April 8, 2025
This analysis identifies the 2021 differential in average risk scores between Medicare Advantage (MA) and Traditional Medicare (TM), with an emphasis on how these patterns differ across the MA plans. It is estimated that in 2021, average risk score at UnitedHealth Group was 0.28 (CI, 0.26 to 0.31) higher than it would have been if its plans had coded identically to TM. In contrast, Kaiser Permanente coded only slightly more intensely than TM. As a result of differential coding, MA plans received an estimated $33 billion (CI, $28 billion to $38.5 billion) in additional payment in 2021.
The article can be found here: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01345