Medicare Advantage
Expert articles and analysis related to medicare advantage.
AI Summary — Last 30 Days
The Trump administration’s CMS is tightening the Medicare Advantage operating environment on two fronts: recalculating 2026 Star Ratings after the Clover Health litigation—creating continued bonus-payment volatility for MA plans—and advancing a 2027 payment update that preserves MA growth while keeping scrutiny on coding intensity and quality measurement. At the same time, RADV extrapolation remains a major financial overhang, with plans facing higher repayment risk tied to risk-adjustment documentation, audit sampling, and overpayment enforcement—raising the stakes for VBC organizations that depend on MA revenue, delegated risk contracts, and accurate population acuity capture. Together, the signal is a more contested MA market where growth continues, but margin strategy increasingly depends on defensible coding, Star Ratings resilience, and compliance infrastructure rather than enrollment expansion alone (RADV extrapolation guide; Star Ratings recalculation).
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95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed - open minds
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Ethics, Risk Adjustment, and a Turning Point for Medicare Advantage – ICD10monitor
Ethics, Risk Adjustment, and a Turning Point for Medicare Advantage – ICD10monitor MedLearn Publishing