Health, drug plan star ratings improve for 2018

CMS issued its star ratings for Medicare health and drug plans for 2018, which according to the agency will assist consumers with information on high-quality health choices for coverage. According to CMS, most areas across the country have Medicare Advantage and Part D plans with four or more stars. In 2018, approximately 73 percent of Medicare Advantage enrollees with prescription drug coverage will be in plans with four and five stars. This rose from the approximately 69 percent of enrollees in four and five star plans in 2017. Approximately 44 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2018.

Medicare Part D prescription drug plan enrollees are also benefiting from improved access to high-quality plans. In 2018, approximately 47 percent of enrollees in stand-alone prescription drug plans will be in plans with four and five stars. This is an increase from the approximately 41 percent of enrollees in four or five star plans in 2017. Approximately 52 percent of stand-alone prescription drug plans will have a rating of four stars or higher in 2018.

The number of Medicare Advantage plans available to individuals to choose from is increasing from about 2,700 to more than 3,100 nationwide. More than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans.


CMS also estimated that the Medicare Advantage average monthly premium will decrease by 6 percent to $30 in 2018 from an average of $31.91 in 2017. About 77 percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018. CMS noted that the average basic premium for a Medicare prescription drug plan in 2018 is projected to decline to an estimated $33.50 per month.

House committee requests justification for Medicare Advantage policy changes

The House Ways and Means committee is concerned that CMS’ proposed changes to encounter data, employer group waiver plans (EGWPs), and risk adjustments are not “appropriately targeted.” The committee requested additional information about these changes from the CMS acting administrator following the 2017 Medicare Advantage and Part D Advance Notice of Payment Policies and Draft Call Letter (see CMS proposes 2017 Medicare Advantage and Part D program changes, Health Law Daily, February 22, 2016). The letter expressed the committee’s appreciation for CMS’ attention to key issues, such as providing better care for those dually eligible for both Medicare and Medicaid.

Encounter data

When CMS first proposed adopting 10 percent of encounter data for risk adjustment, the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) found that the agency needed to make operational changes in order to use the data effectively. The committee requested a summary of how the policy will impact plans, if available, or at least an explanation of the rationale for the change. It also asked how the agency has responded to GAO and MedPAC concerns, and requested information about how CMS plans to monitor the quality and utility of encounter data.

EGWPs and risk adjustments

MA-based managed care benefits are often provided to retirees by their former employers, but the committee believed that the proposed policy changes for EGWPs should not be finalized as written. The members noted that the changes may hamper employers’ ability to provide retiree benefits, and requested a summary of any analysis CMS has done on the impact of the policy change on plants and beneficiaries. It also wondered what authority CMS is using to propose such payment changes, and asked how CMS plans to handle implementing policy changes for multi-year contracts to avoid disrupting plan stability.

While the committee was pleased with CMS’ efforts to reduce the impact of social determinants on the MA plan star rating system, it believed that plans should be offered a reasonable amount of time to make changes as new risk adjustment policies are implemented. It requested a summary of the agency’s methodology and analysis that resulted in claims that the proposed risk adjustment policy would have a small net negative impact on plans. The committee also asked why the agency did not propose policies for addressing care given to low-income beneficiaries who are not dual eligible but have multiple chronic conditions.