Medicare Advantage health plans are blasting a government proposal this week that would keep their reimbursement rates flat next year while making other payment changes.

But some health policy experts say the plan could help reduce billions of dollars in overcharges that have been common in the program for more than a decade.

On Jan. 26, Centers for Medicare & Medicaid Services officials announced they planned to raise rates paid to health plans by less than a tenth of a percent for 2027, far less than the industry expected. Some of the largest, publicly traded insurers, such as UnitedHealth Group and Humana, saw their stock prices plummet as a result, while industry groups threatened that people 65 and older could see service cuts if the government didn’t kick in more money.

In Medicare Advantage, the federal government pays private insurance companies to manage health care for people who are 65 and older or disabled. 

“Chart reviews”

Less noticed in the brouhaha over rates: CMS also proposed restricting plans from conducting what are called “chart reviews” of their customers. These reviews can result in new medical diagnoses, sometimes including conditions patients haven’t even asked their doctors to treat, that increase government payments to Medicare Advantage plans.

The practice has been criticized for more than a decade by government auditors who say it has triggered billions of dollars in overpayments to the health plans. Earlier this month, the Justice Department announced a record $556 million settlement with the nonprofit health system Kaiser Permanente over allegations the company added about half a million diagnoses to its Advantage patients’ charts from 2009 to 2018, generating about $1 billion in improper payments.

KP did not admit any wrongdoing as part of the settlement.

“I do think the administration is serious about cracking down on overpayments,” said Spencer Perlman, a health care policy analyst in Bethesda, Maryland.

Perlman said that while the Trump administration strongly supports Medicare Advantage, officials are “troubled” by plans that rake in undue profits by using chart reviews to bill the government for medical conditions even when no treatment was provided.

In a news release, CMS Administrator Mehmet Oz said curbing this practice would ensure more accurate payments to the plans while “protecting taxpayers from unnecessary spending that is not oriented towards addressing real health needs.”

“These proposed payment policies are about making sure Medicare Advantage works better for the people it serves,” Oz said.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, called the proposal “at least a mildly encouraging sign,” though he said he suspected health plans might eventually find a way around it.

Kronick has argued that switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in the government-run Medicare program, because of unbridled medical coding excesses. The insurance plans have grown dramatically in recent years and now enroll about 34 million members, or more than half of people eligible for Medicare.

David Meyers, an associate professor at the Brown University School of Public Health, called the proposed restriction on chart reviews “a step in the right direction.”

“I think the administration has been signaling pretty strongly they want to cut back on inefficiencies,” he said.

The outcry from industry, mostly directed at the proposal to essentially hold Medicare Advantage payment rates flat, was quick and sharp.

“If finalized, this proposal could result in benefit cuts and higher costs for 35 million seniors and people with disabilities when they renew their Medicare Advantage coverage in October 2026,” said Chris Bond, a spokesperson for AHIP, formerly known as America’s Health Insurance Plans.

CMS is accepting public comments on the proposal and says it will issue a final decision on the payment rates and other provisions by early April.

Meyers said health plans often claim they will be forced to slash benefits when they aren’t satisfied with CMS payments. But that rarely happens, he said.

“The plans can still make money,” he said. “They mostly are very profitable, just not as profitable as shareholders expected.”

The government pays Medicare Advantage plans higher rates to cover sicker patients. But over the past decade, dozens of whistleblower lawsuits, government audits, and other investigations have alleged that health plans exaggerate how sick their customers are to pocket payments they don’t deserve, a tactic known in the industry as “upcoding.”

Many Medicare Advantage health plans have hired medical coding and analytics consultants to review patients’ medical charts to find new diagnoses that they then bill to the government. Medicare rules require that health plans document — and treat — all medical conditions they bill.

Yet federal audits have shown for years that many health plans’ billing practices don’t hold up to scrutiny.

A December 2019 report by the Department of Health and Human Services inspector general found that the health plans “almost always” used chart reviews to add, rather than delete, diagnoses. “Over 99 percent of chart reviews in our review added diagnoses,” investigators said.

The report found that diagnoses reported only on chart reviews — and not on any service records — resulted in an estimated $6.7 billion in payments for 2017.

This week’s proposal is not the first time CMS has tried to crack down on chart reviews.

In January 2014, federal officials drafted a plan to restrict the practice, only to abruptly back off a few months later amid what one agency official described as an “uproar” from the industry.

