Fact Sheet
June 27, 2022

Risk Adjustment in Medicare Advantage

In Medicare Advantage, health plans are paid a capitated, or fixed, prospective amount to cover all care for enrollees. The capitated payments are determined annually by the Centers for Medicare & Medicaid Services (CMS) and based on a county-level benchmark rate that is adjusted for each Medicare Advantage beneficiary’s health status and demographics. Read more in this BMA fact sheet.

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