Medicare Advantage Update: A Look at 2023 CMS Payment Policies, MA Market Dominance, Increases in Premiums and Deductibles

This week in Medicare Advantage (MA), the program is on track to account for 54% of Medicare spending by 2030 and the Centers for Medicare and Medicaid Services (CMS) finalized the plan rates for 2023. Also, Humana takes a look at social needs in Medicare Advantage before COVID and eHealth looks at the rise in premiums and deductibles for 2022 MA plans.

The CMS announcement, the Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, was announced last week following the Advance Notice published in January. Health Leaders Media notes that the announcement includes plan risk adjustment, coding intensity, healthy equity, Star Ratings, overall quality and end-stage renal disease (ESRD) guidance. Healthcare consulting firm Avalere highlighted major takeaways in its 2022 Expert Webinar Series. From Avalere Managing Director Sean Creighton:

This year’s rule reads more like a first-year announcement. The major lever that everyone expected to be pulled was taken off the table, so I can’t describe the Final Announcement as anything but positive, but it depends on what happens with legislation.

With the finalization of payment rates for MA, the overall MA plan revenue should receive an average increase in revenue of 8.5%. Kaiser Family Foundation found that payments to Medicare Advantage plans as a share of total Medicare Spending on Part A and Part B services increased from 26% in 2010 to 45% in 2020, and are expected to rise to 54% in 2030.

A study of more than 100,000 MA members published by Humana in Health Affairs conducted between October 2019 and February 2020 found that under half were positive for at least one social health challenge. Fierce Healthcare notes that financial strain was the most common, reported by 33.1% of members. Other social needs include food insecurity (18.5%) and poor housing quality (17.7%).

Private health insurance marketplace eHealth published a new report demonstrating that Medicare-related premiums and deductibles have increased since 2021. The Medicare Index Report relies on data from 260,000 applications for Medicare plans by eHealth customers during 2022. According to Fierce Healthcare, the Medicare Advantage and Part D plan enrollees are paying $6 and $22 per month more than last year, on average. The premiums remain lower than the Medicare Supplement plans which are an average of $178 per month. Average deductibles also increased across the board.