U.S. Rep. Elise Stefanik, District 21 | Official U.S. House headshot
U.S. Rep. Elise Stefanik, District 21 | Official U.S. House headshot
Congresswoman Elise Stefanik has partnered with Congresswoman Claudia Tenney (R-NY) to introduce legislation aimed at addressing the significant under-projection of Medicare Advantage (MA) local growth due to wage index reclassification.
The Centers for Medicare and Medicaid Services (CMS) utilizes the Medicare Wage Index to determine federal reimbursements to hospitals providing care for patients with original Medicare. The wage index adjusts hospital payments based on labor costs in specific geographic areas. Health plans often use these same payment rates for hospitals caring for their MA members.
In 2023, CMS updated the wage index through its FY24 Inpatient Prospective Payment System (IPPS) Rule, reclassifying many hospitals as "rural." However, the federal government did not increase reimbursements for MA insurers accordingly. This discrepancy has negatively impacted regional plans servicing Upstate New York. Without a correction from CMS, this could lead to higher out-of-pocket costs and premiums for the 119,183 MA beneficiaries living in NY-21.
"Ensuring our seniors have access to the most affordable health plans and are able to maintain their popular Medicare Advantage benefits is one of my top priorities which is why I am proud to co-lead this legislation to address the wage index reclassification," said Congresswoman Elise Stefanik.
"Our community's seniors deserve continued access to affordable, high-quality healthcare," said Congresswoman Claudia Tenney. "By adjusting the benchmark rates to reflect the increased costs faced by our regional plans, we can protect our seniors from losing essential coverage and experiencing higher premiums. This bill will ensure that Medicare Advantage plans continue to provide the robust benefits that so many members of our community rely on."
Read the full text of the bill here.
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