{"id":459795,"date":"2026-02-10T08:18:21","date_gmt":"2026-02-10T08:18:21","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/459795\/"},"modified":"2026-02-10T08:18:21","modified_gmt":"2026-02-10T08:18:21","slug":"updated-cms-data-reshapes-medicare-advantage-risk-scores","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/459795\/","title":{"rendered":"Updated CMS data reshapes Medicare Advantage risk scores"},"content":{"rendered":"

Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers \u2014 reporting on how money influences those businesses and shapes what we all pay for care. He is also the author of the Health Care Inc. newsletter<\/a>. You can reach Bob on Signal at bobjherman.09.<\/p>\n

The health insurance industry was caught off guard by the federal government\u2019s recent proposal to keep next year\u2019s payments to Medicare Advantage plans mostly flat<\/a>, and to change a controversial coding practice<\/a>. But another equally significant change has flown under the radar \u2014 and is a major reason why some insurers may face big hits to revenue.<\/p>\n

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.<\/p>\n

\t\t\t\"\"\t\t<\/p>\n

\t\t\t\t\"\"\/
\n\t\t\t\tSTAT Plus: Trump administration proposes tiny pay raise to 2027 Medicare Advantage plans<\/a><\/p>\n

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\u2019 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\u2019s analysis found.<\/p>\n

STAT+ Exclusive Story<\/p>\n

Already have an account? Log in<\/a><\/p>\n

\t\t\t\"STAT+\"\/<\/p>\n

\t\t\t\t\t
\n\t\t\t\t\t\t\"STAT+\"\/
\n\t\t\t\t\t<\/a><\/p>\n

\t\t\t\tThis article is exclusive to STAT+ subscribers
\n\t\t\t\tUnlock this article \u2014 and get additional analysis of the financial innards of our health care system \u2014 by subscribing to STAT+.<\/p>\n

Already have an account? Log in<\/a><\/p>\n

\t\t\t\t\t\tIndividual plans<\/p>\n

\t\t\t\t\t\tGroup plans<\/p>\n

\t\t\t\tView All Plans<\/a><\/p>\n

\n\t\t\t\t\t\tTo read the rest of this story subscribe to STAT+.\t\t\t\t\t<\/p>\n

\t\t\t\t\tSubscribe<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers \u2014 reporting on how money influences…\n","protected":false},"author":2,"featured_media":459796,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[10212,97,252,9041,253,9448,1343,248],"class_list":["post-459795","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-cms","tag-health","tag-health-care","tag-health-insurance","tag-healthcare","tag-medicare-advantage","tag-policy","tag-stat"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/459795","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=459795"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/459795\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/459796"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=459795"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=459795"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=459795"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}