Policy & oversight
MedPAC Chair Defends Medicare Advantage Overpayment Estimate as Insurers Challenge the Analysis and Congress Considers a Response
The advisory body's chair says its finding that Medicare Advantage costs 14 percent more per enrollee than traditional Medicare is evidence for debate, not a policy target. Insurers disagree, and some lawmakers want competing analyses required by law.
By the Goodsurance editorial teamSeptember 26, 2026
The chair of the Medicare Payment Advisory Commission, Dr. Amol Navathe, publicly defended the commission's estimate that the federal government pays roughly 14 percent more per enrollee in Medicare Advantage than it would cost to cover a comparable person in traditional Medicare, speaking at the Better Medicare Alliance annual meeting on September 23.
Major Medicare Advantage insurers have responded to the estimate with advertising campaigns and published analyses disputing MedPAC's methodology. Congressional Republicans have also introduced legislation that would require federal agencies to produce competing analyses alongside MedPAC's findings.
MedPAC's chair publicly defended the 14% MA overpayment estimate at a major industry event, as insurers push back and Congress weighs requiring competing analyses.
Navathe said the 14 percent figure is not a recommended payment reduction target. He described it as evidence intended to inform serious policy discussion, and he said the commission is open to refining its methods but expects substantive engagement with the underlying research.
MedPAC calculates the estimate by comparing what Medicare pays private insurers per enrollee against the projected cost of covering a similar beneficiary in the traditional government program. Insurers contest key assumptions about how member diagnoses are weighted and how the comparison group is defined.
The debate carries practical weight: if policymakers act on the overpayment estimate, it could affect how much insurers are paid per enrollee, which in turn could influence plan design, premiums, and the benefits available to the more than 35 million people enrolled in Medicare Advantage.
In plain words
A group called MedPAC advises Congress on Medicare spending. It found that the government pays about 14 cents more for every dollar spent on Medicare Advantage compared to regular Medicare. The group's leader gave a speech defending that finding. Insurance companies say the math is wrong and are running ads about it. Some in Congress want to pass a law requiring other groups to run the numbers too. MedPAC says it is open to improving its work but wants people to take the research seriously.
Understand the basics first
Source: Healthcare Dive
Read at the source →