CMS Medicare Advantage Final Rules: Why 2025 will be Significantly Different for Plans, Enrollees and Providers

Keckley Report April 8, 2024
Paul Keckley

Last Monday, CMS announced the base payment rate it will pay Medicare Advantage plans in 2025: plans will see an average 3.7%, or $16 billion, increase in payments once risk scores are factored in but a cut to base payments of 0.16% since 2025 risk scores were expected to be 3.86%. That’s the math.

It came as a surprise to insurers and investors who had imagined CMS would modify its November proposed rule to increase payments as has been the precedent in prior years. Per Bloomberg:

“Only once in the past 10 years have final rates not improved from regulators’ initial proposals…The tougher stance in the face of lobbying signals another hurdle for insurers that already face faster-than-expected increases in...

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