Medicare Advantage (Part C)

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Medicare Advantage (Part C)

Understanding healthcare costs: Medicare Advantage

Employer group pricing support

Insurers often offer group coverages to employer groups that typically request customized benefit packages. Milliman provides underwriting assistance consistent with your CMS bid submission in order to facilitate the rate-development process.

Feasibility analyses

Milliman works with clients to assess the economic costs, required operational changes, and benefits of implementing, sustaining, or expanding a variety of Medicare products. Possibilities include expansion into Medicare products, adding more products, and geographic expansion. We summarize costs and revenues over both the pre-operational period and the first years of operation in order to quantify the necessary investment.

Payment validation

Milliman's payment validation service compares a client's individual membership files to CMS's various membership reports and identifies discrepancies between actual and expected payments, verifying that CMS is adhering to its own payment formulas.

Risk score analyses

Milliman consultants perform analyses to explain recent risk score changes, project future risk scores, and assist with risk score improvement efforts. One of our approaches uses prescription drug data to identify diagnoses not already included in the submissions to CMS.

Competitive market analysis

Milliman concisely summarizes the benefits and premium levels of all Medicare Advantage (MA) products in a given county to allow you to strategically analyze your relative market position and make more intelligent product adjustments. The output is a simple value index measuring the member's value proposition.

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Medicare Advantage (Part C)