The Implications Of Recalibrating Medicare Advantage Risk Adjustment Using Encounter Data

Health Affairs April 17, 2019
Bowen Garrett, Douglas Holtz-Eakin, Laura Skopec, Christopher Holt

The Medicare Advantage (MA) program allows Medicare beneficiaries to receive their Part A and B benefits through private plans that are paid a fixed amount per enrollee (or capitated) by Medicare to provide all such benefits to their enrolled members. MA plans play an increasingly important role in the Medicare program, with enrollment growing from about a quarter of all Medicare beneficiaries (or 11 million) in 2010 to 34 percent of beneficiaries (approximately 20 million) in 2018. And, according to the Congressional Budget Office, enrollment in MA is projected to exceed 40 percent (32 million) of the total Medicare population by 2028.

MA’s popularity indicates that it works well, and one of the reasons the system functions as well as...

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