This white paper synthesizes findings from semi-structured interviews and a closed-door roundtable conducted in 2025 with executives from 12 small and midsize Medicare Advantage Organizations (MAOs)—defined as parent organizations with total MA enrollment under 500,000. The report captures the unique operational challenges, market perspectives, and policy reform preferences of local and regional plans, whose viewpoints are frequently overlooked in federal policy debates.
Takeaways:
- Participating plans broadly agreed that current MA spending trends are unsustainable. They supported shifting policy incentives away from revenue-generating activities with low clinical value (such as aggressively capturing diagnosis codes) toward care coordination and member service.
- Current policies favor the largest national MAOs. Large insurers can balance profitability across states, leverage vertical integration, and outspend smaller plans on marketing and IT infrastructure.
- Major policy overhauls must be phased in gradually to prevent unintended operational shocks that could force smaller plans to withdraw from local markets, accelerating industry consolidation.
- Policymakers should avoid piecemeal, uncoordinated updates and establish a unified roadmap linking risk adjustment, county benchmark adjustments, and quality incentives.
Download the white paper to learn more about policy recommendations covering: risk adjustment, Star ratings/Quality bonus payments, MA Marketing, Supplemental benefits, and prior authorization.