How Medicare Pays Medicare Advantage Plans: Issues and Policy Options
This brief explains how Medicare Advantage payments are determined and provides an overview of policy options to change the Medicare Advantage payment system.
View the Latest: Medicare Advantage
Filter
-
-
Medicare Advantage Glossary
FeatureThis glossary serves as a guide to the sometimes arcane terms that inhabit the world of Medicare Advantage, the private plan alternative to traditional Medicare.
-
Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees
Issue BriefUsing Medicare Advantage encounter data, this analysis finds that 62% of Medicare Advantage enrollees have at least one chart review record and that diagnoses added from chart reviews increase payments from CMS to insurers for 17% of enrollees. The use of chart reviews varies across the largest Medicare Advantage insurers.
-
Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries
Issue BriefMedicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area in 2022, on average. The limitations of provider networks illustrate one of the key tradeoffs for beneficiaries in choosing Medicare Advantage for their coverage.
-
Medicare Advantage Provider Networks Limit Enrollees to About Half of the Physicians in Their Area That Are Available to Beneficiaries in Traditional Medicare, on Average
News ReleaseWith Medicare’s annual open enrollment period underway, a new KFF analysis finds that Medicare Advantage enrollees, on average, had access to just under half (48%) of the physicians in their area who were available to people enrolled in traditional Medicare. The finding illustrates a key tradeoff for beneficiaries in choosing Medicare Advantage.
-
Is Medicare’s New Provider Search Tool a Step in the Right Direction?
Quick TakeThe new provider search tool on the Medicare Plan Finder could make it easier for beneficiaries to figure out if their doctors are in a Medicare Advantage plan's network despite some data issues.
-
What to Know About the Medicare Open Enrollment Period and Medicare Coverage Options
Issue BriefEach year, Medicare beneficiaries have an opportunity to make changes to how they receive their Medicare coverage during the nearly 8-week annual open enrollment period. This brief answers key questions about the Medicare open enrollment period and Medicare coverage options.
-
Medicare Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026
Policy WatchMedicare beneficiaries will have 32 Medicare Advantage plans with prescription drug coverage available to choose from, on average, in 2026.
-
A Current Snapshot of the Medicare Part D Prescription Drug Benefit
Issue BriefThis brief provides an overview of the Medicare Part D prescription drug benefit, including current data on plan availability, enrollment, and spending and financing, and highlights changes made under the Inflation Reduction Act.
-
Medicare Part D Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026
Issue BriefThis brief looks at premium changes for Medicare Part D stand-alone prescription drug plans between 2025 and 2026. For plans that were offered nationwide in 2025 and will continue to be offered in 2026, Part D enrollees in many states will see lower monthly premiums in 2026.