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Journal Article
Escalating Growth of Spending on Medicare Advantage Plans: Save Medicare from Insolvency and Balance the Budget
2025
Overview
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.
Publisher
American Society of Interventional Pain Physician
