Last Thursday, the Centers for Medicare and Medicaid Services finalized a rule that overhauls the Star quality rating system for Medicare Advantage programs, cutting several measures, including the health equity index. The changes are anticipated to net insurers $18.6 billion over the next ten years.
In lieu of the health equity...
The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposal for the 2027 Medicare Advantage (MA) and Part D Advance Notice. The agency proposed a slight increase of 0.09%, shocking shares of publicly traded insurance companies.
The meager increase proposal comes after the Trump administration granted a generous...
Milliman’s analysis of the 2027 Medicare Advantage Proposed Rule concludes that CMS is undertaking a structural realignment of the Star Ratings program by removing a group of topped-out or low-variation measures.
The agency's reductions will shrink the measure set and concentrate weight on areas where plans still show meaningful...
Milliman analysts examine the 2026 MA advance notice, litigation updates, and the Trump administration's executive orders in this February white paper.
Medicare Advantage and Part D Star Ratings are evolving; the average 2025 rating dropped to 3.92 from 4.07 and courts have ordered recalculations for UnitedHealthcare and Centene...
As the Centers for Medicare and Medicaid Services (CMS) appeals a ruling that it recalculate UnitedHealthcare's Medicare Advantage Star Ratings, and another Medicare Advantage (MA) insurer has sued the agency over its quality ratings.
In November, Judge Jeremy Kernoodle ruled that the agency violated the Administrative Procedure Act...
As the annual enrollment period for Medicare Advantage winds to a close, five plans in Arizona received an upgraded star rating from the Centers for Medicare & Medicaid Services (CMS). The agency increased stars for 12 UnitedHealth contracts and seven Centene contracts in revised ratings released Monday.
Centene gained its only...White Papers, E books, Reports and more
Medicare Advantage plans must "fundamentally reassess" their business due to changes in the MA Star Ratings program, according to a new report by Milliman.
The Centers for Medicare and Medicaid Services (CMS) released the 2025 Star Ratings in October, with a noted decline in ratings for Medicare Advantage Part D plans. Part D plans...National News
Humana's rough patch continues as it sues the U.S. Department of Health and Human Services over star ratings and revisits a potential merger with Cigna.
This month, Humana reached a $90 million settlement with the United States over allegations of fraudulent bids submitted to the Centers for Medicare and Medicaid Services (CMS) for...National News
Changes to the Medicare Advantage star ratings calculation are already having major impacts for insurers and their shareholders as Humana saw its stocks plunge after announcing that only a quarter of its members are enrolled in plans rated four stars or higher for 2025.
The Centers for Medicare and Medicaid Services (CMS) awards star...
Earlier this year, two judges ruled that the Centers for Medicare and Medicaid Services (CMS) had improperly calculated Medicare Advantage scores and subsequent bonuses under the Star Ratings program last October. This week, CMS issued revised quality ratings for 2024, with a number of plans receiving far higher ratings and bonuses than...
The Centers for Medicare and Medicaid Services (CMS) have decided to recalculate the 2024 Medicare Advantage (MA) star ratings and allow plans to resubmit bids for 2025 if their scores increase. Insurers are thrilled.
Two federal courts recently determined that CMS improperly calculated MA star ratings for 2024 after applying a...National News
Last week SCAN won its case against the Department of Health and Human Services after claiming the Centers for Medicare and Medicaid Services (CMS) improperly calculated its 2023 MA star ratings, the insurer will now receive a $250 million quality bonus. Shortly after the decision, the same federal court ruled CMS must recalculate BCBS...
Humana has revised its outlook, confident that its expected Medicare Advantage enrollment will increase even more than it originally anticipated in 2023. But Centene has reported the opposite, expecting to lose money in Medicare Advantage and from Medicaid redeterminations.
Centene released its first quarter (Q1) corporate reports on...
The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Advance Notice for the Medicare Advantage (MA) and Part D Prescription Drug Programs that would update next year's payment policies.
In addition to the payment updates, the advance notice outlines several updates and improvements made by...
Every year, ahead of the Medicare Advantage open enrollment period, the Centers for Medicare and Medicaid Services (CMS) publish Medicare Part C and Part D Star Ratings to give Medicare beneficiaries a metric by which to assess plans. Last week, CMS released the 2023 Star Ratings for qualifying MA plans.
Medicare Advantage plans are...
It's safe to say that Medicare Advantage is now a well-established industry all its own -- within but separate from both the Medicare program and commercial insurance. With this new market dominance, the Medicare Advantage industry is now facing the same things all major industries must deal with: increased oversight, regulation and...
Last week, the Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI), seeking comment on ways to improve Medicare Advantage and make the program more equitable, affordable and sustainable.
Medicare Advantage (MA) has been under great scrutiny lately, for policies on prior authorization, the adequacy...
