It’s time for our government to do away with quality ratings of Medicare Advantage plans and bonuses to Medicare Advantage insurers. The Medicare Advantage quality ratings are a joke, and a very misleading one at that–a five-star Medicare Advantage plan could be inappropriately delaying and denying necessary care. Given that the ratings are a joke, billions of dollars in bonuses to four- and five- star Medicare Advantage plans are a total waste of money. Maya Goldman reports for Axios on the state of quality bonuses.
Our government is overpaying Medicare Advantage plans an estimated $76 billion this year alone as a result of a defective payment system. The quality bonuses that insurers receive are based on questionable metrics and compound the overpayments. Moreover, when they receive 1-, 2- and 3-star ratings, the insurers challenge those ratings in court and too often prevail. Still, they might not be meeting their enrollees’ needs.
Clover Health challenged its quality rating recently and managed to win its lawsuit, generating $120 million in additional income for the company. Medicare Advantage plans receive additional income if they have a four- or five-star rating. They can use that money to deliver “extra” benefits to their enrollees.
Medicare experts agree that the star ratings are doing nothing to improve the care that Medicare Advantage insurers deliver. Moreover, the ratings are misleading. They don’t help people choose a high-quality health plan, but they suggest that they do. The ratings should go.
Conservatives believe that the quality bonuses should be reformulated to capture health care quality, which they do not currently do. But, the truth is that the data is not available to create ratings that would allow CMS to assess and pay Medicare Advantage plans based on health outcomes and patient experiences.
The Trump administration reformulated the star ratings in a way that boosts payments to insurers by $18.6 billion over the next ten years. It also ended up increasing rates to insurers in Medicare Advantage by 5 percent in 2027, even though it had proposed freezing this year’s rates.
Here’s more from Just Care:
- Don’t judge a Medicare Advantage plan by its stars
- Medicare hospital star-ratings are a farce
- Don’t trust Medicare nursing home star ratings
- MedPAC blasts Medicare Advantage
- The many disadvantages of Medicare Advantage
