Don’t Backpedal on Progress: Fix Proposed Changes to Medicare Advantage Before Beneficiaries Feel the Effects

It’s no wonder why Medicare Advantage (MA) is so popular among America’s seniors, with a greater share of the Medicare population choosing MA plans as its coverage of choice each year. MA has consistently outperformed conventional fee-for-service Medicare in reducing avoidable hospitalizations, lowering hospital readmissions, and encouraging utilization of preventive services. Patients have benefited from supplemental benefits such as vision and dental care as well as programs to affect the social determinants of health, addressing food insecurity, social isolation and transportation needs, to name a few examples.

This progress should be encouraged. So, needless to say, we were concerned at the proposed changes from the Centers for Medicare and Medicaid Services (CMS) for the 2024 plan year. Three changes – revisions in the MA risk model resulting in a 3.12 percent reduction, reduced quality bonus payments under the Medicare Star Ratings program of 1.24 percent, and a 2.09 percent benchmark, which is less than half of the five percent projected per-enrollee growth in Medicare costs – would result in an average 2.27 percent reduction in MA payment rates in 2024. While not all plans would be affected equally, many enrollees could see higher premiums or a loss of programs and benefits that have a direct impact on health outcomes.

As well, there are concerns about proposed changes to health data, specifically the precision that enables providers to identify a patient’s condition and administer effective treatment. The CMS regulatory proposal would remove nearly 2,300 ICD-10 diagnosis codes. Restricting the ability to recognize asymptomatic diseases would result in an unwanted increase in avoidable emergency room visits and hospital admissions. We could see physician revenue cuts and the closure of clinics in underserved urban and rural areas.

The solutions here are evident. The proposed MA payment growth rate for 2024 should be adjusted to reflect document increases, including inflation, in Medicare costs. Other proposed changes should be delayed in order to gather stakeholder input and fully understand the potential impact on health providers and patients. We have an opportunity to continue the momentum that MA plans have successfully generated, enabling the 65-and-older population to live healthier lives and better manage the chronic illnesses that become more prevalent as we age. CMS should make the adjustments to ensure that we don’t take an unnecessary step backward.