Now two court cases in which insurers prevailed are leading the Centers for Medicare and Medicaid Services to raise star ratings for some Medicare Advantage plans, without data to show they’ve earned a higher rating. Both SCAN Health Plan and Elevance Health both won their legal challenges against the government’s reductions in their Medicare Advantage star ratings. So, the government is going to recalculate 2024 star ratings and only implement changes if the ratings increase, reports Anna Wilde Matthews for the Wall Street Journal.
Don’t trust the Medicare Advantage star ratings–or, for that matter, the Medicare skilled nursing home and hospital star ratings. They have never been reliable. And, now the Medicare Advantage star ratings will be even less reliable.
So, how do you choose a Medicare Advantage plan? There’s no meaningful way to make a choice. The best you can do is avoid plans that do not have 5 stars and pray that your 5-star Medicare Advantage plan will not force you to deal with excessive and unfounded prior authorization requirements or deny and delay your care inappropriately. There’s no way to know in advance.
To date, the star ratings for Medicare Advantage plans do not capture whether the plan forces people to wait long periods for approval of their treatments, makes them go through too many unnecessary hoops to get care or inappropriately denies them care. It also does not capture a Medicare Advantage plan’s mortality rates, even though, according to one study, the bottom five percent of worst performing MA plans are responsible for tens of thousands of unnecessary deaths each year.
Still, having a four or five-star rating results in Medicare Advantage plans getting additional payments from the government. These payments should reflect that the Medicare Advantage plans deliver quality care. But, they do not.
Instead, these bonus payments are given to plans that might be delivering poor care. And, they allow these plans the resources to enhance benefits and attract more members.
SCAN reports that the recalculation of its star rating will earn it an additional $250 million in 2025. Elevance will also see more money from the government. But, the ruling in its case only bears on one Elevance plan. Elevance claims it would have lost $310 million in bonus payments had it not won its lawsuit. Humana could have lost $150 million or so and UnitedHealth $70 million if CMS were not recalculating the star ratings
SCAN projects that the Centers for Medicare and Medicaid Services will end up paying out an additional $1 billion to insurers serving about one million enrollees, as a result of its lawsuit.
Here’s more from Just Care:
- Scan Health plan wins suit against CMS on Medicare Advantage star ratings
- Don’t trust Medicare nursing home star ratings
- Don’t assume a five-star Medicare Advantage plan will provide the care you need
- Medicare hospital star-ratings are a farce
- New study finds you can’t meaningfully choose among Medicare Advantage plans
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