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The U.S. health care system faces escalating costs and inefficiencies, with Medicare projected to reach insolvency by 2036. Despite this, Medicare Advantage (MA) plans continue to receive preferential funding, resulting in overpayments, rising patient out-of-pocket expenses and limited accountability, instead of being a tool to achieve lower spending and increase quality. Physicians endure payment cuts, sequestration, and denied services, threatening access to care. To analyze MA plans' growth, costs, and policy implications and assess their impact on Medicare solvency, physician reimbursement, and patient care quality. A comprehensive policy and financial analysis using data from Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, Congressional Budget Office, peer-reviewed literature, and federal reports from 1997-2025. We reviewed legislative history, financial trends, and quality metrics of Medicare and MA programs. Specific focus was placed on benchmarks, rebates, risk adjustments, favorable selection, coding intensity, and patient access barriers. Data on enrollment trends, geographic variation, and out-of-pocket costs were analyzed. MA enrollment grew from 6.9 million (16% of Medicare beneficiaries) in 2014 to 33.6 million (54%) in 2024. Payments to MA plans exceed fee-for-service (FFS) Medicare by 22%, translating to $84 billion annually, plus $15 billion in quality bonuses. Out-of-pocket maximums surged 859% since 1999, and inappropriate care denials affect 13%-18% of cases. Risk adjustment and coding practices inflate payments, undermining program sustainability. The present investigation relies on secondary data from government agencies and published literature; real-time administrative and clinical data from MA plans were unavailable due to reporting gaps. Originally intended to reduce costs, MA plans have driven higher expenditures, limited access, and increased patient burdens. Policy reforms-including alignment of MA payments with FFS Medicare, elimination of favorable selection and upcoding incentives, and enforcement of coverage requirements-are critical to preserving Medicare solvency and ensuring equitable patient care.

Background Over five million people in the USA miss or delay medical care because of a lack of transportation. Transportation barriers are especially relevant to Medicare Advantage (MA) health plan enrollees, who are more likely to live with multiple chronic conditions and experience mobility challenges. Non-Emergency Medical Transportation (NEMT) helps to address transportation gaps by providing rides to and from routine medical care (for example, medical appointments, laboratory tests, and pharmacy visits) and has been added as a supplemental benefit to some MA health plans. Objective We aimed to characterize MA enrollees’ experiences with supplemental NEMT benefits. Design Qualitative interviews focused on participants’ experiences with existing NEMT benefits, transportation, and mobility. Participants Twenty-one MA enrollees who used their MA NEMT benefit in 2019 and who remained eligible for ongoing transportation benefits through 2021. Approach Using purposive sampling from a list of eligible participants, we recruited individuals who used their MA NEMT benefit in 2019 and who remained eligible for benefit-covered transportation services through 2021. Key Results Participants considered NEMT an essential service, particularly because these services helped them decrease social isolation, reduce financial insecurity, and manage their own medical needs. Navigating logistical challenges associated with arranging NEMT services required participants to commit considerable time and energy and limited the effectiveness and reliability of NEMT. Conclusion Participants described NEMT as a valued service essential to their ability to access health care. They suggested ways to increase service flexibility and reliability that could inform future NEMT policy and practice. As health systems and payers learn how to best address social risks, particularly as the US population ages, our findings underscore the importance of NEMT services and highlight opportunities to advance comprehensive transportation solutions for MA participants.

In 2018, the US Congress enacted a policy permitting Medicare Advantage (MA) plans to cover telehealth services in a beneficiary’s home and through audio-only means as part of the basic benefit package of services, where prior to the policy change such benefits were only allowed to be covered as a supplemental benefit. MA plans were afforded 2 years of lead time for strategizing, negotiating, and capital investment prior to the start date (January 1, 2020) of the new coverage option. Our data analysis found basic benefit telehealth was offered by plans comprising 71% of enrollment in 2020 and increased to 95% in 2021. At the same time, remote access telehealth was offered as a supplemental benefit for 69% of enrollees in 2020, a decrease of 23% compared to 2019. These efforts by MA plans may have enabled traditional Medicare (TM) to leverage an existing telehealth infrastructure as a solution to the access issues created by public health policies requiring sheltering in place and social distancing during the COVID-19 pandemic. The success of this MA policy prompts consideration of additional flexibility beyond the standard basic benefit package, and whether such benefits reduce costs while improving access and/or outcomes in the context of a managed care environment like MA. Subject to oversight, such flexibility could potentially improve value in MA, and facilitate future changes in TM, as appropriate.

Health insurance coverage options are complicated and often leave Medicare beneficiaries, families, advocates, and brokers confused. Medicare should make small changes to its existing “Compare Coverage Options” tool that would enhance the public’s understanding of the trade-offs between Medicare Advantage and supplemental Medigap with Fee-for-Service Medicare. For cost considerations, Medicare should include a projection of annual out-of-pocket (OOP) spending, whether an OOP cap applies and whether the ability to alter OOP for additional clinical benefit is offered. For access considerations, Medicare should provide access to information to educate the public on coverage and costs associated with dental, vision, and hearing benefits, network adequacy, prior authorization, and supplemental benefits. These changes will enhance transparency and decision making.

