• 55. Reforming The Medicare Advantage Minimum Medical Loss Ratio

  • Dec 27 2024
  • Length: 23 mins
  • Podcast

55. Reforming The Medicare Advantage Minimum Medical Loss Ratio

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  • Summary

  • CMS should be cautious in reforming Medicare Advantage’s minimum medical loss ratio requirements. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the recent proposal from CMS to reform the Medicare Advantage minimum medical loss ratio requirements. CMS should be cautious so as not to hurt value-based care. Key Takeaways: In its 2026 proposed rule, CMS proposes to reform the Medicare Advantage minimum medical loss ratio requirements. The minimum MLR is meant to control costs and premiums. Health plans have to spend either 80% or 85% of premium on medical expense. CMS proposes to ensure provider contracts have clinical and quality standards in the contract, gather information on plan-provider contracts, and solicit comments on vertical integration concerns. Many worry that revenue is being passed to providers and other entities and not really being spent on medical expense. The concern is big regarding plans that contract with sister entities within a larger health plan entity. These are called intraparty agreements. Placing standards in provider contracts is reasonable, but CMS should be cautious about limiting profit by providers. CMS should rein in intraparty agreements by requiring them to be arm’s length. Connect with Marc Marc on LinkedIn Marc on Twitter THL Podcast Resources THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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