Medicare Advantage Plans to Get 3.4% Pay Increase

The increase doesn’t account for any adjustment for the underlying coding trend, which CMS expects to increase risk scores.

The Centers for Medicare and Medicaid Services (CMS) announced Monday that Medicare Advantage plans will receive a 3.4% payment increase in 2019, significantly more than the 1.84% raise that had been suggested in the advance notice.

The increase was among several policies adopted to provide beneficiaries more choices, more affordable options, and new benefits, CMS said.

The expected average increase in revenue does not take into consideration any adjustment for the underlying coding trend, which CMS expects to increase risk scores by 3.1% on average.

Related: CMS Unveils Patient Data Access Initiatives

CMS Administrator Seema Verma also announced Monday that CMS finalized policies to lower prescription drug costs and offer additional choices.

“The steps we are taking will drive more competition among plans and pharmacies to meet the needs of seniors and lower costs,” Verma said in a statement.

The administration is finalizing a number of policies designed to reduce drug prices, according to the statement, including the following:

• The maximum amount low-income beneficiaries pay for biosimilars will be reduced.
• Certain low-cost generics will be eligible for substitution onto plan formularies at any point during the year.
• The requirement that certain Part D plans must “meaningfully differ” from one another will be removed.
• The “any willing provider” requirement for pharmacies will be clarified in a way that increases competition.

Furthermore, the agency said it has reinterpreted standards for Medicare Advantage health-related supplemental benefits to include “non-skilled in-home supports and other assistive devices.”