MA is robust, with record enrollment growth, increased plan offerings and historically high levels of extra benefits.
- 60 million seniors are enrolled in Medicare. 31 million of those seniors are enrolled in Medicare Advantage.
- 2023 was the first year in which a majority of seniors – 50.5% – were enrolled in Medicare Advantage, growing from just 19% of seniors in 2007.
- MA grew by 2.7 million seniors in the 2023 open enrollment period.
- Over the past five years, Medicare as a whole has added 5.1 million new beneficiaries.
- MA enrollment increased by 9.1 million while fee-for-service shrunk by 4 million.
To ensure MA meets the demands of future generations, it must modernize and improve:
quality
The star ratings system has achieved its initial purpose: to improve the insurance offerings to seniors and assure basic performance metrics are met. ACHP was proud to be at the creation of the original quality incentive program, the only federal health program that rewards high-quality. Today however, the MA star ratings resemble the “everyone-gets-a-trophy” environment of Lake Wobegon. Seniors deserve a quality boost.
risk adjustment
The most aggressive risk adjusters have discovered that it is easier to code their way to revenue than to achieve it through quality. According to data from MedPAC, a 3.5-star plan with aggressive coding behavior can collect more in rebate dollars than a top-rated, 5-star plan, undermining the intent of both the quality bonus and risk adjustment programs.
consumer enrollment experience
Rapid enrollment growth in MA has attracted aggressive marketing and enrollment tactics. Consumers are inundated with confusing messages, complicating an already complex process. While there are hundreds of MA companies, just five national insurance conglomerates dominate the market, accounting for nearly 70 percent of enrollment. More than two-thirds of new enrollment went to just two mega companies and nearly 85 percent to for-profit MA plans in the most recent open enrollment period. If the trend continues, choice and competition will vanish.
the next generation of seniors deserves MA for Tomorrow.
In designing MA for Tomorrow, ACHP took an honest, data-driven look at the existing MA program and developed practical reforms to address current flaws and enhance the program for seniors today and the future.
MA for Tomorrow …
- Advances equity to level the competitive playing field, reduce disparities and address social determinants of health.
- Promotes transparency to improve consumer knowledge and empower smart shopping.
- Focuses on meaningful measurement and rewards to incentivize high-quality, innovative care.
- Accelerates value-based care to end the addiction to fee-for-service.
- Reduces burden to allow providers to focus on care delivery and use more of the Medicare dollar for care rather than documentation.
Why ACHP is leading this effort
MA for Tomorrow lays out a vision for an MA program that would provide greater choice, higher quality and long-term sustainability, based on five pillars:
Raising the Bar on Quality
Like many successful programs, MA must evolve to keep pace with technological advances and unintended loopholes so that it can drive quality even higher, promote competition and choice, and produce real value for every federal dollar spent.
Advancing Risk Adjustment for Care not Codes
MA for Tomorrow overhauls the risk adjustment model by recalibrating the model on encounter data, scaling coding intensity adjustments to address outliers and targeting audits to the most aggressive risk adjustment behaviors.
Improving Consumer Navigation
MA for Tomorrow builds on initial efforts to rein in misleading marketing practices, limit broker payments and incentivize enrollment in high-quality plans.
Modernizing Network Composition
MA for Tomorrow envisions a new set of standards that embrace virtual care and other innovative delivery models to meet seniors where they are and address workforce shortages.
Transforming Benchmarks
MA for Tomorrow delinks benchmarks from fee-for-service without instituting competitive bidding that would diminish competition and harm consumer choice.
1 Kaiser Family Foundation. Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans. https://www.kff.org/policy-watch/half-of-all-eligible-medicare-beneficiaries-are-now-enrolled-in-private-medicare-advantage-plans/.
2 Chartis 2023 Medicare Advantage Competitive Enrollment Report.https://www.chartis.com/insights/shifting-market-medicare-advantage-shows-continued-growth-0.
3 Kaiser Family Foundation. Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans. https://www.kff.org/policy-watch/half-of-all-eligible-medicare-beneficiaries-are-now-enrolled-in-private-medicare-advantage-plans/.
4 Chartis 2023 Medicare Advantage Competitive Enrollment Report.https://www.chartis.com/insights/shifting-market-medicare-advantage-shows-continued-growth-0.
5 Medicare Payment Advisory Commission. 2023. Report to the Congress: Medicare Payment Policy.https://www.medpac.gov/document/march-2023-report-to-the-congress-medicare-payment-policy/
6 Chartis 2023 Medicare Advantage Competitive Enrollment Report.https://www.chartis.com/insights/shifting-market-medicare-advantage-shows-continued-growth-0.
7 US Department of Health and Human Services. https://www.hhs.gov/aging/index.html.
