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inforceReport | strategy-catalyst

The Current State of Medicare Advantage

Related Topics:
Payer StrategyFinance and Operations
Relevant Roles:
Chief Strategy Officers

Medicare Advantage (MA) has consistently been in the headlines the past few months with rounds of regulatory updates from CMS, dimming payer projections, and a growing number of health systems terminating MA contracts. To keep track of these key developments, Strategy Catalyst put together our Rapid Review on The Current State of MA. This brief is designed to be a one-stop shop background tool on MA, providing must-know details on the current enrollment, payer, regulatory, and LHS landscapes. What’s inside:

  • The variation of MA enrollment rates across counties, how much payers have lowered enrollment projections, and other key statistics

  • The five policy changes impacting MA profitability that you should know

  • The three major reactions LHS are taking as the yields on MA contracts decline

  • MA is now more popular with seniors than traditional Medicare

  • Patients have a dizzying array of choices for MA plans – most with no premiums

  • Payer landscape: MA is still the major profit pool until 2026, but new changes are tightening margins and lowering enrollment projections

  • Regulatory refresher: CMS is limiting MA profitability through several policy changes

  • So what for LHS? As yield on MA contracts goes down, LHS are terminating more MA contracts. Unfortunately, provider-sponsored MA plans have not been a silver bullet for most.