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Medicare Advantage Challenges and Opportunities

Since the Medicare Modernization Act of 2003, Medicare Advantage has grown rapidly. Overall satisfaction is high, and members receive additional and affordable benefits that go beyond the coverage offered by traditional Medicare. Many Medicare Advantage plans offer disease management and care coordination programs to help members stay healthy.

The Patient Protection and Affordable Care Act (PPACA) makes a number of changes to Medicare Advantage and gives a great deal of discretion to the Secretary of Health of Human Services (HHS) to make these changes. If changes are made with an eye toward maintaining benefits, rewarding the best MA plans across the country, and promoting health quality, Medicare Advantage will stay strong, and remain a good choice for Medicare beneficiaries.

Our Position

  • In the interest of easing beneficiary confusion, PPACA gives the HHS Secretary great discretion to determine which plans are and are not allowed to operate in the Medicare Advantage program. Universal American supports this goal but urges the Secretary to work collaboratively with and give Medicare Advantage organizations time to understand and adapt to changes. We believe that avoiding disruption in member healthcare should be a primary goal of the HHS Secretary and Medicare Advantage plans as we transition toward the new rules.
  • PPACA gradually reduces reimbursement to Medicare Advantage plans, but also creates quality bonuses for the plans that provide the best services to their members. These bonus funds will be used to maintain the extra benefits and care management programs that members rely on. Universal American supports this concept, but suggests that the current 'star ratings' program, unless substantially changed, will concentrate quality bonuses in a handful of metropolitan areas. We believe the HHS Secretary has a responsibility to develop a system that recognizes strong performance across the country. We applaud the ‘Star Ratings’ demonstration put in place by the Department of Health and Human Services (DHHS), encourage the DHHS to use the demonstration period to hone a star ratings system in which quality of care is the most important measurement and health disparities across the U.S. are considered.
  • Starting in 2014, PPACA places an assessment on Medicare Advantage and other health plans that have high administrative costs (Medical Loss Ratios), but exempts health quality costs from this assessment. Universal American supports this; our efficient health plans are already at or near PPACA's threshold. But we strongly urge the government to implement this provision of PPACA in a way that does not discourage chronic disease management programs, healthcare fraud detection, and other important practices that help Medicare beneficiaries, particularly the sick and vulnerable among them, stay healthy.