusable for such purpose,” […] “This Health Affairs report highlights that billions of dollars in bonus payments – that could instead be used to expand Medicare benefits to all enrollees – have not improved quality in the MA program.’”

The authors of the report conclude that “[t]he MA quality bonus program poses a substantial and rising expense of $6 billion annually. Given the paucity of evidence for its effectiveness, our study supports calls from stakeholders […] for CMS to substantially revise the quality bonus program or eliminate it altogether.”

We concur.

Reminder: Limited Opportunity to Make Certain Medicare Plan Changes Through the End of March

People who began 2022 enrolled in a Medicare Advantage (MA) plan have an additional opportunity to switch MA plans or disenroll from an MA plan and enroll in traditional Medicare with a Part D plan during the first 3 months of the calendar year, ending on March 31^st.  Note that this enrollment opportunity, called the Medicare Advantage Open Enrollment Period (MA-OEP), is not available to individuals who are in traditional Medicare and enrolled in a stand-alone Part D plan. 

In addition, there are certain rights to use a Special Enrollment Period (SEP) to change or get out of a private Medicare plan in certain circumstances. There are a number of SEPs, including when someone receives inaccurate or misleading information from the Medicare Plan Finder, customer service representatives at 1-800-MEDICARE, or an MA or Part D plan (or its agents). For a full list of available SEPs, see, e.g., for MA SEPs: Medicare Managed Care Manual, Chapter 2 (2021 update available here) and Title 42, Code of Federal Regulations §422.62(b); for Part D SEPs see Medicare Prescription Drug Manual, Chapter 3 (2021 update available here) and Title 42, Code of Federal Regulations §423.38.

As discussed in a previous CMA Alert and an October 2021 Special Report on the Medicare annual enrollment period, there is unequal access to different coverage options in Medicare and Medicare Advantage, and there are flaws in several means of comparing such options (including the MA quality star ratings, discussed elsewhere in this weekly CMA Alert).

CMS Reports Record Enrollment in 2022 Affordable Care Act Health Plans

By mid-December, with a month left in the open enrollment period, enrollment for health coverage through Healthcare.gov and state-based marketplaces had already reached a record high. According to the Centers for Medicare & Medicaid Services (CMS), 13.6 million people enrolled in Affordable Care Act (ACA) health insurance coverage for 2022 by mid-December.

According to CMS, the 2022 plan year has the most participating issuers, with 213 issuers offering coverage through HealthCare.gov, an increase of 32 issuers compared to the 2021 plan year. CMS reports that the average consumer now has between six and seven issuers to choose from, up from four to five issuers in 2021.

Open enrollment has been extended by a month this year, lasting until January 15, 2022, for coverage starting on February 1, 2022.

In December, the Kaiser Family Foundation also released a useful issue brief on how the premiums for plans purchased through marketplaces are changing for 2022.

FREE WEBINAR | Medicare Coverage of Home Health Services

Wednesday, January 12, 2021 @ 2 – 3 PM EST

Medicare’s home health benefit offers coverage of a range of services for beneficiaries who qualify, but the benefit is often misunderstood. This free webinar by the Center for Medicare Advocacy will review the services the Medicare home health benefit covers, including skilled nursing; physical, occupational, and speech therapy; medical social services; and home health aides. The webinar will also discuss current challenges and possible strategies for beneficiaries who are trying to access or maintain home health services, especially if they have longer-term, chronic conditions. There will be an opportunity for questions for Center for Medicare Advocacy staff members.

Register Now: https://attendee.gotowebinar.com/register/7879007285776193551

THANK YOU FOR BEING PART OF OUR COMMUNITY

Thank you to everyone who generously donated to the Center this past year. Whether you are a returning or first-time donor, you energize and help sustain the Center with your support. We realize there are many urgent causes in the world today, but we also know the Center opens doors to necessary health care, which is particularly crucial now. Our unique advocacy, education, and responsiveness to the needs of families all over the country make a real difference, every day.

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