Congresswoman Claudia Tenney (NY-24) reintroduced legislation aimed at addressing reductions in Medicare Advantage (MA) access and benefits. The bill addresses reimbursement shortfalls to local MA plans from the Centers for Medicare and Medicaid Services (CMS). Specifically, the bill allows CMS to adjust benchmark amounts based on local wage indices that have increased by 20 percent or more to ensure enrollees continue to receive comprehensive benefits and quality care.
Rep Tenney was joined in introducing this legislation by Representatives Elise Stefanik (NY-21), Nick Langworthy (NY-23), and Mike Lawler (NY-17).
In 2023, CMS made a needed adjustment to the wage index for Upstate New York hospitals, treating geographically rural and rural reclassified hospitals equally. This change led to wage index increases of 20-40% across Upstate New York. While this provided significant relief for hospitals that had been severely underpaid by the fee-for-service program, it inadvertently placed substantial financial pressure on regional MA plans, which are predominantly non-profit organizations.
Because CMS did not account for these new costs in their benchmark rates for 2024, MA plans have experienced significant financial challenges that jeopardize plans’ ability to provide affordable, quality coverage to their beneficiaries. Without relief, health plans will be forced to cut benefits and increase premiums for seniors who can least afford it.
Last week, Rep. Tenney sent a letter to CMS urging the agency to reassess the ongoing misalignment between hospital wage index increases and MA benchmark adjustments in Upstate New York.
“Our community's seniors deserve continued access to affordable, high-quality healthcare. Unfortunately, the payment disparity has already affected local plans’ offerings and limited seniors’ coverage choices. By adjusting the benchmark rates to reflect the increased costs faced by our regional plans, we can restore MA options for our seniors and protect them from higher premiums in the future. This bill will ensure that Medicare Advantage plans continue to provide the robust benefits that so many members of our community rely on,” said Congresswoman Tenney.
Congresswoman Claudia Tenney (NY-24), alongside Congressman Paul Tonko (NY-20), Congresswoman Elise Stefanik (NY-21), Congressman Joseph Morelle (NY-25), Congressman Nick Langworthy (NY-23), Congressman Brandon Williams (NY-22), and Congressman Marc Molinaro (NY-19) introduced bipartisan legislation to protect benefits and access to care for hundreds of thousands of seniors enrolled in Medicare Advantage plans in Upstate New York.
Last year, the Centers for Medicare and Medicaid Services (CMS) made a needed adjustment to the wage index for Upstate hospitals, treating geographically rural and rural reclassified hospitals equally. This change led to wage index increases of 20-40% across Upstate New York.
While this provided significant relief for hospitals that had been severely underpaid by the fee-for-service program, it inadvertently placed substantial financial pressure on regional Medicare Advantage (MA) plans, which are predominantly non-profit organizations. Because CMS did not account for these new costs in their benchmark rates for 2024, MA plans have experienced significant financial challenges that jeopardize plans’ ability to provide affordable, quality coverage to their beneficiaries. Without relief, health plans will be forced to cut benefits and increase premiums for seniors who can least afford it.
This legislation would address these dramatic reductions in access and benefits by granting CMS the ability to adjust their benchmark amounts to account for local areas with wage indices that grew by 20 percent or greater. This needed relief will ensure regional, non-profit MA plans remain viable and safeguard enrollees’ robust benefits and access to quality care.
“Our community's seniors deserve continued access to affordable, high-quality healthcare,” said Congresswoman Tenney. “By adjusting the benchmark rates to reflect the increased costs faced by our regional plans, we can protect our seniors from losing essential coverage and experiencing higher premiums. This bill will ensure that Medicare Advantage plans continue to provide the robust benefits that so many members of our community rely on.”
“Ensuring our seniors have access to the most affordable health plans and are able to maintain their popular Medicare Advantage benefits is one of my top priorities which is why I am proud to co-lead this legislation to address the wage index reclassification,” said Congresswoman Stefanik.
“Many Upstate New Yorkers rely on not-for-profit Medicare Advantage plans,” said Congressman Molinaro. “I’m proud to support Rep. Tenney’s bill to give CMS the authority to ensure seniors have access to the benefits they earned and are fully cared for.”