Purpose of Review Medicare Advantage (MA), or Medicare Part C, is the program that allows private health insurance companies to provide Medicare services. MA is growing exponentially with increasing enrollment of older adults who are more medically and socially complex and more racially and ethnically diverse. Legislative and regulatory oversight of MA has lagged behind its growth. Here we review key aspects of MA pertinent to older adults and those with serious illness, and we highlight recent major federal policies shaping MA. Recent Findings While MA was initially developed to provide cost savings, generate innovations in care, and improve healthcare quality, data indicate that costs are higher and quality is variable as compared to traditional Medicare. Development of functional impairment or worsening illness are associated with people switching from MA to traditional Medicare, which raises concerns about whether MA can adequately meet the needs of complex older adults. Recent legislative and regulatory updates have allowed MA plans to expand supplemental benefits that target social determinants of health and offer access to palliative care. Regulations continue to work towards increased transparency around quality and marketing of MA plans. Summary MA has the potential to be beneficial for older adults and those with serious illness, but there remain challenges for those with increasing social and medical complexity. Now that 50% of older adults will have insurance coverage through MA, there is great need for thoughtful, patient-centered federal policies for MA to ensure quality care for older adults, especially the most vulnerable. Clinicians, educators, and researchers need to be aware of how MA works, its implications for older adults, and how the latest federal policy changes to MA will affect the practice of medicine and what care their patients can access.

While the issue of loneliness is large and complex, we are beginning to understand how critical transportation access can be in helping to remedy this significant societal issue. Recognizing the connection between mobility (or a lack thereof) and loneliness, as well as these accessibility issues, Medicare Advantage programs are becoming more progressive in their transportation benefit programs.

China is at a critical juncture in its economic transition. A comprehensive reform of its pension and social security systems is an essential element of a strategy aimed toward achieving a harmonious society and sustainable development. Among policy makers, a widely held view is that the approach to pension provision and reform efforts piloted over the last 10-15 years is insufficient to enable China's economy and population to realize its development objectives in the years ahead. This volume suggests a national pension system that no longer distinguishes along urban and rural locational or hukou lines yet takes account of the diverse nature of employment relations and capacity of individuals to make contributions. This volume is organized as follows: the main text outlines this vision, focusing on summarizing the key features of a proposed long-term pension system. It first examines key trends motivating the need for reform then outlines the proposed three-pillar design and the rationale behind the design choices. It then moves on to examine financing options. The text continues by discussing institutional reform issues, and the final section concludes. The six appendixes provide additional analytical detail supporting the findings in the main text. The pension system design can play an important role in supporting or constraining such economic and demographic transitions: 1) fragmentation and lack of portability of rights hinder labor market efficiency and contribute to coverage gaps; 2) multiple schemes for salaried workers, civil servants, and, in some areas, migrants similarly impact labor markets; 3) legacy costs that are largely financed through current pension contributions weaken incentives for compliance and accurate wage reporting; 4) very limited risk pooling and interurban resource transfers limit the insurance function of the urban pension system and create spatial disparities in old-age income protection; 5) low retirement ages affect incentives and benefits and undermine fiscal sustainability; and 6) relatively low returns on individual accounts result in replacement rates significantly less than anticipated while at the macro level, are likely to inhibit wider efforts to stimulate higher domestic consumption.

With the aim to provide guidelines for countries wishing to introduce or improve income support systems for the unemployed, the book summarizes the evidence about the performance of five such systems: unemployment insurance, unemployment assistance, unemployment insurance savings accounts, severance pay, and public works. These systems are evaluated by two sets of criteria: (i) performance criteria, evaluating how well these systems work – how they protect incomes and what other, particularly efficiency related, effects they may have; and (ii) design and implementation criteria, evaluating how these systems fit the country – how suitable are these programs given country-specific conditions, chief among them being labor market and other institutions, the capacity needed for administering income support programs, the size of the informal sector, and prevalence of private transfers. Income Support for the Unemployed also offers summary evaluations of alternative systems by describing the strengths and weaknesses of each system and pointing out the country specific circumstances which are particularly conducive to performance.

During periods of high unemployment, many workers exhaust their unemployment insurance (UI) benefits before regaining employment. To help alleviate this problem, Congress created the extended benefits (EB) program, expanding the number of weeks of benefits available to UI recipients in high unemployment states. The EB program operates by \"triggering on\" additional weeks of benefits in states where unemployment and UI benefit receipt are above federally established thresholds. We analyze the performance of the EB program by creating a series of policy simulations using weekly UI claims and unemployment data from the program's inception in 1970 through the most recent economic expansion in 2005. Overall, we find that EB triggers, as currently constructed, fail as a policy tool for extending UI benefits. Minor adjustments to the triggers are unlikely to be effective. We develop an alternative set of \"fix point\" triggers that allow the EB program to trigger on and off in a more timely fashion. These triggers outperform all previously legislated triggers as well as other commonly proposed triggering mechanisms on criteria of timeliness, breadth, and duration.