Medicare Advantage News
2024-09-24 // 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.
**Reported in STAT **
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.”