Commonwealth Fund March 4, 2024

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As enrollment in Medicare Advantage plans continues to grow, how they are paid, and how much, becomes increasingly important

Effective and efficient payment to Medicare Advantage plans helps ensure that plans meet patients’ health needs while making good use of taxpayer dollars

Medicare Advantage offers Medicare benefits through private insurance plans, as an alternative to traditional Medicare. The federal Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, pays these private plans on a capitated basis — a per person, per month rate to cover health care services for each enrollee.

Every year, CMS is statutorily required to update how much Medicare Advantage plans are paid to cover their enrollees. The rates are revised upward or...

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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, Patient / Consumer, Payer, Provider
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