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September 23, 2021

CMS Imposes Enrollment Sanctions on Five Medicare Advantage Plans for Failure to Meet MLR Requirements

On September 2, CMS notified five MA plans that they had failed to satisfy medical loss ratio (MLR) requirements and therefore are prohibited from enrolling new beneficiaries in their prescription drug plans for the 2022 contract year. Under Section 1857(e)(4) of the SSA, MA plans are required to spend at least 85% of premiums on medical care and certain quality improvement activities. A plan that fails to meet the 85% threshold for three consecutive years is prohibited from accepting new enrollments. CMS notices were issued to three plans operated by UnitedHealth Group, as well as a plan operated by Anthem and a plan operated by MMM Healthcare. United and other health plans have said that the ongoing COVID-19 pandemic and the corresponding disruption in access to medical care has resulted in plans having lower MLRs.