Medicare Advantage News
Humana announced that it will leave 13 Medicare Advantage (MA) markets in 2025 due to a a 0.16% payment rate cut. In a process known as risk adjustment, the Biden administration phased-in changes in how MS carriers record and code member’s health conditions. Insurers argue that the cut does not take into account rising utilization among beneficiaries or increasing medical costs.
Deputy CMS administrator and director of the Center for Medicare Meena Seshamani, M.D., Ph.D, reported that the changes were a result of actuarial guidance and analysis “based on past risk score trends.”
Fitch Ratings reported that Covid-19 infections which increased morbidity during the pandemic contributed to the tightening of MA pricing decisions.
“Recent instability in Medicare Advantage, driven by a convergence of program adjustments and an unexpected increase in utilization, has muddled the outlook for the program.”
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