Elevance Medicare Advantage Plans 2025

Navigating Medicare Advantage plans can be complex, especially with providers like Elevance Health. What sets their plans apart, and how are they affected by Medicare’s quality star ratings?

Our article dives into the specifics of Elevance Medicare Advantage plans, shedding light on their unique benefits and the impact of recent healthcare changes on their quality ratings.

 

Key Takeaways

 

  • A significant legal battle has been initiated by Elevance Health against the government, challenging changes to the Medicare Advantage star ratings calculation, which threaten to diminish their bonus revenues by an estimated $500 million, emphasizing the methodological and financial implications of the rating system.

 

  • CMS has implemented adjustments such as guardrails and the Tukey outlier deletion method to stabilize Medicare Advantage star ratings, which have impacted the ratings distribution and led to insurers challenging these methods as they significantly affect plans’ future performance benchmarks and revenues.

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Understanding Medicare Advantage Star Ratings

 

Elevance Medicare Advantage Plans 2025, Understanding Medicare Advantage Star Ratings

 

A brainchild of the Centers for Medicare & Medicaid Services (CMS), the Medicare Advantage Star Ratings serve as a performance measurement tool. They evaluate the quality of health and drug services provided by Medicare Advantage plans.

The ratings range from one to five stars, with each star reflecting performance indicators such as:

  • customer service

 

  • member experiences

 

  • preventive health measures

 

  • management of chronic conditions

 

Star ratings serve as a critical tool for beneficiaries to evaluate and compare Medicare Advantage plans. They enhance transparency and aid in the selection process. With these star ratings, you can gauge the quality of healthcare services offered by each plan, making an informed decision before committing.

 

The Role of Star Ratings in Health Plans

Star ratings play a pivotal role in swaying consumer choices. They highlight how existing members have rated the plan and the plan’s performance areas such as preventive care or customer service.

Overall star ratings, representing a summary of these individual ratings, often make plans with higher ratings stand out, influencing potential members to consider them above others.

Higher Star Ratings also improve a health plan’s marketability. They can be used in marketing strategies to attract new members and indicate competitive superiority. However, while Star Ratings are beneficial in evaluating health plans, individual health needs remain the most crucial factor when choosing a plan.

 

Quality Bonus Payments and Revenue

In the Medicare Advantage universe, higher Star Ratings are more than just bragging rights. They carry with them financial rewards and a quality reputation. Medicare Advantage plans achieving four stars or above are eligible for a 5% bonus payment through the Quality Bonus Payment (QBP) program.

These Quality Bonus Payments serve to incentivize Medicare Advantage plans to enhance their care quality and member satisfaction, directly influencing health outcomes.

The additional bonus payments received from achieving higher ratings are mandated by law to be used for providing extra benefits, such as improved vision, hearing, or dental coverage, enhancing the plan’s appeal. This reinvestment into services or reduced premiums further increases a health plan’s competitive edge and value to beneficiaries.

The link between a health plan’s Star Rating and its revenue is significant, a fact evidenced by Elevance Health, which projected a decrease in quality bonus payments by approximately $500 million due to lower star ratings.

Elevance Health and Its Medicare Advantage Plans

 

Elevance Medicare Advantage Plans 2025, Elevance Health and Its Medicare Advantage Plans

 

Transitioning from a traditional health benefits organization, Elevance Health has evolved into a lifetime trusted health partner. Serving over 100 million people at various stages of health, Elevance Health has adopted an integrated approach to whole health.

They even announced that their affiliated health plans would offer Medicare Advantage plans with customizable supplemental benefits in 2025. Designed to provide simplicity, flexibility, and affordability, these health plan options focus on whole health as part of the Medicare program.

 

Company Background

Dedicated to improving the health of humanity, Elevance Health focuses on four core areas:

  • Whole health

 

  • Exceptional experiences

 

  • Care provider

 

  • Digital solutions

 

The company has made innovation, integration, and partnerships the cornerstone of its approach to enhancing healthcare.