The health insurance industry has for years relied on aggressive lobbying and public relations campaigns to fight efforts to rein in overpayments or otherwise reduce taxpayers’ costs for Medicare Advantage.

What happens this time will say a lot about the seriousness of the Trump administration in its crack down on controversial, long-standing payment practices in the program.

Perlman, the policy analyst, said it is “quite common” for CMS to partially backtrack when faced with opposition from the industry, such as by phasing in changes over several years to soften the blow on health plans.

David Lipschutz, an attorney with the Center for Medicare Advocacy, a nonprofit public interest law firm, said finalizing the chart review proposal “would be a meaningful step towards reining in overpayments to Medicare Advantage plans.

“But in the past, he said, even a minor change to Advantage payments has led the industry to protest that “the sky will fall as a result, and the proposal is usually dropped.”

“It’s hard to tell at this stage how this will play out,” Lipschutz said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

EDITOR’S NOTE:  If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide & Crisis Lifeline by dialing 988 to connect with a trained counselor, or visit the 988 Lifeline website.

People in the United States can expect to live longer than ever, as death rates returned to pre-pandemic levels in 2024.

Life expectancy in the US had been trending up for decades before dropping by nearly a year and a half between 2019 and 2021, but it’s been on the rise again since 2022.

Another 4% drop in the death rate between 2023 and 2024 raised life expectancy by more than half a year.

This dramatic rebound has brought life expectancy at birth up to 79 years in 2024 — the highest it has ever been, the US Centers for Disease Control and Prevention said.

There were 722 deaths for every 100,000 people in the US in 2024 – nearly 3.1 million deaths overall – according to final, age-adjusted data published Thursday by the CDC’s National Center for Health Statistics.

The 10 leading causes of death accounted for more than 70% of all deaths in the US in 2024, led by heart disease and cancer that killed more than 600,000 people each.

But death rates declined for each of the 10 leading causes of death in 2024, including a particularly sharp drop in unintentional injuries — a category that is largely comprised of drug overdose deaths.

Drug overdose deaths spiked during the Covid-19 pandemic, but the rate has been declining since 2022, according to the CDC. In 2024, drug overdose death rates fell among all age groups and among all racial and ethnic groups — leading to a sharp overall drop of more than 26% in one year.

Fentanyl and other synthetic opioids are still involved in most overdose deaths, ​but their involvement is becoming less prevalent — likely a key factor driving the overall decline in overdose deaths. About 6 in 10 overdose deaths in 2024 involved fentanyl or another synthetic opioid, CDC data shows, down from more than 9 in 10 in 2023.

Deaths involving psychostimulants such as methamphetamine and cocaine also declined in 2024, according to the CDC data.

Drug overdoses are still a leading cause of death in the US — more than 79,000 people died from one in 2024 — but provisional data from the CDC shows continued drops into 2025.

Covid-19 quickly rose to the third leading cause of death in the US in the first two years of the pandemic, falling to fourth in 2022 and tenth in 2023, according to CDC data. But it dropped out of the 10 leading causes of death in 2024, replaced by suicide.

There are still tens of thousands of Covid-19 deaths in the US each year, but suicide mortality reached a record high in the US in 2022 and has decreased only slightly in the years since.

In 2024, more than 14 million adults had serious thoughts of suicide, 4.6 million made a suicide plan and 2.2 million attempted suicide, according to survey data from the Substance Abuse and Mental Health Services Administration. Millions of people have called, texted, or sent chats to the 988 Suicide & Crisis Lifeline since mid-2022; about a tenth of those individuals who reached were routed to a specialized subnetwork for LGBTQ+ youth — a service the Trump administration ended last year.

Overall, women can still expect to live a few years longer than men but that gap is shrinking, CDC data shows. The life expectancy for women increased by 0.3 years to 81.4 in 2024, while life expectancy for men increased 0.7 years to 76.5.

Death rates decreased across all racial and ethnic groups between 2023 and 2024, but stark disparities remain. Despite higher than average declines, American Indian men and Black men continued to have the highest age-adjusted death rate in 2024 — about 1,200 deaths and 1,000 deaths per 100,000 people, respectively.

Death rates also decreased across age groups, except among children ages 5 to 14 for whom the death rate held relatively steady between 2023 and 2024.

Infant mortality had been trending down in the US for decades before spiking in 2022, and the latest CDC data shows that recovery is slow. More than 20,000 babies died before they turned 1 in 2024 – about 5.5 deaths for every 1,000 live births. Last year, the Mississippi health department declared a public health emergency over rising infant mortality rates in the state.