For skilled nursing facilities, the fact that 72% of MA enrollees remain in bonus-receiving plans means the major payers driving admissions decisions are also the ones accumulating outsized quality payments — tightening their financial position heading into contract negotiations. The persistently low bonus payouts for special needs plans – the lowest average per enrollee at $330 – raises questions about whether the star rating system adequately rewards plans serving the complex, high-acuity populations that SNFs disproportionately treat.
Medicare Advantage Quality Bonus Payments Will Total at Least $11.8 Billion in 2024
After increasing by more than 400% between 2015 and 2023, federal spending on Medicare Advantage bonus payments will decline by $1 billion (8%) to $11.8 billion in 2024, following the expiration of pandemic-era policies that temporarily increased star ratings for some plans. Despite the decline, total spending on Medicare Advantage plan bonuses is higher in 2024 than in every year between 2015 and 2022. Most Medicare Advantage enrollees (72%) are in plans that are receiving bonus payments in 2024. Though the share declined from 2023 (85%), it is similar to the share observed in 2022 (75%). The average bonus payment per enrollee is highest for employer- and union-sponsored Medicare Advantage plans ($456) and lowest for special needs plans ($330).
— KFF, September 11, 2024
Biniek, Jeannie Fuglesten, et al. “Medicare Advantage Quality Bonus Payments Will Total at Least $11.8 Billion in 2024.” KFF, 11 Sep. 2024. https://www.kff.org/medicare/issue-brief/medicare-advantage-quality-bonus-payments-will-total-at-least-11-8-billion-in-2024/.
KFF: Insurers set to rake in $11.8B in Medicare quality bonus payments for 2024
UHC and Humana, which together account for just shy of half of the MA market, are set to receive 50% of quality bonus payments this year. Overall, payouts tend to track with market share, the study found.
— Fierce Healthcare, September 16, 2024
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