The Centers for Medicare & Medicaid Services has suspended enrollment in three Medicare Advantage plans offered by UnitedHealthcare and one by Anthem because they did not meet the minimum quota for benefits expenditure.
The Social Security Act requires MA organizations to maintain a medical loss ratio of at least 85%, that is, they must spend 85% of their premium income on medical benefits and claims. When an organization fails to do so for three consecutive years, “CMS must suspend that organization’s ability to accept new enrollments in the plans it offers…for the contract year following submission of the report,” the agency wrote in letters to the health plans.
The plans, whose medical loss ratios ranged from 77% to 84.9%, will not be able to enroll any new members until 2023.
Though the move is not new — CMS has suspended enrollment in Medicare and MA plans before — it cannot be characterized as a common course of action, said Dr. Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research, in a phone interview.
The UnitedHealthcare plans that were suspended are UnitedHealthcare of the Midwest, UnitedHealthcare of New Mexico and UnitedHealthcare of Arkansas, which operate in six states in total. Their suspension will impact about 80,000 people currently enrolled in the plans, a small percentage of its nearly 7.5 million MA members as of August.
The Anthem plan is an