Medicare Advantage (MA) Benchmarks, Bids, and Program Payment


Note: (1) This analysis is based on MedPAC analysis of MA plans’ bid submissions, and does not include any assumptions regarding coding intensity, nor are the figures adjusted to reflect actual MA and FFS experience. These data represent national averages. (2) MedPAC changed their methodology for estimating FFS expenditures in 2010 in a way that reduced the estimated MA payment ratio. Data for years 2006 – 2009 reflect projection of FFS experience under current law, which includes the expected cut in physician fee schedule due to the Sustainable Growth Rate (SGR) system. For 2010 – 2014, the FFS projection is based on a scenario of a 0 percent physician update. (3) MedPAC assumes that plans in 2014 bidded, and will be paid about the same relative to fee-for-service as they were in 2013.
Source: Medicare Payment Advisory Commission (MedPAC) Reports to Congress, March 2007-March 2014

Medicare Advantage (MA) Benchmarks, Bids, and Program Payments as a Percentage of Fee-For-Service Expenditures, 2006-2014 (1)

YearMA Benchmarks as a % of FFS Expenditures (includes local and regional benchmarks)MA Bids as a % of FFS Expenditures (represents bids for Medicare Part A and Part B benefits)MA Program Payments as a % of FFS Expenditures (bids plus rebates)
2014112%98%106% (2)