Medicare Advantage often plays a central role in employer-sponsored retiree health strategy — yet the program’s funding structure, payment benchmarks, and regulatory mechanics are complex and often misunderstood. For labor funds, public sector employers, and consultants, understanding how Medicare Advantage and Part D are financed is essential to managing costs and long-term plan sustainability.
This Medicare Overview series provides clear, technical explanations of the core financial and policy components that shape employer-sponsored retiree coverage. Each blog breaks down a key element of the Medicare program to support informed, strategic decision-making.
Medicare Advantage Payment Benchmarking
In this blog, we explain how benchmarks for Medicare Advantage payments are calculated annually. We cover county-level benchmarking, Fee-for-Service spending baseline, quartile percentages, quality bonuses, and more.
Medicare Advantage Risk Adjustment
In this blog, we explain how risk is calculated and applied to payments from the federal government to Medicare Advantage (MA) plans are risk-adjusted to account for differences in members’ expected medical spending. We cover CMS-HCC risk-adjustment model, calculating risk scores, and applying risk scores to predict risk-adjusted MA payments.
Medicare Part D Overview
In this blog, we provide Q&A for foundational knowledge of Medicare Part D drug coverage. We explain how Medicare Part D works, including funding, cost-sharing phases, eligibility rules, and 2026–2027 updates affecting employer-sponsored retiree plans.
