MA Health Plans: Are you ready for the CMS rate change?

Updated on May 20, 2024

With the recent Centers for Medicare and Medicaid Services (CMS) 2025 Medicare Advantage (MA) Rate Announcement, came finalized plans for a decrease in benchmark rates for 2025. Under the new rate changes, MA benchmark payments are set to be cut by 0.16% — so how will this impact the MA health plan market? Essentially, the rate announcement put MA health plans on notice that now’s the time to go above and beyond the status quo to protect margins.

While the CMS announcement is another reminder of rising costs in healthcare, it is also an opportunity for MA health plans to explore innovative ways to evolve and stand out. It has never been more important for plans to offer members value-added benefits that help prevent avoidable medical costs and set the stage for members to have positive outcomes. The good news is that these efforts deliver meaningful cost savings and favorable ROIs for plans while supporting members’ health and wellness. 

An effective and immediate way health plans mitigate rising costs and pressure in the market is by focusing on initiatives to reduce avoidable medical costs and preventable injuries, such as falls and fall-related injuries. Older people are dying from falls at more than 2x the rate of 20 years ago and fall-related injuries rank among the top 20 most expensive medical conditions. Fall-related claims result in $31 billion in Medicare costs every year. Because most falls are preventable, this is an area where health plans can make an impact with evidence-based fall prevention programs.

Science-backed fall prevention programs provide members with tools and resources to avoid future falls and serious injuries. In addition to being more affordable, newer digital fall prevention programs are scalable, engaging and more effective in reducing fall risk and fall-related claims. Health plans offering digital fall prevention programs such as Nymbl Science, report benefiting by as much as $3 Per Member Per Month (PMPM) and garnering a 3:1 ROI in the first year alone with preventive initiatives. If that wasn’t enough, certain digital fall prevention programs also positively affect Stars Ratings, which are crucial as Medicare consumers shop and compare health plans.

A recent study of 42,000 “high-risk” MA members who participated in a science-backed fall prevention program found that 62% experienced clinically meaningful improvements and more than 70% reported no longer being fearful of losing their balance at home. Results like these prove preventive initiatives are highly effective and make a difference for members and health plans alike.

As health plans prepare to implement the latest rate adjustments next year, it is paramount for plans to take a proactive approach to continue providing cost-effective best-in-class benefits to members. Today there are technology leaders that make it easy for health plans to roll out programs using digital technology (e.g. smartphones) to remove the physical and emotional barriers that often are associated with aging.

By adopting preventative initiatives, like fall prevention programs that help older adults minimize falls, maintain mobility and reduce associated medical costs, health plans can elevate offerings, evolve with rate changes and stand out in the crowded market. But most importantly, health plans can help members live independently and thrive today and in the future.

Nymbl Bob Mirsky Headshot copy
Bob Mirsky
Chief Medical Officer at Nymbl Science

Bob Mirsky, MD, MMM, FAAFP, is Chief Medical Officer at Nymbl Science, a digital health provider and leader in scalable fall prevention and bladder training for aging adults. Previously, he served as Chief Medical Officer and Vice President of Medical Operations for Aetna Medicare. He has also held leadership roles for North Shore-LIJ CareConnect Insurance Company, the Mid-Atlantic Region of Coventry Health Care, Gateway Health Plan in Pittsburgh, FloridaBlue, and Tenet Health System Florida. He practiced family medicine for 10 years in New York and Florida and completed his residency and chief residency at St. Joseph’s Medical Center.