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10 Top States for 2020 Medicare Advantage Capitation Payment Increases

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The Medicare Advantage county-level monthly capitation payment is the mysterious ingredient that makes the Medicare Advantage pricing system hum.

Program managers at the Centers for Medicare and Medicare Services (CMS) do complicated things to their Medicare fee-for-service pricing data and come up with… 3,223 rows of 2020 benchmarking data.

(Related: Insurers Hug Medicare Part D Less Passionately)

The annual election period for 2020 coverage is set to start Oct. 15 and run until Dec. 7.

The capitation payment spreadsheet shows about how much Medicare Advantage program managers think they should be paying each month for each Medicare Advantage plan enrollee’s care.

Carriers set their actual prices by bidding against the capitation payment amounts. Carriers with plans that do well on Medicare Advantage program quality measures get a higher monthly capitation payment.

The 2020 county-level averages range from $755 per month, in Presidio, Texas, up to $1,609, in Nome, Alaska.

To simplify things, we calculated state-level averages. The 2020 state-level averages ranged from $883 per month, in Hawaii, up to $1,168, in Alaska.

We also calculated how fast each state’s average capitation level changed between 2019 and 2020. The year-over-year change ranged from 4%, in Delaware, up to 8.2%, in one state.

For a look at the 10 states with the biggest growth in the capitation payment benchmark between 2019 and 2020, see the date cards in the slideshow above.


The Medicare Advantage program ratebooks and supporting data files are available here.

— Read More Medicare Advantage Enrollees Slide Away: Deft, on ThinkAdvisor.

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