Payment

Plans must cover the same benefits as Traditional Fee-For-Service (FFS) Medicare, and these payments are risk adjusted to reflect the specific characteristics and anticipated cost of providing care to each beneficiary. Within this capitated payment, plans, providers, and community-based partners must work together to effectively care for the beneficiary. The goal of managing within a fixed payment is to encourage coordinated care that emphasizes prevention, customized care, and innovation to improve outcomes and prevent avoidable adverse events.

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Medicare Advantage Achieves Better Outcomes Than Traditional Medicare

Overview Medicare is the largest payer of healthcare in the United States. Medicare Advantage, the private Medicare health plan option available to beneficiaries, now...
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More About Payment

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Fact Sheet
Key Facts: • Medicare Advantage plans are paid a capitated amount based on the average cost of FFS Medicare. That payment is risk adjusted for...
Fact Sheet
Key Facts • CMS adjusts Medicare Advantage plan payments to account for cost differences associated with health status and demographic factors through a process called...
Fact Sheet
Medicare Advantage Payments The Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage plans a monthly, per-person, fixed rate, also known as a capitated...