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A little over half of
Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered
in 2023 received an overall rating of 4 stars or higher, according to Medicare
Parts C and D Star Ratings data
released by CMS on Oct. 6. As expected, the new ratings reflect a return to
normal after adjustments made for the COVID-19 public health emergency
(PHE) resulted in a staggering 70% of MA-PD plans earning 4 stars or higher
for 2022. But as the market becomes more saturated across the country,
industry experts are watching closely to see whether recent steps taken by
CMS to penalize poor performers will really level-set the market or demonstrate
that more changes are needed to ensure members enroll in high-quality
plans.
New policy will limit
2024 expansions
- This was the first year CMS had a new policy in place
to limit the expansion of plans based on their Star Ratings history.
According to a final
rule published in May, CMS may deny a new application or
service area expansion request from any plan that receives 2.5 stars
or less for two years in a row on their Part C summary rating, Part D
summary rating or their overall rating.
- “We’re seeing a lot of low-performing contracts opening
additional [service areas] and enrolling members in low-performing
contacts, and I think CMS has added Star Ratings to [its past
performance] methodology to kind of put the brakes on that a little
bit,” remarks Jessica Assefa, chief quality officer with ATRIO Health
Plans in Minnesota.
- According to CMS data, 41 contracts fell below 3 stars
for 2023, and 25 contracts that received an overall rating of 3 stars
or higher had a Part C or Part D summary rating below 3 stars. “That’s
66 contracts in jeopardy, and for a good chunk of those, this year was
strike two for them.”
- The change is effective in spring 2023 for the 2024
plan year, and it is applied at the legal entity level, rather than
the contract or parent organization level. The insurer that may see
the greatest impact in 2024 is Centene Corp., which had 24 contracts
fall below the 3-star mark for 2023. The company during earnings calls
had previously warned of
disappointing Stars scores.
Humana retained high
ratings, while others dropped off
- According to an analysis from AIS’s Directory
of Health Plans, Humana Inc. outperformed other
major insurers with 96% of its MA-PD members estimated to be in 4 star
or higher plans next year, down slightly from 97.4% this
year.
- Major insurers experiencing considerable drops
included: UnitedHealthcare, which saw MA-PD membership in 4-star or
higher plans drop from nearly 95% in 2022 to 80.2% this year; Cigna
Corp., which went from 92% in 4-star or higher plans to 62%; and
Elevance Health (formerly known as Anthem, Inc.), which declined from
72% for 2022 to 64% in 2023.
- Meanwhile, CVS Health Corp.’s Aetna on Oct. 6 said it
expects the percentage of Aetna members in 4-star or higher plans to
decrease from 87% in 2022 to 21% in 2023. In a filing with the
Securities and Exchange Commission, the insurer attributed the drop
primarily to a 1-star decrease in the Aetna National PPO, which fell
from a 4.5 overall rating to 3.5 stars, “while many other Aetna plans
remain rated at 4+ stars.”
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