More than 27 million Americans choose Medicare Advantage (MA) because it delivers better services, better access to care, and better value. But as part of their continuing budget negotiations, it has been reported that
To better understand how changes to coding intensity in MA would impact seniors, Avalere examined the results of increasing coding intensity to 7%, 8%, or 9%, compared to the current 5.9% adjustment. Among other key findings, the Avalere study found that if the coding intensity factor increased to 9%, MA premiums could double. And conversely, the proportion of MA enrollees paying a monthly premium at or below
"MA plans are more efficient and effective than original Medicare," said
MA plans are compensated based in part on the expected health care costs of their enrollees, with higher payments for enrollees who have chronic conditions or serious illnesses. This is one way in which MA plans are incented to coordinate care and offer benefits and services to help improve the health of more at-risk seniors and people with disabilities.
Coding intensity increases could also impact MA supplemental benefits (reduced cost sharing, transportation, nutrition support, in-home services, etc.). Today, over half of MA enrollees pay no premium (beyond their mandatory Part B premium) for their combined MA and Part D benefit. A coding intensity increase to 7% or more could mean no plans with a
"More complete coding is essential in identifying the health conditions of enrollees at the earliest opportunity to improve health. The data clearly show MA has delivered on its promise of lower costs and higher quality. Average spending per original Medicare enrollee is 6.4% higher than average spending per MA enrollee. In addition, Medicare Advantage serves a racially diverse population, outperforms original Medicare on several quality measures, and has seen a 34% decrease in premiums over the past four years," Eyles continued. "AHIP is committed to working with
Please click here (http://www.ahip.org/wp-content/uploads/09222021-Final-AHIP-Memo.pdf) to view and download the Medicare Advantage Coding Intensity analysis.