CMS backs down on Medicare Advantage cuts

The final 2015 Medicare Advantage rates announced Monday by the Centers for Medicare and Medicaid Services reflected only a 0.4 percent decrease, but that did not win it the adulation of America’s Health Insurance Plans’ (AHIP), the organization that represents U.S. insurance companies.

Since CMS proposed the original 1.9 percent proposed Medicare Advantage rate cut in February, AHIP had mobilized thousands of Medicare Advantage plan members to contact their elected officials in Congress and push for no reduction in rates. According to AHIP’s analysis, the 1.9 percent cut would actually have worked out to be closer to a 6 percent cut and would have increased monthly premiums for Medicare Advantage plan holders by $35 to $75. As a result of these efforts, 270 members of Congress signed onto a letter asking CMS not to decrease Medicare Advantage rates despite a mandate in the Patient Protection and Affordable Care Act to eventually equalize what the government spends for healthcare services through Medicare Advantage and what it spends on for those same services through traditional fee-for-service Medicare.

“The changes CMS included in the final rate notice will help mitigate the impact on seniors, but the Medicare Advantage program is still facing a reduction in payment rates next year on top of the 6 percent cut to payments in 2014. We remain concerned about the impact year-over-year cuts to Medicare Advantage would have on the high-quality, affordable coverage millions of seniors like and rely on today,” said AHIP President and CEO Karen Ignagni in a public statement.

Cuts to Medicare Advantage could trickle down to healthcare providers in terms of less leeway to negotiate reimbursement rates with the insurance companies that provide the private Medicare plans, as well as efforts by the insurers to narrow the network of providers in the plans to only those willing to accept the lowest reimbursement rates.

But are the cuts hurting insurers as much as the AHIP claims? CMS noted in its release that since 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has increased by 38 percent to an all-time high of more than 15 million beneficiaries — nearly a third of all Medicare beneficiaries.

Many news outlets also have noted the disparity between the claims of hardship by the AHIP and the confidence investors have shown in the public stocks of Medicare Advantage providers. Humana and United Healthcare Group — two of the leading companies in the Medicare Advantage market — saw their stocks drop Tuesday following the CMS announcement, but they were up overall for the past three months, the year to date and the past year.

In addition to lowering the cut to Medicare Advantage rates, CMS also made some additional changes in the final rule to lower out-of-pocket drug costs for Medicare Advantage beneficiaries, prohibit insurance companies from significantly raising cost or cutting benefits on a plan in a single year, and to ensure that beneficiaries have reasonable notice of upcoming changes to plans’ provider networks ahead of open enrollment periods so that they can switch plans if needed to continue seeing a particular trusted provider.