Learn About latest CMS Medicare Advantage Rules

CMS to raise Medicare Advantage pay rates by 3.3% in 2024; phase in risk adjustment changes

Summary

• The Biden administration has finalized a proposal to increase Medicare Advantage payments by 3.32% in 2024, which is higher than the 1% raise initially proposed, following lobbying from insurers who argued that the original proposal would cut plans. The Centers for Medicare & Medicaid Services (CMS) will also implement changes to the MA risk adjustment model over three years instead of next year, with the goal of accurately paying plans in the program

• The Centers for Medicare & Medicaid Services (CMS) will phase in changes to the Medicare Advantage (MA) risk adjustment model over three years, while opposition to the rule also came from provider groups concerned about the removal of over 2,000 diagnostic codes and the short transition time. The MA program has been steadily gaining popularity, but some critics have claimed that plan payments have outpaced traditional Medicare due to gaming of risk adjustment tactics, and the new payment rule is part of a larger effort by CMS to address such tactics.