Medicare Advantage
Latest updates on Medicare Advantage plans for 2022. Learn about enrollment trends, how CMS pays MA plans, the role of rebates, and the impact of coding intensity on MA plans.
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Presentation Transcript
Medicare Advantage 2022 Update Ed Weisbart MD, CPE, FAAFP Missouri@PNHP.org
As of 2021, Medicare Advantage Plans have Nearly Half of All Medicare Beneficiaries 46% 43% 40% Percent of eligible beneficiaries enrolled in MA plans 37% 35% 33% 32% 31% 30% 28% 26% 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
CMS pays MA Plans Based on Benchmarks, Risk, and Quality CMS MA Plan Bid Benchmarks Submitted to CMS for a capitated payment Capitation adjusted by CMS based on intensity of dx codes Established based on local TM spending Highest spending counties: Set at 95% of TM expenses Codes generated by claims, chart reviews, and HRAs Lowest spending counties: Set at 115% of TM expenses https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
CMS pays MA Plans Based on Benchmarks, Risk, and Quality CMS MA Plan Bid Gap filled either by Premiums or Rebates Benchmarks If an MA Plan s Bid is higher than the Benchmark: CMS pays the Benchmark; enrollees pay a premium to make up the difference. If an MA Plan s Bid is less than the Benchmark: CMS pays the Bid plusa percentage of the difference as a Rebate . Rebate percentage is larger for plans with higher scores on quality metrics. Rebates must be used to fund additional benefits or reduce member costs. https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
Because they fund the extra benefits that attract enrollees, Rebates Are One of the Ways Plans Compete Lower health care costs Plan submits lower Bid MA Plan s rebates are increased; MA Plan offers more of the extra benefits; Higher rebate percentage Improve quality MA Plan attracts more enrollees Increase coding intensity Raise Plan benchmark https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; Rebates are only available for plans bidding below their benchmark (nearly all plans in 2022)
MA Coding Intensity Is Growing 3.6% 3.2% MA coding impact relative to FFS 2.3% 1.4% Total impact minus CMS adjustments 2017 2018 2019 2020 https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
MA coding generated Excess Payments in 2020 Traditional Medicare Medicare Advantage Little incentive to code more diagnoses Financial incentive to code more diagnoses Greater MA risk scores for equivalent health status generated $12 billion in excess payments in 2020 $37 for every person inthe United States https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
Impact of COVID-19 on MA Plan Profitability 2020 2021 2022 2023 Record low utilization increased MA plan profits Profits likely boosted for a second year as rebounded utilization is uneven geographically and over time Delayed care rebound has not yet borne out Payment windfall for plans due to relaxed Quality Bonus Program rules under the public health emergency https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
Policy Reforms Are Urgently Needed Average MA member has access to nearly $2,000 in annual extra benefits Medicare pays MA plans 104% of FFS for similar enrollees Most Medicare beneficiaries will be in an MA plan by 2023 Why are only Medicare Advantage members allowed to receive these publicly-funded benefits?* *Question not raised by MedPAC https://www.medpac.gov/wp-content/uploads/2021/10/MA-status-MedPAC-Jan22.pdf Accessed Jan. 15 2022; data was preliminary and subject to change
