The battle over how much more the administration will pay insurers offering Medicare Advantage plans in 2025 is over. According to the Centers for Medicare and Medicaid Services (CMS), insurers will get a $16 billion increase. The insurers are playing with the numbers to suggest they are getting a cut, when, as it is, they are receiving $83 billion more this year than they should be.
The insurers were hoping that the CMS final rate notice, issued last week, would give them an increase over the CMS proposed rate. Social Security Works, People’s Action, Be a Hero, Public Citizen and many other advocates and experts called for Medicare Advantage rate cuts, given the massive overpayments to the insurers. Even with the massive overpayments, some insurers are denying and delaying care inappropriately and they are failing to pay money due hospitals, physicians, home health agencies, rehab facilities and nursing homes for services provided with their approval.
It’s not clear when or how Congress will step in to address the insurer overpayments, inappropriate care denials, and failure to pay providers in Medicare Advantage. A recent story in Newsweek focuses on the fact that insurers are not paying nursing homes appropriately. The American Medical Association has not spoken out against the insurers offering Medicare Advantage for not paying physicians appropriately, though it has highlighted the sometimes deadly consequences of prior authorization, a tool the Medicare Advantage plans use to inappropriately delay and deny care.
Meanwhile, the American Hospital Association continues to speak out about the failings of Medicare Advantage plans. And, many hospitals have cancelled their Medicare Advantage contracts.
Will the insurers cut extra benefits in Medicare Advantage plans? Time will tell. It’s hard to believe they will. Many enrollees do not take advantage of them. They are a valuable marketing hook. Insurers are still making a fortune off of Medicare Advantage.
Here’s more from Just Care:
- How will the administration address Medicare Advantage overpayments in 2025?
- Medicare Advantage plans denied two million prior authorization requests in 2021
- Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts
- Medicare Advantage poses grave risk to rehab facilities and nursing homes
- Medicare Advantage: Expect lots of care denials
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