2024's 10 biggest Medicare Advantage stories

2024 was a tumultuous year for Medicare Advantage. 

Increased government scrutiny, tighter CMS regulations, reduced base payments and rising healthcare costs are putting pressure on the program. Enrollment in MA continues to climb, with more than 32 million beneficiaries enrolled in MA plans in 2024.

More change could be on the way for Medicare Advantage in 2025, as the second Trump administration takes charge of CMS. 

Here are the 10 biggest MA stories from 2024: 

1. The disruptions across the industry led at least 11 payers to exit Medicare Advantage markets for 2025. At least three payers ended their MA offerings entirely.
   
   
2. In addition to existing markets, some Medicare Advantage insurers cut back on benefit offerings for 2025, prioritizing margin improvement over attracting new members.
   
   
3. Tensions between hospitals and insurers over Medicare Advantage plans reached an inflection point in 2024. At least 32 hospitals chose to drop some or all Medicare Advantage plans in 2024, often citing excessive prior authorization denial rates and slow payments from insurers. One hospital CEO said a lack of payment from Medicare Advantage plans led to layoffs.
   
   
4. The disruptions in the industry may have caused the program to lose its luster for some investors, analysts said.
   
   
5. In 2024, the two-midnight rule took effect. The regulation requires Medicare Advantage plans to provide coverage for an inpatient admission when the admitting physician expects the patient to require hospital care for at least two midnights. Some hospital executives said the rule led to "more aggressive" denial tactics from payers. On the payer side, some insurers said the rule was tied to rising inpatient costs, while others said it had little effect on costs. 
   
   
6. In April, CMS issued its final 2025 Medicare Advantage and Part D rule setting new standards around marketing, broker payments and prior authorization.
   
   
7. Medicare Advantage insurers faced more scrutiny over potential upcoding in the program in 2024. An investigation published in The Wall Street Journal in July found MA plans received $50 billion in payments between 2018 and 2021 for "questionable diagnoses" insurers added to medical records. An audit by HHS' Office of Inspector General published in October found MA companies brought in $7.5 billion in "questionable" payments found during in-home visits and chart reviews.
   
   
8. CMS recalculated 2024 star ratings for several Medicare Advantage plans after Elevance Health and the SCAN Group successfully challenged the agency's methodology in court. In October, the agency published star ratings for 2025, with the average star rating declining. UnitedHealthcare and several other insurers have sued the agency over their 2025 star ratings.
   
   
9. President-elect Donald Trump nominated Mehmet Oz, MD, a proponent of Medicare Advantage, as CMS administrator. The former television personality has advocated for a broad expansion of the program. Some lawmakers have questioned his financial ties to the healthcare industry, including MA insurer UnitedHealth Group.
   
   
10. In its proposed rules for Medicare Advantage in 2026, CMS laid out a set of major changes for the program, including requiring insurers to cover weight-loss drugs for enrollees with obesity and stricter guidelines around the use of AI.