Payments to Medicare Advantage: The Methodology
- Positions and Publications
Under Original Medicare, Medicare pays providers a fixed rate for each service rendered to enrollees. By contrast, Medicare pays private Medicare Advantage plans a fixed monthly rate for each enrollee; the plans then pay providers to deliver care. The Medicare Advantage payment rates are set annually through a complicated series of determinations and adjustments that have significant bearing on Medicare financing. In this fact sheet, we review those processes and impacts.
This work was supported in part by Arnold Ventures. Medicare Rights Center maintains full editorial control over all of its policy analysis and communications activities.
Recent Resources
Any changes to the Medicare program must aim for healthier people, better care, and smarter spending—not paying more for less. As policymakers debate the future of health care, we will provide our insights here.
Thinking ahead to Medicare's future, it’s important to modernize benefits and pursue changes that improve how people with Medicare navigate their coverage on a daily basis. Here are our evolving 30 policy goals for Medicare’s future.
You can help protect and strengthen Medicare by taking action on the important issues we are following, subscribe to newsletter alerts, or follow along on social media. Any way you choose to get involved is a contribution that we appreciate greatly.