Medicare Advantage

Many ACHP members offer Medicare Advantage plans – in all, ACHP members enroll about 14 percent (nearly 2.4 million) of the 17.2 million Medicare Advantage members.

ACHP member plans provide top-notch health coverage and care to over 2.4 million seniors through Medicare Advantage. Our plans are amongst the highest quality plans in the nation, scoring four or more stars in the Medicare Star Quality ratings. ACHP advocates on behalf of improved care coordination for beneficiaries in Medicare Advantage as well as innovative health care delivery models such as telehealth. ACHP’s advocacy efforts also include restoring quality incentive payments to community plans to ensure the highest scoring plans are rewarded for their performance.

ACHP’s nonprofit, community-based health plans provide the highest quality MA coverage to seniors nationwide. To learn more about MA and our plans’ performance, click here.

Medicare Quality Star Ratings 

Of 12 MA plans receiving 5 stars for the 2016 plan year, eight are ACHP members. ACHP organizations:

  • Enrolled nearly 93 percent of the beneficiaries in 5-star plans
  • Enrolled 40 percent of the beneficiaries in plans with 4.5 stars or better
  • Offered 4, 4.5 or 5 star plans in 18 states and the District of Columbia

Read more information on ACHP members’ performance on health care quality ratings:

For more information on the value of MA to beneficiaries, please see:

Medicare Advantage Benchmark Cap

Since 2009, enrollment in Medicare Advantage (MA) programs has doubled to more than18 million Americans – over 30 percent of all Medicare beneficiaries. Medicare Advantage plans are held to important quality measures with those achieving the highest quality ratings being rewarded with a “quality incentive payment” (QIP). By law, these payments must be returned to enrollees in the form of reduced premiums or increased services.

ACHP’s member plans that provide Medicare Advantage coverage repeatedly achieve the highest quality ratings. During the 114th and the current 115th Congress, our efforts have focused on restoring the flow of these payments to reward the highest performing plans for delivering the best care.

ACHP has proudly supported the efforts of Rep. Mike Kelly (R-PA), Rep. Ron Kind (D-WI), Rep. Mike Doyle (D-PA) and Rep. Brett Guthrie (R-KY) to fix this problem and continues to advocate for the passage of the Medicare Advantage Quality Payment Relief Act of 2017.

Letter to Ways and Means Committee on mark-up for exploration of fix to benchmark cap, June 2018
Letter to Ways and Means Subcommittee on Health on addressing barriers to innovation in health care, April 2018
Letter to House of Representatives regarding solution to Benchmark Cap issue, November 2016
Letter to Senate regarding solution to Benchmark Cap issue, November 2016 

Improved Care Coordination

ACHP advocates for innovative and cost effective approaches to caring for those receiving Medicare benefits with the goal of improving health outcomes. Our efforts are focused on the reauthorization of Special Needs Plans, expansion of telehealth in Medicare Advantage, restoring quality payments under the MA benchmark cap, and increasing flexibility to offer coverage using Value-Based Insurance Design.

Statement for the Record: Ways & Means Committee MA Hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries, June 2017

Telehealth in Medicare

ACHP members increasingly utilize telehealth to expand access, provide clinical care and strengthen coordination of services. Health plans are using electronic visits, video technology, and remote monitoring to provide care as well as diagnose and treat when appropriate.

Statutory and regulatory restrictions currently inhibit the use of these technologies in both the traditional Medicare program and in Medicare Advantage. ACHP believes that telehealth technologies should be considered a complementary means of providing clinical services, and not a service itself. That’s why ACHP is working to enact legislation that would allow Medicare Advantage plans to utilize the full range of remote technologies to care for beneficiaries.

ACHP Recommendations to CMS for Regulations Implementing Telehealth Provisions of the Bipartisan Budget Act, July 2018
National Coalition of Health Care Letter to Congressional Leaders on Extenders Package, February 2018
Letter to Congressional Leaders on the Extenders Package, February 2018

Additional efforts

ACHP response to CMS proposal to lower drug prices and reduce out-of-pocket expenses in Part D and Medicare Advantage, January 2019
Letter to Congressional Leaders on the Lame Duck Session, November 2018
Letter to CMS Administrator Seema Verma on Deeming, October 2018
Letter to Senate Finance Committee regarding CHRONIC Care Act, May 2017