Medicare Advantage in the Headlines: 15 Recent Updates

Payers are expanding Medicare Advantage plans to new markets for 2023, and many are facing increased scrutiny and legal action for overpayments.

Here are 15 Medicare Advantage updates Becker’s has reported since Sept. 30. 

1. Ohio and New York have the most five-star Medicare Advantage plans available, while four states have just one five-star option. 
   
2. A judge in Delaware temporarily blocked the state from moving its public retirees to a Medicare Advantage plan, the Delaware News Journal reported. The state awarded Highmark a three-year contract in February to administer a Medicare Advantage plan for 25,000 retired state employees. The plan was set to go into effect in January 2023. 
3. Nearly a third of beneficiaries said they chose traditional Medicare or a Medicare Advantage plan with the help of an insurance broker, according to the Commonwealth Fund’s “2022 Biennial Health Insurance” survey. The survey also found nearly a quarter of those 65 and older who chose to enroll in Medicare Advantage plans over traditional Medicare did so because of its additional benefits. 
   
4. The Justice Department is suing Cigna for allegedly making its Medicare Advantage members appear sicker than they were by submitting false diagnosis codes to the government in order to receive higher reimbursement rates.
   
5. Payers are expanding their Medicare Advantage plans and adding new plan options. Here are 13 recent expansions reported by Becker’s. 
   
6. Two U.S. representatives introduced a bill that would rename Medicare Advantage plans and prohibit private insurers from using Medicare in plan titles or advertisements. The Better Medicare Alliance pushed back on the proposal. 
   
7. Excellus Blue Cross Blue Shield and Humana both announced new Medicare Advantage plans tailored for veterans. 
   
8. CMS will release 90 audits of Medicare Advantage plans accused of overcharging the government in response to a lawsuit from Kaiser Health News. 
   
9. Forbes compiled the six best Medicare Advantage plan providers. 
   
10. Payers have exploited Medicare Advantage through elaborate schemes that make patients appear sicker than they actually are — thereby leading to higher payments from CMS, according to an Oct. 8 report from The New York Times.
    
11. The average star rating for Medicare Advantage plans decreased for 2023, after CMS implemented methodology changes in the way contracts are rated and ended most pandemic-era provisions. A total of 57 plans received the five-star designation. Humana and UnitedHealthcare scored the highest median ratings of the nation’s six largest payers in the ratings, according to CMS data. 
    
12. A trio of authors outlined proposed improvements to the prior authorization process for Medicare Advantage in an opinion piece published in JAMA Network.  
    
13. Elevance Health is facing a federal lawsuit alleging the payer received more than $100 million in overpayments from CMS after a judge declined to dismiss the suit.
    
14. Around 16 percent of Medicare Advantage enrollees switch insurance after one year of enrollment, a new study in the American Journal of Managed Care found.
    
15. Providers, nursing home representatives and advocates for patients say Medicare Advantage plans are sending enrollees home from skilled nursing and rehabilitation centers before they are healthy enough to leave, according to a Kaiser Health News and Fortune report.