On January 31, the Centers for Medicare & Medicaid Services (CMS) released an Advance Rate Notice proposing an overall pay increase to MA plans of 3.7% in 2025 (see CMS fact sheet here). According to CMS, “This is over a $16 billion increase in expected MA payments for next year.”
On one hand, CMS appears to continue to phase-in risk adjustment model updates implemented last year (which the insurance industry opposed); on the other hand, if finalized, this will be a payment increase at a time when MA plans are already significantly overpaid (between $88 billion this year, according to MedPAC, and $140 billion annually, according to Physicians for a National Health Program).
The Center for Medicare Advocacy is reviewing this proposal and will provide further analysis.
February 2, 2024 – D. Lipschutz