A new Trump administration Medicare Advantage rule will make it easier for Medicare Advantage plans to receive high star ratings, resulting in more money to them. The final rule does nothing to help people avoid bad actor Medicare Advantage plans. Instead, it eliminates several metrics that the insurers say are burdensome.
The Medicare Advantage star-rating system has always been a farce. It has never captured denial rates, prior authorization frequency, or delay rates, let alone health outcomes for people in different Medicare Advantage plans. People with Medicare are left with no way to make an informed choice among Medicare Advantage plans.
Even if people avoid one, two and three-star plans, they can’t avoid four and five star plans that have high rates of inappropriate denials, let alone high mortality rates. Based on the research, some, if not many, likely do. And, CMS is not using metrics for the star ratings that would identify the health plans with the best clinical outcomes, though CMS would likely you to believe it is.
If CMS cared about clinical quality, it would be measuring and reporting on clinical outcomes for people with cancer and other complex and costly conditions, which it is not.
The new rule helps the insurers and makes it even harder for people choosing a Medicare Advantage plan. CMS eliminated a metric that looked at provider complaints, a potential indicator of poor MA plan performance. It also eliminated a metric focused on appeal rates. High appeal rates could indicate serious issues with a Medicare Advantage plan.
CMS put back in place a bonus system that increases the amount of money insurers receive if they have four- and five-star ratings. The star-rating system makes it easier for insurers to have plans with four- and five-star ratings. As a result, American taxpayers are projected to pay an extra $18 billion (on top of the $1 trillion in overpayments) to insurers offering Medicare Advantage plans over the next ten years.
Here’s more from Just Care:
- Medicare hospital star-ratings are a farce
- Medicare ratings of Medicare Advantage plans a farce
- Don’t trust Medicare nursing home star ratings
- Three reasons why you can’t choose a health plan that’s “right for you”
- 2026: Big changes in Medicare Advantage
