Taking Advantage of Reimbursement Increases & New Benefit Opportunities for MA?

The Centers for Medicare & Medicaid Services (CMS) has provided increases in reimbursement to plans, and Gorman Health Group believes this trend will continue for Medicare Advantage (MA) for the immediate future. So how are you taking advantage of this?

  1. Are you increasing your service area?
  2. Are you entering MA for the first time?
  3. Are you increasing your benefits and lowering premiums in existing plans?
  4. Are you introducing new products that will be more competitive in the market?

If you answered “yes” to any of these questions, the time to start planning for 2020 is now.

The Notice of Intent is due to CMS on November 12 of this year. You now have less than two months to ensure you have a clear strategy in place if you plan on increasing your service area or are entering MA for the first time. If you answered “yes” to either question #1 or #2, now is the time to do the following:

  • Market analysis of proposed new counties you are planning to enter
  • Three-year enrollment opportunity analysis
  • Development of a scorecard to understand which counties have the best opportunity
  • Feasibility study to provide guidance on how long it will take to be profitable


For existing plans that are not expanding their service area, now is the time to do the following:

  • Membership analysis by plan including:
    o Age
    o Geography
    o Length of time with plan
    o Chronic conditions and how they affect the MLR
    o Disenrollment findings
    o Plus other data based on the story it tells
  • Competitive product and benefit analysis utilizing 2019 plans and benefits
  • Market analysis

Now is the time to develop your strategy so by 1st quarter 2019 you are ready to start implementing your strategy for new plans and more competitive benefits for 2020. CMS have now given plans enormous leeway in developing benefits—now is the time to take advantage of this opportunity. Today, some benefits will need to have returns on investment, and others will need to be researched to find new vendors to actually provide the benefits. In addition, you need to ensure operational limitations are not hindering you from finding the right set of benefits for your plans.

If you need help, please don’t hesitate to contact me. We at Gorman Health Group are happy to assist in any way.



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