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Area of Science:

  • Health Economics
  • Health Policy
  • Medical Insurance

Background:

  • Medicare Advantage (MA) plans use diagnostic coding to influence payment.
  • Differential coding practices by MA plans increase plan payments.
  • The Centers for Medicare and Medicaid Services (CMS) implemented a new payment model (V28) in 2024 to address this.

Purpose of the Study:

  • To assess insurer responses to the V28 payment model changes.
  • To evaluate how changes in supplemental benefits, cost-sharing, and premiums occurred.
  • To determine the extent to which revenue impacts were passed to beneficiaries.

Main Methods:

  • Analysis of insurer responses to the V28 risk-adjustment model.
  • Examination of changes in supplemental benefits, cost sharing, and premiums for 2024-2025.
  • Quantification of revenue reduction passed to beneficiaries.

Main Results:

  • Insurers showed a muted response to the V28 model in 2024-2025.
  • 17-24% of anticipated revenue reductions were passed to beneficiaries.
  • This was observed through reduced benefits or increased cost sharing and premiums.

Conclusions:

  • Insurers largely absorbed the financial impact of the V28 payment model adjustments.
  • This suggests a degree of stability in MA plan offerings despite payment reforms.
  • Findings may inform policymakers considering future adjustments to MA payment models.