| |  | Industry Rx | A new analysis from a congressional advisory panel is reigniting one of the more persistent Washington fights: whether private insurers are being overpaid to administer benefits, and whether it’s driving up costs for older Americans. → It comes as insurers press the Trump administration to increase proposed federal payment rates for Medicare Advantage plans, which are adjusted every year. The report, released on Tuesday by the Joint Economic Committee, estimates that the federal government paid Medicare Advantage plans $76 billion to $84 billion more in 2025 than it would have spent covering the same patients in traditional Medicare. - The overpayments resulted in premiums that were $212 higher each month than they otherwise would have been, and most of the cost is shouldered by older Americans.
- The underlying numbers in the report rely heavily on data from the Medicare Payment Advisory Commission, or MedPAC — a legislative branch agency that analyzes Medicare trends and advises lawmakers on policy.
Insurers dispute those estimates, arguing the commission’s methodology overstates Medicare Advantage overpayments by relying on assumptions that they say don’t reflect the program’s actual costs or the extra benefits that plans provide. Susan Reilly, a spokesperson for the Better Medicare Alliance, a group that advocates for Medicare Advantage pointed to research done by the Centers for Medicare & Medicaid Services. The research, published in Januarylast month, showed that the differences in reimbursement between Medicare Advantage and traditional Medicare are smaller than MedPAC projects. “MedPAC’s projections rely on assumptions and methodologies that many experts have questioned for years,” Reilly said. “Claims that Medicare Advantage ‘overpayments’ significantly increase seniors’ Part B premiums stem directly from those disputed assumptions. When more current data and updated risk-adjustment models are used, the magnitude of those claims falls dramatically.” The Medicare Advantage program — which covers more than half of all Americans on Medicare — is broadly popular with its enrollees and offers benefits that traditional Medicare doesn’t, such as dental and vision coverage. → But the congressional scrutiny stemming from the report is noteworthy because of the long-standing bipartisan support that Medicare Advantage typically enjoys from many lawmakers on Capitol Hill. “If Congress is serious about affordability, fiscal responsibility and fairness, we must take a hard look at Medicare Advantage and make sure the rules are the same for everyone,” said Rep. David Schweikert (R-Arizona), the chairman of the Joint Economic Council. “Today, between aggressive upcoming, questionable quality bonuses and structural overpayments in Medicare Advantage, seniors who stay in traditional Medicare are effectively subsidizing the system,” he said. “That’s not sustainable, it’s not fair, and it can be reformed.” The Better Medicare Alliance has been meeting with CMS officials as the agency works to finalize its payment rate proposal for the private Medicare plans. The Trump administration, which has proposed a roughly flat payment rate, will finalize its decision by April 6. “Policy discussions about Medicare should be grounded in accurate, up-to-date data and should focus on strengthening the coverage more than 35 million seniors depend on — not repeating outdated claims that undermine confidence in and stability of a program that continues to deliver for America’s seniors,” said Reilly | 
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