Medicare Advantage Works - But It Needs the Right Support from Washington

During my tenure as a hospital administrator, I learned that health care doesn't stand still. Costs keep rising while patient needs keep evolving and workforce issues keep shifting. If the policies that support the system don't keep pace with these changes, then providers, patients, and families feel the impact quickly.

That's why I've been paying close attention to the latest developments out of Washington regarding Medicare Advantage. Earlier this year, there was real concern about where things were headed for this program. An initial announcement from the Centers for Medicare & Medicaid Services, or CMS, released in January called for a payment increase to Medicare Advantage plans of just 0.09%. That didn't even come close to reflecting what anyone in health care was seeing on the ground.

Fortunately, CMS listened to public feedback and adjusted its final rate for 2027 to a 2.48% increase. It doesn't match the 7% increase in healthcare costs we've seen over the past few years, but it's a big step in the right direction. While that adjustment helps, it doesn't mean the work is finished. There are still underlying threats to the stability and efficacy of Medicare Advantage that need to be addressed.

Medicare Advantage has become a big part of how seniors in Alabama get their care. It brings care together in a way that's easier to manage, and it includes prescription drug coverage. Plans often offer additional support that helps people stay healthier and avoid unnecessary hospital stays.

From a provider standpoint, coordination makes a real difference. If care is connected, then patients are more likely to stay on track with their treatment, which means they're less likely to end up back in the hospital. That's better for patients and families, and it's easier on the system. But it only works if the program is supported in a way that reflects the actual cost of care.

Despite the CMS' improved rate update for next year, there are still policies being debated in Washington that could move things in the wrong direction. One of those is the No UPCODE Act.

Proponents of the No UPCODE Act say that the bill address waste and improve oversight, both of which are important goals. In reality, the No UPCODE Act would reduce funding for key parts of Medicare Advantage, including in-home care and care coordination programs.

Those are the very services that help patients manage chronic conditions and avoid more serious complications. They're also the services that help keep people out of the hospital and reduce overall costs.

The impact of this bill would be especially hard on the people who rely on these services the most. Seniors managing conditions like diabetes or heart disease could lose access to programs that help keep them stable, rural patients could see fewer options for care close to home, and lower-income seniors could lose access to benefits like dental, vision, and hearing coverage.

Medicare Advantage has proven that a more coordinated approach to care can improve outcomes and help control costs over time. CMS's move to strengthen its rate update for 2027 shows that policymakers are listening. Now the focus should be on building on that progress, not reversing it.

Alabama's congressional delegation, including Senators Britt and Tuberville, must continue working with CMS and the administration to ensure payment policies reflect the actual cost of care. They should also take a hard look at proposals that could end up shifting costs onto seniors and limiting access to care.

Terry Andrus is the former CEO of East Alabama Medical Center

Opinions expressed are those of the author and do not necessarily reflect the views of the Alabama Gazette staff or publishers.