1、Milliman Medicare Webinar SeriesA year of change:State of the 2025 Medicare Advantage industryFebruary 12,2025PresentersJordan CatesFSA,CERA,MAAAConsulting A Mark FranklinASA,MAAAAssociate A Julia FriedmanFSA,MAAAPrincipal&Consulting A Joanne FontanaFSA,MAAAPrincipal&Consulting A 2025 MA-PD Headwind

2、s4MA-PD Headwinds MA Revenue BenchmarksSource:2020 2025 Rate Announcements and 2026 Advance Notice released by CMS.2025 nationwide benchmark trend remains at a lower level than recent yearsSTATE OF THE 2025 MEDICARE ADVANTAGE INDUSTRY:A YEAR OF CHANGE|2025 MA-PD HEADWINDS Nationwide benchmark trends

3、 decreased in payment years 2024 and 2025.Driven by Medicare FFS costs as well as a technical adjustment to the calculation methodology which is phased in over three years(2024 2026).Actual benchmark trends can vary significantly by county.5MA-PD Headwinds Risk ScoresSource:https:/ 2024 Part C CMS-H

4、CC Model which is phased in from 2024 2026 generally results in lower risk scoresSTATE OF THE 2025 MEDICARE ADVANTAGE INDUSTRY:A YEAR OF CHANGE|2025 MA-PD HEADWINDS 2024 Part C CMS-HCC risk score model introduced with substantial clinical revisions.CMS estimates the combined impact of new model phas

5、e-in and annual normalization factor updates to be-2.2%in 2024,-2.5%in 2025,and-3.0%in 2026.Milliman study estimated the fully implemented impact of the new model to be-3.5%to risk scores on average.Impacts of the 2024 model can vary significantly by MAO and plan type.-3.10%-1.60%-5.80%-11.10%-1.80%

6、-12.00%-10.00%-8.00%-6.00%-4.00%-2.00%0.00%GeneralEnrollmentEGWPD-SNPC-SNPI-SNPChange in Risk ScoreHigh Level Impacts of Fully Implemented 2024 Risk Score Model,Based on 2019 Diagnoses6MA-PD Headwinds Star RatingsSource:2021 2024 Star ratings published by CMSOverall average Star ratings decreased fo