Fact Sheet

The Impact of the Medicare Advantage Benchmark Cap on Beneficiaries

Key Facts

  • Medicare Advantage, plans that earn a high Star Quality Rating receive a quality bonus they must apply to enhanced benefits.
  • In some counties, the benchmark cap prevents these high quality plans from receiving the quality bonus they earned.
  • As a result, beneficiaries do not receive the enhanced benefits enabled by quality incentives. 
  • In 2018, over 4 million beneficiaries in 4-Star or higher plans were denied enhanced benefits, including reduced cost sharing, due to the benchmark cap.
  • Another nearly 1.5 million beneficiaries were enrolled in counties where the benchmark is above the cap.
  • The number of beneficiaries impacted by the benchmark cap has grown significantly.