With nearly 100,000 associates working towards improving lives and communities, Elevance Health operates with an expectation of excellence. Their corporate responsibility extends beyond just providing healthcare services. They are committed to:

  • Shaping the company and communities for the better

 

  • Improving health outcomes

 

  • Promoting equity

 

  • Ensuring accessibility

 

Medicare Advantage Plans Offered

Stepping into the Medicare Advantage arena, Elevance Health’s affiliated plans will be available to nearly 38.5 million Medicare-eligible consumers across 22 states and Puerto Rico. Brands such as:

  • Wellpoint

 

  • HealthSun

 

  • Simply Healthcare

 

  • Freedom Health

 

  • Optimum HealthCare

 

  • MMM in Puerto Rico

 

will offer these Medicare Advantage plans under Elevance Health.

These plans include a host of benefits designed with the consumer in mind. From Dual Eligible Special Needs Plans (D-SNPs), Chronic Condition Special Needs Plans (C-SNPs), to Institutional Special Needs Plans (I-SNPs), Elevance Health has something for everyone. Most plans predominantly feature a $0 premium and $0 copay for primary care provider visits.

The plans also include enhanced prescription drug coverage, improved dental care, and access to the Essential Extras supplemental benefits. These benefits offer flexibility for members to customize their plans to suit their needs.

From dental, vision, hearing, to even utilities and groceries, these plans ensure that members’ healthcare needs are comprehensively met.

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The Legal Battle Surrounding Star Ratings

Elevance Medicare Advantage Plans 2025

Elevance Health initiated a lawsuit against the federal government concerning changes in the Medicare Advantage star ratings calculation, which could cost them hundreds of millions in bonus revenue.

The legal challenge asserts that the adjusted methodology for determining 2025-star ratings is both ‘arbitrary and capricious’ and contravenes the Administrative Procedure Act.

The consequence of these changes was the exact opposite result of what was intended: a drastic reduction in high-performing plans, causing the percentage of plans with four or more stars to drop significantly for 2025, with only 34% retaining their high ratings, down from over 64% the previous year.

 

Lawsuit Filed Against HHS and CMS

Taking the battle to the courts, Elevance Health filed a lawsuit against the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), claiming violations related to star rating methodologies.

The lawsuit specifically challenges the unexpected use of the ‘Tukey’ method and the deletion of outlier contracts for star ratings, which were not part of the 2022 rules but were reintroduced in 2023.

Elevance Health contends that CMS’s application of the Tukey method resulted in a significant drop in their star ratings, a change that exceeded the guardrails requirement that limits changes to a maximum of five percentage points from the previous year.

This case has brought to light concerns regarding specific quality measures, suggesting a need for future rating systems.

 

Potential Impact on Health Plans

The lawsuit against CMS could have a significant financial impact on health plans due to potential decreases in star ratings. Elevance Health claims the loss of an estimated $190 million in bonuses due to a dropped phone call during star ratings assessments, holding the government accountable for the financial loss.

If Elevance Health’s lawsuit is successful, it could lead to significant adjustments in the way cut points are determined, impacting how Medicare Advantage plans are rated in the future.

It also brings into focus the ending of the disaster provision, which allowed plans to use the better of current or historical performance for most measures but will not be applied for the 2023 rating year.


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How CMS Achieved Stability in Star Ratings

 

Elevance Medicare Advantage Plans 2025, How CMS Achieved Stability in Star Ratings

 

During this tumult, CMS has been busy adjusting stabilized Medicare Advantage star ratings. The agency introduced guardrails to limit year-over-year changes in cut points for non-CAHPS measures starting in rating year 2023.

Additionally, the agency’s use of the Tukey outlier deletion method to remove performance outliers from the calculation of non-CAHPS measure rating cut points will begin in rating year 2025.

These adjustments are aimed at increasing predictability and enabling plans to invest in quality improvement initiatives more confidently.

 

Guardrails Requirement and Outlier Contracts

The introduction of guardrails aims to stabilize cut points for lower star ratings and improve the ability for plans to predict performance benchmarks. On the other hand, the introduction of the Tukey outlier deletion method is intended to create more predictability and stability within the star ratings system.

However, these new measures have not been without controversy. Insurers have challenged the use of the Tukey method, stating it led to a drop in star ratings that exceeds the guardrails’ stipulated limit of a five-percentage point change.

