Healthcare DIVE September 3, 2025
The Alliance for Community Health Plans’ analysis adds to existing research suggesting major insurers are unfairly profiting from MA’s risk adjustment system.
Major insurers are gaming Medicare Advantage’s risk adjustment system to reap higher payments from the government, costing Medicare billions of dollars, according to a new analysis of CMS data.
UnitedHealthcare, the biggest MA insurer in the U.S., collected up to $785 more per beneficiary than local nonprofit plans in 2023, costing Medicare more than $6 billion in excess payments that year, according to the research released Wednesday from the Alliance of Community Health Plans, a group that represents local and regional nonprofit payers.
Similarly, Humana, the second-biggest MA payer, collected $423 more per beneficiary that year than if...
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