Rep. Kelly Bill Would Fix Obamacare's Unfair Treatment of Rural Medicare Advantage Plans

Press Release

U.S. Representative Mike Kelly (R-Pa.) joined Representatives Ron Kind (D-Wis.), Brett Guthrie (R-Ky.), and Mike Doyle (D-Pa.) to unveil the Medicare Advantage Quality Payment Relief Act of 2021, legislation to fix an Obamacare benefit calculation that limits incentives for insurers to improve rural Medicare Advantage plans.

"Obamacare was written to benefit urban areas," said Kelly. "Our legislation will ensure that seniors in rural communities like Western Pennsylvania get a fair shake by enhancing incentives for insurers to lower their premiums and increase benefits."

Background

Under current law, insurers who offer Medicare Advantage plans are eligible to receive quality bonus payments that are based on CMS' Star Ratings System. The bonus payments must be used to reduce premiums or add additional benefits and services for beneficiaries.

The ACA established a benchmark calculation that determined how much of the Star Ratings System's quality bonus payments plans are eligible to receive. The formula prioritizes plans that had the most room to improve at the time the ACA was enacted, most of which were in urban communities. Rural Medicare Advantage plans had traditionally performed well under the Star Rating System, and are thus eligible for less funding under the program.

As the gap in quality has closed, the benchmark calculation continues providing urban areas with higher bonus payments, leaving rural seniors with plans that improve more slowly, if at all. The Medicare Advantage Quality Payment Relief Act of 2021 aims to fix this disparity by leveling the playing field.

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