Health Care Matters | March 20
Medicare Advantage Overpayments Drive Rising Premium Pressure
A growing body of analysis is drawing renewed attention to how Medicare Advantage (MA) payment dynamics are affecting costs across the broader Medicare program. A recent congressional report finds that higher-than-expected payments to MA plans are contributing to increased Medicare Part B premiums, adding an estimated $13.4 billion in costs in 2025 alone. On average, this translates to roughly $200 more per beneficiary annually, regardless of whether they are enrolled in MA or traditional Medicare.
At the same time, broader projections suggest these pressures may continue to build. Some estimates indicate that Medicare premiums could nearly double over the next decade, driven by a combination of rising health care costs, demographic trends, and ongoing questions about payment accuracy and risk adjustment in MA. Together, these findings reinforce a consistent theme: how Medicare pays for care, particularly within MA, has system-wide implications that extend beyond any single program or population. Read more here, here and here.
Why It Matters
Pressure on Medicare Advantage continues to build. Recent federal activity, including a CMS request for information on MA, signals increased focus on risk adjustment, coding, and plan oversight. At the same time, evidence linking MA payments to rising premiums is reframing this as a broader affordability issue that affects all beneficiaries. We should expect continued scrutiny and a higher likelihood of policy action which could include refinements to risk adjustment and tighter oversight of coding practices, along with changes to how plans are benchmarked and paid. These shifts will influence plan behavior, provider alignment, and the direction of value-based care. For organizations operating across Medicare, this reinforces the need to track MA policy closely and understand how changes will flow through the broader system.
Fraud Enforcement Moves to the Center of Federal Health Policy
Federal focus on fraud, waste, and abuse is accelerating through a series of concrete actions. The administration recently launched a cross-agency anti-fraud task force and rolled out a broader “CRUSH” initiative, alongside a CMS request for information on potential new fraud regulations. At the program level, this is translating into steps such as deferring federal Medicaid payments to states under investigation, issuing formal inquiries to multiple states on fraud prevention practices, and implementing a nationwide moratorium on new Medicare enrollment for certain high-risk suppliers.
At the same time, these actions are unfolding in a contested political environment, with ongoing disagreement in Congress about the scale of fraud and the appropriate level of federal intervention. Questions are also emerging about how enforcement may affect access, particularly in Medicaid programs serving people with disabilities and those relying on home- and community-based services. Read more here and here.
Why It Matters
The current federal focus signals a more proactive and centralized approach to fraud enforcement. We should expect continued use of tools like payment holds, enrollment restrictions, and targeted state oversight, along with potential new regulatory requirements coming out of the CMS RFI. In practice, that likely means more frequent audits, tighter documentation expectations, and greater scrutiny of high-risk service categories.
At the same time, fraud enforcement is increasingly intersecting with broader policy debates about Medicaid spending and program design. That raises the stakes for how these actions are implemented and where they are targeted. For organizations operating in this space, the implication is twofold: compliance expectations are rising, and the operating environment may become less predictable as enforcement, policy, and politics continue to converge.
Look for the Helpers: Medical Debt Relief Reaches 30,000 Massachusetts Residents
A new initiative in Massachusetts is eliminating $42.3 million in medical debt for nearly 30,000 residents through a partnership between a health equity foundation, hospitals, and the nonprofit Undue Medical Debt. Eligible patients will have their debt automatically forgiven without needing to apply, helping relieve financial strain and improve access to care. The effort reflects a growing movement to address medical debt as a barrier to health, using targeted, system-level solutions to support patients and families. Read here.
What We Are Reading
Recommendations for How Employers Can Support Family Caregivers: Results From an Expert Delphi Consensus Panel
An analysis from the Johns Hopkins Bloomberg School of Public Health highlights expert consensus on practical strategies employers can use to better support working family caregivers and reduce impacts on workforce participation and productivity. Read here.
Rural Health Transformation Program: State Focus on Behavioral Health
NASHP explores how states are leveraging Rural Health Transformation Program funding to integrate behavioral health into primary care and expand access in rural communities. Read here.
Can Rural Health Be Transformed Through a New Federal Program?
The Commonwealth Fund examines whether the federal Rural Health Transformation Program can meaningfully improve access, workforce capacity, and care delivery in underserved rural areas. Read here.
Supporting the Forgotten Middle: What Oregon’s Project Independence Medicaid Can Teach Other States
A Health Affairs Forefront article looks at how Oregon’s program addresses gaps for individuals who do not qualify for Medicaid but still struggle to afford long-term services and supports. Read here.
Addressing Health-Related Social Needs Through Medicaid Section 1115 Waivers: Challenges
Health Affairs outlines key challenges states face when using Section 1115 waivers to address health-related social needs, including funding constraints, implementation complexity, and evaluation limitations. Read here.
Budgetary Impact of the Medicare Shared Savings Program on Traditional Medicare
A study in JAMA Health Forum analyzes trends in health policy and care delivery, highlighting implications for access, cost, and system performance across populations. Read here.
What We're Attending
Standing Committee on Primary Care – March 2026 Open Meeting
The National Academies of Sciences, Engineering, and Medicine will host a virtual public meeting on March 26, 2026, from 1:00 PM to 4:00 PM ET, bringing together sponsor organizations to discuss current primary care priorities. The agenda includes panels on next steps for hybrid payment models, shared savings, and the physician fee schedule, as well as patient incentive considerations in primary care. The session offers a timely look at how payment and policy discussions are evolving in primary care delivery. Register here.
Pop Health Podcast
From Concept to Model: The Making of LEAD
In this episode, Coral's Maria Alexander and Joy Chen welcome Meredith Yinger, Model Lead for the Innovation Center’s LEAD (Long-term Enhanced ACO Design) Model and Emily Bezold, Senior Advisor to the Center’s ACO portfolio. Together, they explore more about the mission and vision for LEAD, how the model came to fruition, the Center’s rationale for key design features, and what potential applicants may want to know before they apply.