Fact Sheet

The Impact of the Medicare Advantage Benchmark Cap on Beneficiaries

Millions of Medicare Advantage beneficiaries in 4 or 5-Star rated plans are negatively impacted by the benchmark cap and do not receive the full benefits of a high quality plan.

Key Facts

  • In 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 2016, over two million beneficiaries were denied enhanced benefits, including reduced cost sharing, due to the benchmark cap.
  • In total, over three million Medicare Advantage beneficiaries are enrolled in counties impacted by the benchmark cap.