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.