With these changes, about half of the Medicare Advantage plans could see a decrement in their ratings in the rating year 2023.

 

Cut Points and Rating Changes

The new methodologies for determining cut points have significantly impacted Medicare Advantage (MA) plans. These changes challenge them to improve their performance to maintain or achieve higher star ratings.

Contracts with 3.5 and 4.0-star ratings are most likely to be impacted, with approximately 23% of these contracts potentially experiencing a decrease of 0.5 stars due to new cut point methodologies.

A decline in average MA Star Ratings for the calendar year 2025 has been attributed to expiring COVID-19 provisions and planned measure adjustments. Simulations suggest that with the removal of the current reward factor and the addition of the proposed new health equity index, some MA prescription-drug contracts may gain or lose a half star on their overall rating.

The addition of new measures and alterations to existing measures’ specifications have significantly affected the distribution of star ratings from 2023 to 2025.

The Future of Medicare Advantage Star Ratings

Despite providing bonus payments, the current system has not consistently shown better care outcomes when compared to traditional fee-for-service Medicare, indicating potential inefficiencies.

 

HHS Secretary Xavier Becerra’s Stance

 

Elevance Medicare Advantage Plans 2025, The Future of Medicare Advantage Star Ratings

 

In this evolving landscape, HHS Secretary Xavier Becerra has made his stance clear. He aims to strengthen Medicare Advantage by:

  • Enforcing higher accountability standards for insurance companies serving seniors and individuals with disabilities

 

  • Pushing for new protections that ensure beneficiaries of Medicare Advantage obtain the quality care they are entitled to

 

  • Endorsing measures to streamline prior authorizations

 

  • Expanding behavioral health care

 

Secretary Becerra promotes policies that improve payment accuracy to ensure the Medicare Advantage program uses taxpayer dollars effectively.

He supports the development of a health equity index within the Star Ratings to reward Medicare Advantage and Part D plans that deliver exceptional care to underserved populations.

 

Possible Changes in Rating System

 

Elevance Medicare Advantage Plans 2025, The Future of Medicare Advantage Star Ratings

 

There have been calls for reform or replacement of the Quality Bonus Payment (QBP) system, indicating possible changes to the Medicare Advantage star rating system. The reforms may target a more effective balance between penalties for lower performance and bonuses for higher performance in the QBP.

If the QBP system is changed, healthcare providers and insurers may need to adjust their strategies to mitigate the impact of potential new methodologies on their star ratings.

Reallocated funds, as part of the reformed QBP, could potentially reduce government overpayment to Medicare Advantage plans and impact overall Medicare spending.

Summary

In the end, it’s clear that the Medicare Advantage Star Ratings system, while designed to promote quality healthcare, has become a complex battlefield of legal disputes, policy changes, and financial implications.

Yet, amidst all the controversy, the primary goal remains – to provide beneficiaries with a transparent and reliable measure of healthcare.

 

Frequently Asked Questions

 

How many Medicare Advantage members does Elevance Health have?

Elevance Health has a total Medicare membership of 2 million, according to its fourth-quarter earnings report. This makes it a significant player in the Medicare Advantage market.

 

Is Elevance suing over Medicare Advantage star ratings?

Yes, Elevance Health is suing over the new Medicare Advantage star rating methodology, alleging its unlawfulness.

 

What are Medicare Advantage Star Ratings?

Medicare Advantage Star Ratings are a tool used to evaluate the quality of health and drug services of Medicare Advantage plans, awarded by the Centers for Medicare & Medicaid Services (CMS).

 

What role do the star ratings play in health plans?

Star ratings play a crucial role in influencing consumer choice and improving a health plan’s marketability by highlighting the plan’s performance and member satisfaction.

This can help consumers make informed decisions about selecting a health plan.

 

What is the significance of Quality Bonus Payments?

Quality Bonus Payments in Medicare Advantage plans serve as an incentive for plans to improve the quality of care and member satisfaction, which in turn has a direct impact on health outcomes.

Additionally, these payments provide financial rewards for plans that achieve higher star ratings.

Elevance Medicare Advantage Plans by State

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1-844-350-0776
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Mon-Fri : 8am-9pm ET