Medicare Advantage Competition at the Local Level: A Case Study of Birmingham, Alabama
Competition is central to the design of Medicare Advantage (MA), with the potential to encourage pla...
Medicare Advantage Payment
Federal spending and the sustainability of the Medicare program are central to the policy debate. With the majority of beneficiaries now enrolled in Medicare Advantage (MA), and payments to MA now exceeding what spending would have been in traditional Medicare, understanding how MA plans are paid is essential. MPI’s work in this area breaks down the MA payment system and looks at the policy levers that shape how private plans are financed, with particular attention to topics such as risk adjustment, coding intensity, quality bonus payments, plan rebates, and payment benchmarks.
Explore policy proposals related to Benchmarks for plan payments, Risk adjustment, Quality bonus program and star ratings, Supplemental benefits and rebates, and Encounter data in our Medicare Advantage Compendium.
The Push for Medicare Advantage Transparency: How Recent Legislation in the House Targets Existing Data Gaps
With Medicare Advantage (MA) becoming the dominant form of coverage in Medicare, understanding MA is...
Medicare Advantage Quality Bonus Program: Court Decisions Spotlight Flaws
This Health Affairs Forefront piece by Erica Socker and Katie Keith examines how recent court challe...
From “Flat” to Favorable: How Medicare Advantage Payments Increased in the Calendar Year (CY) 2027 Rate Announcement
In January 2026, the Centers for Medicare & Medicaid Services’ (CMS) Calendar Year (CY) 2027 Medic...
The Game(ing) isn’t Over: Upcoding After v28
As policymakers weigh the success of recent reforms, this blog explores why the a mathematically pro...
A Policymaker’s Guide to Interpreting Studies that Compare Medicare Advantage and Traditional Medicare Payment
With Medicare spending projected to reach $2 trillion by 2032, getting the cost story right matters....
Contract Year 2027 Medicare Advantage and Part D Proposed Rule
This presentation highlights key policies in the Contract Year 2027 Medicare Advantag...
CMS Takes Aim at Upcoding: Ending “Unlinked” Chart Reviews in Medicare Advantage
MPI’s Neil Patil and Carrie Graham explain how unlinked chart reviews currently function within MA...
Apples to Oranges: Including the MA Risk Score Trend in CMS’s Estimates of MA Payments
MPI Health Policy Director Neil Patil breaks down how to evaluate the CMS reported expected average ...
Response to CMS Request for Information on Future Directions in Medicare Advantage – Risk Adjustment and Quality Bonus Payments
This formal comment letter responds directly to a federal Request for Information regarding the futu...
A Policymaker’s Guide to Medicare Advantage Payment
Medicare Advantage payment is a complex web, with a multitude of equations, calculations, and risk a...
The Impact of Health Risk Assessments and Chart Reviews on Medicare Advantage Payment
This fact sheet examines how health risk assessments (HRAs) and retrospective chart reviews have con...
Assessing Medicare Advantage Quality at the Plan versus Contract Level
Under the Quality Bonus Program, Medicare Advantage (MA) contracts are assigned a star rating of 1 t...
Implications of measuring Medicare Advantage quality at the contract level: What that means for beneficiary choices and plan payments
Currently, CMS measures Medicare Advantage quality at the contract level rather than the plan level....
[Webinar] Medicare Advantage Payment and Opportunities for Cost Containment
On May 2, 2025, The Georgetown University Center on Health Insurance Reforms (CHIR) Medicare Policy ...
Does Medicare Advantage Save the Government Money?
Medicare Advantage (MA) is a program that allows private health insurance companies to provide Medic...
What to Know About CMS’s Announcement That it Plans to Terminate VBID
On December 16, CMS announced its intention to terminate the Medicare Advantage (MA) Value-Based Ins...