Enrollment in Medicare Advantage (MA) has grown remarkably, increasing from 24% of Medicare beneficiaries in 2010 to 51% in 2023. Under MA, private insurers are paid using risk-adjusted per beneficiary per month rates, an approach that CMS and others believe will encourage efficient resource use and quality. Yet many stakeholders argue that MA plans are overpaid and have questioned the program’s value. In light of unprecedented enrollment growth, understanding how MA can be reformed to deliver on its promise is essential.
Center for Advancing Health Policy through Research
Medicare Advantage
The other half of the 62 million Medicare beneficiaries receive coverage through private plans for Medicare enrollees, known as Medicare Advantage.
Recent news
The article discusses how home health care workers in Rhode Island are fighting for better wages and working conditions through unionization, but their efforts are at risk due to proposed federal Medicaid cuts. David J. Meyers, a health economist at Brown University, warns that such cuts could have a “massive, qualitative impact on people’s lives” and ultimately increase health care spending as unmet needs at home lead to more hospitalizations and emergency visits.
Turn on the Lights Podcast
Health system ownership with Hayden Rooke-Ley
Is Medicare Advantage improving healthcare efficiency or creating higher costs that favor insurers? Hayden Rooke-Ley explores its rapid expansion, questions about cost and care quality, and the challenges of implementing effective regulations.
The Wall Street Journal
The Sickest Patients Are Fleeing Private Medicare Plans—Costing Taxpayers Billions
An increasing number of Medicare Advantage patients, especially those in their final year of life, are switching to traditional Medicare, leading to a significant cost shift from private insurers to taxpayers.
The Washington Post
Medicare Advantage insurers fear losing millions over a few bad phone calls
This article examines lawsuits from Medicare Advantage insurers, who claim minor customer service issues threaten millions in bonuses, while experts like Brown University's David Meyers argue that these cases reveal deeper flaws in a rating system that overstates plan quality without accurately reflecting patient care.
This article explores a study led by Brown University researchers on the billions in potentially redundant payments Medicare Advantage plans receive for veterans primarily cared for by the VA, despite industry claims, like those from UnitedHealthcare, that these payments reflect actual costs.
Chicago Sun Times and KFF Health News
Medicare Advantage plans got ‘alarming’ break from the U.S. government a decade ago: Here’s why
A decade ago, CMS tried to rein in Medicare Advantage overbilling, only to withdraw amid industry pressure, now fueling a $2 billion fraud case against UnitedHealth. Newly released court documents expose the struggle to protect taxpayer dollars while navigating powerful industry pushback.
Health Affairs Forefront
Are Changes To The Medicare Physician Fee Schedule Driving Value In US Health Care?
The Medicare Physician Fee Schedule is a cornerstone of U.S. healthcare policy, directly influencing how services are priced and covered. This Health Affairs blog delves into a brief analysis of the CY25 Physician Fee Schedule Proposed Changes and what impact it could have moving forward.
Dr. Ashish K. Jha, dean of the Brown University School of Public Health, addressed the House Committee on Ways and Means on why the U.S. is seeing a decline in private medical practices and what we can do about it.
Health Affairs Forefront
2025 Medicare Advantage Advance Notice: Small Changes, Missed Opportunities
Under the CMS 2025 Medicare Advantage Advance Notice, CAHPR researchers emphasize the expected revenue increases and minor changes in risk adjustment practices; highlighting the impactful changes on the horizon and the critical reforms that still await attention.
Read this NPR article or listen to the All Things Considered NPR broadcast featuring Dr. David Meyers where he talks about the difficulties a beneficiary can face when enrolled in Medicare Advantage.
Are fully integrated Medicare Advantage plans for dual-eligible individuals delivering on their promise of improved care coordination and patient experience? Find out by reading this article featuring Dr. David Meyers.
Researchers at Brown University School of Public Health in Providence found that many Medicare Advantage beneficiaries disenroll from their plans within five years of enrolling.