Medicare will recalculate quality ratings of Medicare Advantage Plans, WSJ reports

By Thomson Reuters Jun 13, 2024 | 3:16 PM

(Reuters) – The federal government plans to redo this year’s quality ratings of private Medicare plans, the Wall Street Journal reported on Thursday, citing people familiar with the matter.

The move could deliver hundreds of millions in additional bonus payments to insurers next year, benefiting Medicare insurers at a time when their business is under pressure from rising healthcare costs and lower-than-expected rates for next year, according to the report.

A decision by the Centers for Medicare and Medicaid Services could be announced as soon as Thursday, the report added.

The ratings for a year determine bonus payments to the insurers in the following year.

Two court rulings have faulted the agency’s ratings in cases filed by insurers SCAN Health Plan and Elevance Health, the report said. SCAN, a nonprofit, and Elevance, one of the biggest Medicare insurers, won their challenges of CMS’ ratings calculations last week, it added.

CMS did not immediately respond to a Reuters request for comment.

(Reporting by Puyaan Singh and Juveria Tabassum in Bengaluru; Editing by Shilpi Majumdar)