A new Berkeley Research Group (BRG) analysis, commissioned by the Better Medicare Alliance, a Medicare Advantage (MA) research and advocacy group, estimates the impact of the No UPCODE Act to MA plan rebates and payments.
The report examines the No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act, bipartisan legislation introduced in March that would make major changes to the MA payment system. The bill proposes to use two years of diagnostic data in the MA risk adjustment model instead of one year; exclude diagnoses from chart reviews and health risk assessments as sources of diagnoses; and require the Centers for Medicare & Medicaid Services (CMS) to evaluate coding differences between MA and traditional Medicare.
BRG says the impact of the legislation would be significant. The combined effect of the No UPCODE Act would:
- Reduce per-member rebates by 43 percent to 58 percent
- Cut total payments to MA plans by 9 percent-20 percent from 2027 to 2035
- Lead to nearly six million fewer MA enrollees by 2035, a 12 percent decline from current projections
- Reduce popular supplemental benefits, such as dental, vision, hearing, and transportation coverage
- Deliver disproportionate losses in states with high local PPO penetration—including North Dakota, South Dakota, Montana, Wyoming, and Minnesota, where support for supplemental benefits would fall 70 percent or more
However, the report notes that if MA plans continued to offer the same level of benefits, enrollees would need to pay a new premium of approximately $2,663 per year, or $222 per month.
Mary Beth Donahue, president and CEO of Better Medicare Alliance, said the analysis shows the potential harm to millions of MA beneficiaries, particularly those in rural areas who already struggle with health care access if the legislation becomes law.
“We share policymakers’ goal of improving the Medicare Advantage program, but this legislation is not the answer,” Donahue said in an announcement. “It would increase seniors’ health care costs, reduce crucial health benefits, and weaken care coordination that beneficiaries count on. We can strengthen Medicare Advantage while protecting seniors, and we are eager to work with policymakers on solutions.”