The Lake Wobegon effect in Medicare Advantage

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Nine out of 10 Medicare Advantage members are enrolled in plans that earned the government’s highest quality scores for 2022 new federal data.

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Between the lines: health insurer were early To Talk about Quality Score In Press releases. but the federal government made easy on grade during the pandemic, and experts have long called the MA’s quality system “flawed and inconsistent

running news: Medicare issues MA star ratings each year before the program’s open enrollment window, which begins October 15 and runs through December 7, helping seniors shop for plans (versus enrolling in traditional Medicare). .

  • Using a five-star system, a Medicare grad MA plans on things like their customer service, members’ access to medicines and services, and how well they help people get health screenings.
  • Insurers who receive at least four stars receive additional bonus payments from the federal government. This bonus has increased from $3 billion in 2015 to $11.6 billion in 2021. Kaiser Family Foundation.

big picture: A decade ago it was too hard to classify as a “high-quality” plan.

  • In 2013, only 38% of MA enrollees with four or more stars were in the plan.
  • A large part of that change can be attributed to the insurance companies operating on the system.
  • Over the years, large insurers have merged lower-rated plans with higher-rated plans to receive the bonus amount, and with no apparent improvement in quality, wall street journal Reported in 2018.

Bottom-line: Just because a Medicare Advantage plan gets at least four stars, it doesn’t mean that the quality is guaranteed.

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go in: Medicare Advantage continues to grow despite longstanding problems


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