Three of Upstate New York’s largest not-for-profit health insurers are calling on Congress to act swiftly to protect Medicare Advantage members from rising costs and reduced care access. Excellus BlueCross BlueShield, CDPHP, and MVP Health Care say nearly 450,000 older adults in the region are at risk due to recent changes in federal Medicare policy.
At issue is a 2023 adjustment to the Medicare wage index, which increased federal funding for hospitals but left health plans without matching reimbursement. Health insurers warn that unless Congress intervenes, the financial burden will lead to higher premiums, steeper out-of-pocket costs, and fewer options for older residents relying on Medicare Advantage.
“We have faith that New York’s congressional delegation will find a solution to avoid catastrophic consequences for nearly 450,000 Medicare Advantage members with not-for-profit health plans in upstate New York,” said Jim Reed, president and CEO of Excellus BCBS.
The wage index change brought $1 billion in new federal dollars to upstate hospitals but failed to adjust payments to health plans, leaving insurers to absorb hundreds of millions in losses. Brian O’Grady, president and CEO of CDPHP, said the recent Medicare Advantage Rate Notice from the Centers for Medicare and Medicaid Services (CMS) addressed some rising costs but not the financial damage caused by the wage index shift.
“Our local, not-for-profit plans will continue to battle the effects of the wage index, which has left the future of our great health plan – and the 75,000 older adults who entrust us with their care – in jeopardy,” O’Grady said.
To address the issue, members of New York’s congressional delegation are reintroducing bipartisan legislation aimed at adjusting Medicare reimbursements for regional plans. First introduced last May by Rep. Claudia Tenney (NY-24), the bill is now backed by lawmakers including Reps. Tim Kennedy, Nick Langworthy, Mike Lawler, John Mannion, Joe Morelle, Josh Riley, Elise Stefanik, and Paul Tonko.
The legislation would allow CMS to apply a region-specific adjustment to Medicare reimbursements, helping community-based health plans stay viable and continue offering comprehensive benefits.
“We thank Congresswoman Tenney and our bipartisan Congressional delegation for supporting this imperative legislation,” said Chris Del Vecchio, CEO of MVP Health Care. “It will ensure that MVP can continue to innovate with our community provider partners and provide critical benefits to our Medicare members.”
In addition to the legislation, members of the delegation have co-signed a letter urging CMS to act on its own authority to correct the imbalance.
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