Bill Oxford
The US Centers for Medicare and Medicaid Services plans to recalculate the 2024 quality ratings for Medicare Advantage plans following court rulings in cases brought by plan providers 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 confirmed Friday. The newspaper first reported the story on Thursday.
According to a report by STAT Friday morning, the payments could amount to as much as $1B.
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:NYSE:ELV). The company had said the 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:NYSE:HUM) and UnitedHealth (NYSE:NYSE:UNH).
Other leading providers of Medicare Advantage plans include CVS Health (NYSE:CVS) and Cigna (NYSE:CI).