The health insurance industry was caught off guard by the federal government’s recent proposal to keep next year’s payments to Medicare Advantage plans mostly flat, and to change a controversial coding practice. But another equally significant change has flown under the radar — and is a major reason why some insurers may face big hits to revenue.
The Centers for Medicare and Medicaid Services is proposing to use newer data when paying Medicare Advantage plans in 2027. And that data implies people with chronic health problems are not seeing their doctors nearly as much as their health profiles suggest they should.
STAT Plus: Trump administration proposes tiny pay raise to 2027 Medicare Advantage plans
As a result, CMS is ratcheting down payments to Medicare Advantage plans for enrollees who have common chronic diseases, such as diabetes, morbid obesity, and lung disease, a STAT analysis shows. The agency also is reducing payments tied to enrollees’ ages and slashing add-on payments that plans receive if people have five or more diseases. Overall, Medicare is proposing to decrease payments for two-thirds of codes for the typical Medicare Advantage enrollee, STAT’s analysis found.
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