As we age, most of us will rely on Medicare to cover doctor visits, hospital stays, medical equipment, emergency care, prescription drugs, and more. But it’s a complex and costly program that can and should deliver better value to its beneficiaries and to the taxpayers who foot the bill. Read more on our blog.
Under the Quality Bonus Program, Medicare Advantage (MA) contracts are assigned a star rating of 1 to 5 based on about 40 quality measures. In this MPI Blog, Laura Skopec discusses the advantages and disadvantages of measuring MA quality at the plan and contract level.
Currently, CMS measures Medicare Advantage quality at the contract level rather than the plan level. In this MPI blog, Rachel Schmidt outlines problems associated with measuring MA quality at the contract level and the implications for beneficiary choices and plan payments.
We are delighted to welcome our new Research Fellow Ciannah Correa.
In this MPI blog by Neil Patil and Jack Hoadley, we take lessons learned from prior authorization in Medicare Advantage and raise questions for policymakers and stakeholders to ensure Medicare beneficiaries receive appropriate access to timely benefits under this new model.
Jack Hoadley, Beth Fuchs, and Rachel Schmidt The authors have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers can call for unbiased assistance choosing among Medicare …
By Neil Patil and Carrie Graham On April 4, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D Final Rule. While CMS’s decision not to require Medicare and Medicaid to cover GLP-1 medications for treating obesity is likely to make headlines, another important issue has …
By Jack Hoadley The Trump Administration announced on April 4, 2025, that it would not broaden coverage of anti-obesity drugs in Medicare. They did not rule out reconsidering this possibility in the future, however, and others have offered policy proposals for expanding coverage of these drugs. These proposals are included in the compendium of policy …
By Carrie Graham and Madeline McBride A number of conservative policymakers and think tanks have pushed to make “privatizing Medicare” part of the current Trump administration’s healthcare agenda. One path toward more privatization is to “default” Medicare beneficiaries into private managed care plans called Medicare Advantage (MA). This would mean that instead of being in traditional …
Part of the Georgetown University McCourt School of Public Policy’s Center on Health Insurance Reform (CHIR), the Medicare Policy Initiative (MPI) is shining a light on how Medicare and the Medicare Advantage program can be strengthened so that seniors and taxpayers can get the best possible care and value for their money. This new initiative at CHIR …
Two research professors from Georgetown University’s Medicare Policy Initiative, Rachel Schmidt and Jack Hoadley, have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers …
By Rachel Schmidt and Carrie Graham On December 16, CMS announced its intention to terminate the Medicare Advantage (MA) Value-Based Insurance Design (VBID) demonstration at the end of 2025 due to the model’s substantial cost. Evaluations of the VBID model found $2.3 billion higher program spending associated with the model in 2021 and $2.2 billion …
