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The US government reportedly plans to recalculate the quality ratings of Medicare Advantage plans in the wake of federal court rulings in cases brought by insurers SCAN Health Plan and Elevance Health.
The recalculations are expected to give “hundreds of millions in additional bonus payments to insurers next year,” The Wall Street Journal reported Thursday.
The Journal said the Centers for Medicare and Medicaid Services could make an announcement as soon as Thursday that it intends to recalculate the plans.
The move comes after a federal judge ruled in favor of SCAN Health Plan, ordering CMS to recalculate the insurer's ratings. SCAN Health has said the recalculation would raise its Medicare payments by around $250M for 2025.
A second federal judge made a similar ruling in a case brought by insurer Elevance Health (NYSE:ELV). The company had said a lowering of its 2024 Medicare quality ratings had resulted in a roughly $310M reduction in bonus payments.
The Journal added CMS is expected to conduct recalculations across the entire insurer sector, including Medicare plan providers Humana (NYSE:HUM) and UnitedHealth (NYSE:UNH).
Other leading providers of Medicare Advantage plans include CVS Health (CVS) and Cigna (CI).
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