Apr 7, 2020 - Health

Feds relax Medicare Advantage regulations amid pandemic

Bob Herman

Medics wheel a coronavirus patient on a gurney outside a hospital emergency room. — An older coronavirus patient at a New York City hospital. Photo: Tayfun Coskun/Anadolu Agency via Getty Images

Federal payments to Medicare Advantage companies will increase by 1.66% in 2021, and several of the insurance program's policies are being waived or changed due to the coronavirus outbreak, the Centers for Medicare & Medicaid Services said Monday.

The bottom line: Medicare Advantage continues to grow at a lofty rate, and the Trump administration is protecting those health insurers through the pandemic and into next year.

By the numbers: The 1.66% payment rate hike for 2021 plans was higher than the proposed rate, but lower than what the industry got for 2020.

Depending on how many medical codes Medicare Advantage insurers attach to their elderly and disabled members, the average rate increase could be as high as 3.6% next year.

Between the lines: New regulatory changes, issued due to the coronavirus, are arguably more important than the payment increase.

CMS is "reprioritizing" audits of Medicare Advantage plans that looked for exaggerated coding — a move that will temporarily give a reprieve to the industry that feared the audits would claw back billions of dollars.
Companies can expand telehealth options and waive copays this year for people who are affected by the outbreak.
The coronavirus is making it difficult for health plans and doctors to collect quality data; therefore, the federal government will be more lenient on data requirements for 2021 and 2022, which likely will protect bonus payments that plans receive.

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Feds relax Medicare Advantage regulations amid pandemic

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