Category Archives: Medicare Data & Policy
CMS HPMS Memo to Review Data Used for Medicare Part C, D Star Ratings and Display Measures, Apr-24
CMS Memo to Review Data Used for Medicare Part C and D Star Ratings and Display Measures Posted in Health Plan Management System (HPMS), Issued April 11, 2024.
MedPAC Annual Report to Congress, Mar-24
1. Medicare Payment Advisory Commission’s (MedPAC) Annual Report to Congress, Published March 2024.
2. MedPAC Report to Congress, June 2023
2. MedPAC Report to Congress, March 2023
2. MedPAC Report to Congress, June 2022
2. MedPAC Report to Congress, March 2022
3. MedPAC Report to Congress, June 2021
3. MedPAC Report to Congress, March 2021
4. MedPAC Report to Congress, June 2020
CMS Calendar Year 2025 Medicare Advantage Value-Based Insurance Design (VBID) Model Application, Feb-24
1. CMS Calendar Year 2025 Medicare Advantage Value-Based Insurance Design Model Application Memorandum, February 29, 2024
2. CMS Calendar Year 2025 Medicare Advantage Value-Based Insurance Design Model Application, December 13, 2023
3. CMS Calendar Year 2025 Medicare Advantage Value-Based Insurance Design Model Application Hospice Benefit
CMS Medicare Advantage Final Rule Coverage Criteria and Utilization Management Requirements FAQs, Feb-24
CMS Medicare Advantage Final Rule Coverage Criteria and Utilization Management Requirements Frequently Asked Questions (FAQs), Feb-24
CMS Releases Memo Providing CY 2025 SMAC Submission Instructions, Medicare Managed Care Manual Updates
The Centers for Medicare & Medicaid Services (CMS) released on January 25, 2024, a memorandum providing the Contract Year (CY) 2025 State Medicaid Agency Contract (SMAC) Submission Instructions, as well as updates to Chapter 16-B of the Medicare Managed Care Manual, which include changes to Dual Eligible Special Needs Plans (D-SNPs) definitions and additional D-SNP requirements. Regulatory changes may impact plans’ qualification as a fully integrated D-SNP (FIDE SNP) or highly integrated D-SNP (HIDE SNP). Applications to offer FIDE or HIDE SNPs will be due February 14.
CMS D-SNP Integration Status Reports, CY 2021-24
1. The Centers for Medicare & Medicaid Services (CMS) Integration Status for Contract Year 2024 Medicare Advantage D-SNPs, Published September 2023
2. CMS Integration Status for Contract Year 2023 Medicare Advantage D-SNPs, Published January 2023
3. CMS Integration Status for Contract Year 2022 Medicare Advantage D-SNPs, Published January 2022
4. CMS Integration Status for Contract Year 2021 Medicare Advantage D-SNPs, Published February 2021
Medicare Advantage Enrollment by State, Interactive Tool
The attached Medicare Advantage Enrollment Tool allows users to search for Medicare Advantage enrollment data by state and among top plans for the period indicated and for the corresponding prior-year period. Data includes market share as well as minimum and maximum Star Ratings, premiums, and deductibles by plan.
Medicare Advantage SNP Enrollment by State, Interactive Tool
The attached Medicare Advantage Special Needs Plan (SNP) Enrollment Tool allows users to search for Medicare Advantage SNP enrollment data by state and among top plans for the period indicated and for the corresponding prior-year period.
MLRs at TN Medicare Advantage MCOs Average 82.1%, 2019 Data
Average medical loss ratio among 10 Tennessee Medicare Advantage plans was 82.1% in 2019. Per member per month premiums averaged $1,087.
MLRs at TX Medicare Advantage MCOs Average 87.3%, 2019 Data
Average medical loss ratio among 18 Texas Medicare Advantage plans was 87.3% in 2019. Per member per month premiums averaged $1,161.
