The effect of Lake Wobegon in Medicare Advantage

Data: Centers for Medicare & Medicaid Services; Graphic: Axios Visuals

Nine in 10 Medicare Advantage members are enrolled in plans that have achieved the government’s highest quality marks for 2022, according to new federal data.

Between the lines: Health insurers were quick to tout the quality scores in press releases. But the federal government took it easy during the pandemic, and experts have long viewed MA’s quality system as “flawed and inconsistent.”

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Driving the news: Medicare publishes MA star ratings each year prior to the program’s open enrollment window, which begins Oct. 15 and ends Dec. 7, to help seniors purchase plans (versus enrollment in Traditional Medicare).

  • Using a five-star system, Medicare rates MA plans on things like their customer service, members’ access to medications and services, and how they help people get medical exams.

  • Insurers who achieve at least four stars receive additional premiums from the federal government. These bonuses have almost quadrupled, from $ 3 billion in 2015 to $ 11.6 billion in 2021, according to the Kaiser Family Foundation.

The big picture: It was much more difficult to be classified as a “high quality” plan ten years ago.

  • In 2013, only 38% of master’s enrollments were in plans with four or more stars.

  • Much of this change can be attributed to the insurance companies operating the system.

  • In recent years, large insurers have merged lower-rated plans with higher-rated plans to get the bonus money, and with no noticeable improvement in quality, the Wall Street Journal reported in 2018.

The bottom line: Just because a Medicare Advantage plan gets at least four stars doesn’t mean the quality is guaranteed.

Go further: Medicare Advantage Continues to Grow Despite Long-Standing Problems

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About John Tuttle

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