Wednesday, April 12, 2017

Four Observations from the 2018 Medicare Advantage call letter |

It's that time of year.....CMS announces the plan for 2018 for it's programs, in this case the Medicare Advantage Programs.  And there are many, with differing deductibles and co-pays as well.  

Medicare anticipates changes in premiums based upon the average rate increase for health plans after careful deliberation finalized its 2018 payment rates for Medicare Advantage plans, settling on an average rate increase of 0.45% after initially proposing a 0.25% increase.

The CMS says the updated policies included in this year's rate announcement give MA organizations the incentive to develop new plan offerings with "innovative provider network arrangements" that may further encourage enrollees to access high-quality healthcare services.

The policy drew the approval of AMGA, a trade group that represents multispecialty medical groups and integrated systems of care.

The complete 185 page CMS document can be downloaded here

A few highpoints are listed below

The Table II-1 below shows the National Per Capita MA Growth Percentage (NPCMAGP) for

An adjustment of −0.226 percent for the combined aged and disabled is included in the
NPCMAGP to account for corrections to prior years’ estimates as required by section

The combined aged and disabled change is used in the development of the

Table II-1. Increase in the National Per Capita MA Growth Percentages for 2018 

Prior increases Current increases NPCMAGP for 2018
with §1853(c)(6)(C)
2003 to 2017 2003 to 2017 2017 to 2018 2003 to 2018
Aged + Disabled 54.84% 54.49% 2.76% 58.76% 2.53%

Current increases for 2003-2018 divided by the prior increases for 2003-2017 

The Affordable Care Act of 2010 requires the Medicare Advantage benchmark amounts be tied
to a percentage of the county FFS amounts. 

Table II-2 below provides the change in the FFS
USPCC which was used in the development of the county benchmark. The percentage change in
the FFS USPCC is shown as the current projected FFS USPCC for 2018 divided by projected
FFS USPCC for 2017 as estimated in the 2017 Rate Announcement released on April 4, 2016. 

Table II-2 – FFS USPCC Growth Percentage for CY 2018
Aged + Disabled Dialysis–only ESRD
Current projected 2018 FFS USPCC $847.73 $7,133.42
Prior projected 2017 FFS USPCC 825.20 7,023.24
Percent change 2.73% 1

The information on the CMS web site is only understood by those with accounting and statistical backgrounds.  The overall simplification appears in the blue section of the post.

4 observations from the 2018 Medicare Advantage call letter | FierceHealthcare
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