For years, the Centers for Medicare and Medicare Services (CMS) has been giving additional money to Medicare Advantage plans that get four and five-star ratings. The goal was to promote quality, but the reality is that the five-star rating system is a farce and needs an overhaul. CMS has taken some steps to overhaul it but Jackob Emerson reports for Becker’s that Elevance Health is suing HHS for “unlawful, and arbitrary and capricious” methodology changes to how Medicare Advantage and Part D star ratings are calculated.
Don’t be misled by the government’s Medicare Advantage star-rating system. As of now, Medicare Advantage plans with four and five stars could have high denial rates, high mortality rates, endless prior authorization requirements and narrow networks that undermine access to care.
CMS uses 40 quality measures to rate Medicare Advantage plans, but these measures don’t give you a good clue as to whether a Medicare Advantage plan will actually cover the care you need, when you need it from physicians and hospitals you want to use.
CMS has gotten a bit stricter in giving out four and five-star ratings. And, Elevance says it is losing revenue because fewer of its Medicare Advantage plans are getting at least four stars.
For reasons that are unclear to me, CMS cannot change MA plan star-rating scores more than five percent from one year to the next. Somehow, Elevance claims that CMS did not abide by this restriction. Elevance therefore asks the court to require CMS to recalculate all scores for purposes of star-ratings for 2024.
Here’s more from Just Care:
- Medicare ratings of Medicare Advantage plans a farce
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Medicare Advantage: Denials and more denials, some deadly
- If you’re in a Medicare Advantage plan, watch out! Your doctor or hospital might no longer be in-network
- Medicare Advantage: Denials increase 56 percent
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