CMS suspends enrollment in some Medicare Advantage plans

The agency suspended enrollment in five MA plans, three of which are offered by UnitedHealthcare.

The Centers for Medicare and Medicaid Services (CMS) has suspended beneficiary enrollment in five Medicare Advantage (MA) plans this month citing their non-adherence to medical loss ratio requirements.

According to the agency’s website, between Sept. 2 and 17 CMS suspended enrollment in plans offered by UnitedHealthcare of the Midwest, UnitedHealthcare of New Mexico, UnitedHealthcare of Arkansas, Triple-S Advantage, and MMM Healthcare. In letters to the CEO of each organization, CMS explained that the plans must be closed to new beneficiaries in 2022 because the plans failed to meet 85 percent medical loss ratio required by law three years in a row.

The letters say that the three UnitedHealthcare plans’ medical loss ratio fluctuated between 78 percent and 84.5 percent over the past three years. MMM Healthcare, which was acquired by Anthem earlier this year, saw its medical loss ratio fall between 77 percent and 82.4 percent, and Triple-S Advantage fluctuated between 73.6 percent and 84.7 percent.

The plans will not be available for enrollment from Jan. 1, 2022, to Dec. 1, 2022, and will not appear on the prepared list of plans from which beneficiaries will pick a plan for 2022. The organizations will be able to continue accepting and processing enrollments that become effective on or before Dec. 1 of this year, according to the letters.

If the organizations can submit a 2021 report in 2022 that demonstrates the plan has achieved a medical loss ratio of at least 85 percent, they can resume accepting enrollment that become effective Jan. 2023. If the report does not show a medical loss ratio of at least 85 percent, enrollment will remain closed. If a MA plan fails to hit the 85 percent medical loss ratio for five years in a row, CMS must terminate the contract, the letters say.

The letters note that CMS lacks any discretion in this sanction and that the data the determination was based on was supplied by the organizations.