Insurer Agrees in making Medicare Advantage Changes

@TRL1111 I have read the link that you provided and, at first, are lead to believe that there is some "gaming the system" taking place. However, I suspect large providers of MA Plans such as UHC and Humana are not going to risk losing lucrative contracts/business trying to increase Medicare payments by small amounts. With regard to medical terminology which I think is called ICD (International Classification of Diseases) and the corresponding codes, I do not know if a providers changes the code over time. For example, I obtain a medical physical every year and my glucose was creeping up in the range that is acceptable. Although not a diabetic, my physician suggested a diabetic eye exam from an ophthalmologist. As you know, there is good news and not so good news. I did not have diabetes or vision related issues related to diabetes, but had cataracts. I was connecting some vision issues that I was experiencing with cheap glasses that I bought from a popular vision franchise. Anyway, the doctor called it "age related" and still uses that diagnosis for follow up visits even though I had cataract surgery on both eyes. So, I do not know if or when a diagnosis code changes. Once again, think hypertension (high blood pressure) that is controlled by medication and an appropriate lifestyle ( i.e., stop smoking, diet, exercise, etc.). Follow up visits are probably coded hypertension even though a person's blood pressure is in range. 

At any rate, Medicare payments to MA Plans are complicated. I will try to link an article or two that provides some of the complex calculations that are utilized by Medicare. https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage-enrollee-adds-to-medicares-solvency-and-affordability-challenges/ Another article that is informative concerns Quality Bonus Payments https://www.kff.org/medicare/issue-brief/medicare-advantage-quality-bonus-payments-will-total-at-least-11-8-billion-in-2024/ and lastly https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-spending-and-financing/#:~:text=per%20capita%20spending-,(Figure%206,-). Hopefully, I copied and pasted the articles correctly. It will help folks to understand why MA Plans are paid the way they are paid. There are statistics, numbers, other data that require concentration. I read more articles, but thought the three that I linked will provide the concepts on how MA Plans are paid. If folks grasp anything from the info/concepts, they should understand that Medicare is not just issuing increased payments to MA Plans. So, it would be interesting to know what Humana is proposing that would change the current methodology; and, hopefully, keep a MA Plan viable and a going concern. Maybe, Humana who is second in MA Plans behind UHC believes some of the other smaller MA Plan insurers will fall by the wayside and Humana may be able to obtain some of that business. Medicine is a competitive business.