It’s been a bit of a roller coaster ride for Medicare Advantage (MA) plans lately.

Just about one week ago, the Centers for Medicare & Medicaid Services gave the plans a pleasant surprise — a 3.32% bump in payments for 2024. The government also granted the plans another welcome move — a three-year phase-in of a new risk adjustment model. The gradual phase-in is expected to minimize changes in payment rates from year to year and soften any blow to the loss of MA supplemental benefits, which have become a major selling point for many plans.

“The phase-in will also help to mitigate any impact on MA supplemental benefits,” Tyler Overstreet Cromer, a principal at the research firm ATI Advisory told McKnight’s Home Care Daily Pulse earlier this week. “MA plans strive to have consistent and reliable benefits. Once an MA plan offers a benefit, and their members begin to use and like it, they work hard to not remove or significantly reduce the benefit, as that can lead to members leaving.”

All of this, of course, was before the final MA rule, which came down on Wednesday. The rule cracks down on misleading marketing by MA plans and helps streamline the prior authorization process to eliminate barriers to access. MA plans likely did not greet the final rule with the same enthusiasm as the payment upgrade a week prior.

William Dombi, president of the National Association for Home Care & Hospice, alluded to this during a webinar Thursday. The rule for MA plans, while not perfect, seeks to “hold their feet to the fire,” he said. Dombi noted that because of marketing gimmicks, many people think they are receiving the “nirvana of healthcare” only to discover a less heavenly reality. No question TV spokesmen like football great Joe Namath and Jimmie Walker of “Good Times” fame help to contribute to the mistaken allure around the plans.

Both of these rules illustrate the rocky path CMS is treading. Given the astronomical growth of MA plans, they are a major player in seniors’ insurance. But that shouldn’t mean they have carte blanche. Serious ongoing concerns, including patient access to care and exorbitant plan profits, likely will continue to make CMS keenly interested in the way MA plans conduct business.

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].