CMS to Rework Quality Ratings for Medicare Advantage Plans

Source: Reuters | Published on June 17, 2024

CMS and Medicare Advantage Plans

UnitedHealth, Humana, and other insurers offer Medicare Advantage plans under which they are paid a set rate by the government to manage healthcare for people aged 65 and older or with disabilities.

An increase in bonus payments would be a relief to health insurers who are already struggling with high medical costs and lower-than-expected rates for next year.

The recalculation comes after two lawsuits over the Star Ratings, filed by insurers SCAN Health Plan and Elevance Health. Both insurers won their challenges last week.

A decision on whether to appeal those judgments has not yet been reached, a CMS spokesperson said.

The federal agency said it plans to disclose the updated 2024 Star Ratings in the next few weeks. Ratings for plans will not be decreased as a result of the recalculation, it added.

The potential changes – which will apply to the ratings for 2024 – would impact 2025 earnings for health insurers.

For Elevance, the recalculation should provide much needed relief, said Mizuho analyst Ann Hynes, who added the news was also positive for Humana, CVS, Centene and Molina Healthcare.

https://www.reuters.com/business/healthcare-pharmaceuticals/cms-rework-quality-ratings-medicare-advantage-plans-2024-06-14/