Becker's Healthcare June 30, 2025
For years, we’ve worked closely with independent physician groups across the country—OB/GYNs in Tennessee, retina specialists in the Midwest, mental health clinics on the coasts. Again and again, we see the same thing: contracts from Medicare Advantage (MA) plans, particularly those from UnitedHealthcare, reimburse providers 25–30% less than traditional Medicare.
And yet somehow, these plans report a compliant medical loss ratio (MLR) – the measure of how much a health plan’s premium is spent on medical care – despite paying significantly below the regional benchmark.
To add another layer, traditional Medicare spends approximately 27% more per member compared to Medicare Advantage Organizations (MAOs).1 Some would say this is the promise of Medicare Advantage, an increase in efficiency and a decrease...
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