Medicare Advantage in the headlines: 10 recent updates

CMS published updated star ratings for dozens of Medicare Advantage plans, and a federal judge paused a new CMS regulation that would cap the amount insurers can pay brokers who sell their plans. 

Here are 10 key Medicare Advantage updates Becker's has reported since June 25:  

1. Two systems are going out-of-network with Medicare Advantage. Fort Myers, Fla.-based Lee Health's Physician Group primary care providers will be out of network with Florida Blue's MA plans by September. Albany (N.Y.) Med Health System split with Humana Medicare Advantage for non-emergency services June 30.
   
   
2. Krischa Winright, president of Medicare Advantage at Blue Cross Blue Shield of Michigan, sat down with Becker's to discuss the "critical success factor" behind the insurer's MA program. 
   
   
3. Medicare Advantage plans received $50 billion in payments between 2018 and 2021 for "questionable diagnoses" insurers added to medical records, a Wall Street Journal investigation published July 8 found.
    
4. CMS published revised star ratings for dozens of MA plans after the agency recalculated its ratings for 2024.  The agency said it would recalculate stars after insurers successfully challenged the methodology used to calculate the ratings. Forty insurers received upgraded ratings, and seven received five-star ratings. 
   
   
5. A federal judge paused the implementation of CMS regulations capping the amount Medicare Advantage companies can pay brokers that sell their plans. 
   
   
6. HHS' Office of Inspector General will audit MA  plans' use of prior authorization in post-acute care settings. 
   
   
7. Delaware lawmakers passed a law requiring the state to offer its retired state employees Medicare supplement plans rather than Medicare Advantage plans. The law was passed after a group of retirees successfully challenged the implementation of a MA plan for retired state employees in court. In New York City, a key union pulled its support for a MA plan for retired city employees.
   
   
8. Every year it feels like it's getting harder and harder to work with Medicare Advantage plans, Essentia Health's senior vice president of revenue services, Melanie Wilson, told Becker's.
   
   
9. Duluth, Minn.-based Essentia is one of nearly 400 organizations backing recently introduced legislation aiming to reform the Medicare Advantage prior authorization process. 
   
   
10. Lawmakers are pushing CMS to do more to prevent misuse of artificial intelligence by Medicare Advantage plans. In June, a group of 51 lawmakers penned a letter to CMS Administrator Chiquita Brooks-LaSure, asking the agency to implement more stringent oversight regarding the technology. 
    
    
11. As large national Medicare Advantage carriers face financial headwinds and tensions with health systems, one New York payer says business in the market is booming.