Medicare Advantage (MA): Proposed Benchmark Update and Other Adjustments for CY2027 in Brief

Medicare Advantage (Part C, or MA) is an alternative way for Medicare beneficiaries to receive covered benefits. Under MA, private health plans are paid a per person monthly amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll in their plan. Unlike under original Medicare, where providers are paid for each item or service provided to a beneficiary, the same capitated monthly payment is made to an MA plan regardless of how many or how few services a beneficiary actually uses. The plan is at risk if costs for all of its enrollees exceed program payments and beneficiary cost sharing; conversely, in general, the plan can retain savings if aggregate enrollee costs are less than program payments and cost sharing. Medicare Advantage MA Part C Advance notice of methodological changes for CY2027 Capitation Rates, AHIP Benchmark Bid National Per Capita MA Growth Percentage US Per Capita Cost Growth Percentage USPCC, NPCMAGP EGWP Employer Group Waiver risk adjustment normalization cap payments quality bonus payment demonstration applicable amount specified amount Affordable Care Act phase-in to new benchmark coding pattern differences normalization ACA (P.L. 111-148, as amended) SUMMARY TO BE SUPPRESSED