What’s Trending in the News: Mounting Pressure on Medicare Advantage Insurers

Growth in the Medicare Advantage market may slow in coming months while insurers strategize to manage increases in regulation and the costs of utilization and care. The past several years have seen a boom in the MA market as evidenced by expanding enrollment and plan options. However, the MA industry may be at a turning point as pressure mounts to control costs and adapt to increased competition.

The Centers for Medicare and Medicaid Services (CMS) has been in the news recently as it rolls out significant changes for MA plans, including

• New data reporting requirements. Kaiser Family Foundation reports that CMS aims to increase transparency by collecting data on use and spending for supplemental benefits starting this year. Starting in 2026, CMS will require MA payers to make specific data related to use and timeliness of prior authorizations available on their websites.
• Enacting caps on broker compensation. Fierce Healthcare noted in its summary of the 2025 Final Rule that CMS aims to increase objectivity in MA plan recommendations by requiring fixed broker compensation. 
• Expanding health equity. As part of its ongoing work to close gaps in health care access, quality and outcomes, the CMS 2025 Final Rule includes new MA plan network adequacy requirements for outpatient behavioral health to help increase access to mental health services for individuals in underserved communities. 

Controlling spending while also providing fair and adequate payments to public health stakeholders, including hospitals, physicians and Medicare Advantage plans, will continue to be a challenge for CMS. 

How SKYGEN Can Help MA Insurers Adapt to Thrive

SKYGEN is an experienced Medicare Advantage partner to insurers leading the MA market. We use our transformative dental and vision benefits automation platform and top specialty benefits industry expertise to help our partners:

• Promote preventive care to help maintain member health 
• Flex for different markets and changing market pressures with custom plans
• Create enhanced, member-first experiences with modern, streamlined technology and digital tools as well as provide communication options with experienced Call Center representatives and 24/7 IVR
• Keep administrative costs low with automation that efficiently handles complex benefit designs, frequent plan changes, and dual eligibility
• Retain members and brokers with a consistently exceptional experience

SKYGEN helps insurers compete to win in the evolving MA market. To start a conversation with a knowledgeable SKYGEN MA dental and vision benefits expert, put us touch in with you. You can also take a quick look at SKYGEN solutions that can help you manage the growing pressures of the MA dental market.