CMS Finalizes Medicare Advantage Rates for 2019

The finalized 2019 Medicare Advantage plan rates will rise an average of 3.4 percent, and with another 3.1 percent adjustment from a change in risk scores (a measure of the sickness or health of the population served), the payment increase could be as high as 6.5 percent. According to the Centers for Medicare and Medicaid Services Administrator Seema Verma, the agency is changing how it uses encounter data (created by healthcare providers during visits with patients) to set risk scores by boosting the percentage of such data to 25 percent, up from 15 percent. The remaining 75 percent will come from Medicare fee-for-service data. The agency is also adding additional mental health, substance use disorder and chronic kidney disease conditions to its risk adjustment model.