Medicare Advantage and Total Medicare Spending

By April 16, 2026Commentary2 min read

Lot of news and research around Medicare and Medicare Advantage in particular these days.  Some is put out by people with clear agendas, but it can still be accurate and useful.  Elevance is a large Blue Cross company which has a significant MA business and it obviously wants to defend the value of the program.  It commissioned a study which on a county geographic level looked at the percent of Medicare Advantage penetration compared to per beneficiary overall Medicare spending in the county.  More MA penetration was associated with lower total per capita Medicare spending.  For every 10% of additional MA penetration, total spending was about $140 lower per year, after adjustment for upcoding, without that adjustment the spending was even lower.  Not a lot but suggests that Medicare Advantage is very unlikely to be causing Medicare to spend more than it would if all the beneficiaries were in fee-for-service Medicare.

The likely explanation is a spillover impact from MA to fee-for-service Medicare in utilization patterns.  MA plans encourage doctors to manage patients in an evidence-based manner and avoid unnecessary spending.  Those practice patterns likely influence how doctors treat all their Medicare patients.  The result is also consistent with other evidence, like the fact that Medicare spending has consistently fallen below CBO projections, at the same time as MA enrollment was surging.  (Sage Article)

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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