Health Affairs November 26, 2025
Medicare Advantage (MA) is privately administered health care insurance for seniors and persons with disabilities. The program has grown rapidly and now covers more than half of Medicare-eligible enrollees. Federal payments to MA plans are adjusted to account for enrollees’ health status through a risk-adjustment system, known as the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) model. In late 2024, CMS previewed a significant revision to the risk-adjustment model that has long been considered by policy makers and researchers. This revision requires thoughtful consideration of several methodological questions to ensure program stability for beneficiaries and promote accuracy in MA plan payments.
Risk-Adjustment Model Used To Adjust MA Payments Is Based On Fee-For-Service Enrollees’ Experience
Payments to MA...
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