MPI Blog

In this blog, Carrie Graham and Laura Skopec explore the views of local and regional plans expressed in a 2025 closed-door roundtable convened by Georgetown University’s Medicare Policy Initiative and West Health. Representatives of smaller plans expressed support for several reforms to the MA risk adjustment methodology to rein in aggressive upcoding and to refocus competition on the quality of care, not the volume of diagnoses.

In this blog, MPI’s Neil Patil and Carrie Graham explain how unlinked chart reviews currently function within MA risk adjustment, why CMS and federal oversight bodies have raised concerns about their role in upcoding and overpayments, and how the proposal aligns with longstanding recommendations from government oversight bodies and MA payment experts.

In this blog, MPI Health Policy Director Neil Patil breaks down how to evaluate the CMS reported expected average MA payments to plans and what the number might really mean once all factors are accounted for.

In a new blog, Laura Skopec and Carrie Graham share findings from a 2025 closed-door roundtable and interviews with 12 local and regional MA plans. The blog highlights how high and variable commissions, opaque third-party marketing practices, and aggressive sales tactics can disadvantage smaller plans, despite their important role in local innovation, community engagement, and beneficiary-centered care.

Last month, the Centers for Medicare & Medicaid Services (CMS) announced the negotiated Medicare prices for the 15 selected Medicare Part D drugs for 2027. In this MPI blog, Health Policy Director Neil Patil examines these recent drug pricing actions and whether the steps taken under Trump’s second term will actually improve the affordability of prescription drugs.

CMS’ decision to suspend enforcement of key prior authorization and utilization management rules in Medicare Advantage will halt a source of information and transparency. In this MPI blog, Research Fellow Ciannah Correa breaks down the rules that CMS has suspended, what PA transparency rules still take effect in 2026, and how these changes may affect enrollee choice and oversight in MA.

Recent headlines suggest the Medicare Advantage (MA) market is in turmoil—with insurers pulling back and a slowing of the MA enrollment boom that we have seen over the last few years. In this new blog, guest blogger Laura Skopec and Director Carrie Graham take a closer look at the data, policy changes, court rulings and competing narratives shaping next year’s MA landscape.

Under the Quality Bonus Program, Medicare Advantage (MA) contracts are assigned a star rating of 1 to 5 based on about 40 quality measures. In this MPI Blog, Laura Skopec discusses the advantages and disadvantages of measuring MA quality at the plan and contract level.

Currently, CMS measures Medicare Advantage quality at the contract level rather than the plan level. In this MPI blog, Rachel Schmidt outlines problems associated with measuring MA quality at the contract level and the implications for beneficiary choices and plan payments.

We are delighted to welcome our new Research Fellow Ciannah Correa.

In this MPI blog by Neil Patil and Jack Hoadley, we take lessons learned from prior authorization in Medicare Advantage and raise questions for policymakers and stakeholders to ensure Medicare beneficiaries receive appropriate access to timely benefits under this new model.

By Jack Hoadley, Beth Fuchs, and Rachel Schmidt The authors have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers can call for unbiased assistance choosing among …

By Neil Patil and Carrie Graham On April 4, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D Final Rule. While CMS’s decision not to require Medicare and Medicaid to cover GLP-1 medications for treating obesity is likely to make headlines, another important issue has …

By Jack Hoadley The Trump Administration announced on April 4, 2025, that it would not broaden coverage of anti-obesity drugs in Medicare. They did not rule out reconsidering this possibility in the future, however, and others have offered policy proposals for expanding coverage of these drugs. These proposals are included in the compendium of policy …

By Carrie Graham and Madeline McBride A number of conservative policymakers and think tanks have pushed to make “privatizing Medicare” part of the current Trump administration’s healthcare agenda. One path toward more privatization is to “default” Medicare beneficiaries into private managed care plans called Medicare Advantage (MA). This would mean that instead of being in traditional …

Part of the Georgetown University McCourt School of Public Policy’s Center on Health Insurance Reform (CHIR), the Medicare Policy Initiative (MPI) is shining a light on how Medicare and the Medicare Advantage program can be strengthened so that seniors and taxpayers can get the best possible care and value for their money. This new initiative at CHIR …

Two research professors from Georgetown University’s Medicare Policy Initiative, Rachel Schmidt and Jack Hoadley, have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers …

By Rachel Schmidt and Carrie Graham On December 16, CMS announced its intention to terminate the Medicare Advantage (MA) Value-Based Insurance Design (VBID) demonstration at the end of 2025 due to the model’s substantial cost. Evaluations of the VBID model found $2.3 billion higher program spending associated with the model in 2021 and $2.2 billion …