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HEALTH SOLUTIONS

Medicare

Making Medicare work for all concerned

OVERVIEW

Milliman Medicare solutions

Medicare Advantage

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Medicare Part D

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Operational consulting

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Bid development, desk review, and audit support

Bid development, desk review, and audit support

Webinar series

All things Medicare

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Insight

Milliman Medicare insight

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Article

2025 Medicare IPPS and OPPS trend summary

Outlining the key pricing factors released by CMS in the 2025 IPPS Final Rule, IPPS Interim Final Action with Comment Period (IFC), and OPPS Proposed Rule.

White paper

Medicare price negotiation: Anchored drug prices in uncharted waters

Maximum Fair Price (MFP) Issue Brief 2

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White paper

Medicare Advantage dental utilization: A changing landscape

An analysis of changes in the national average utilization rates for dental services for 2021 through 2023

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Preheading

How will Medicaid Pay for Cell and Gene Therapies

Amid the development of new cell and gene therapies, we present some strategies that states have used to control costs and risk among their MCOs.

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White paper

Star Ratings in Retrograde: Decoding the 2025 Decline

We discuss the causes and revenue implications in the historic decline in Star Ratings for Medicare Advantage and accompanying prescription drug contracts.

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White paper

CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?

In April, the Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Advantage (MA) and Part D final rule and MA rate notice.

Article

ACO Primary Care Flex Model: Five key takeaways for ACOs considering participation

In this paper we share five key takeaways for ACOs as they evaluate the program.

White paper

Healthcare utilization among Medicare FFS beneficiaries living in historically redlined neighborhoods

We present our key findings from a look at healthcare utilization among Medicare fee-for-service beneficiaries living in historically redlined neighborhoods.

White paper

The next generation of Medicare bundled payments: Considerations regarding TEAM

The Centers for Medicare and Medicaid Services (CMS) recently announced the Transforming Episode Accountability Model (TEAM),

Article

Out of whose pocket? Many beneficiaries will spend less than expected to reach the IRA’s new $2,000 out-of-pocket spending limit

We dive into ramifications of the Inflation Reduction Act on out-of-pocket spending limits for health insurance markets and Medicare Part D.

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Healthcare changes in the Inflation Reduction Act

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RELATED PRODUCTS

Milliman Medicare products

Benchmarking
HEALTHCARE UNIT COST INSIGHTS

Milliman Commercial Reimbursement Benchmarks

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Claims data analytics
Claim pricing

Medicare Reference Pricer

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Medicare advantage benchmarking
Medicare Advantage benchmarking

Milliman MACVAT (Medicare Advantage Competitive Value Added Tool)

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Healthcare cost modeling
Healthcare cost modeling

Health Cost Guidelines Suite

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Healthcare analytics
Healthcare analytics

MedInsight

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Claims data analytics
Claims data analytics

Medicare Repricer

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Healthcare analytics
ACO analytics

Milliman ACO Builder

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ACA utilization and cost evaluation
Medicare plan selection solution

Medicare Suggest

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Healthcare risk adjustment
Healthcare risk adjustment

Milliman Advanced Risk Adjusters

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Alternative payment
Alternative payment

ACO Care Management Impact Model

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ACA utilization and cost evaluation
ACO utilization & cost evaluation

ACO Insight

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Claims data analytics
Claims data analytics

Bundled Payment Reporting Interface

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RELATED SERVICES

Milliman Medicare services

Resources

Milliman Medicare resources

Article

Medicare Advantage Uniformity Flexibility benefit offerings

A review of the Uniformity Flexibility benefits offered during the contract year 2019 plan year.

Video

Optimizing hospital partnerships

Learn why Health Alliance Plan relies on the MedInsight Hospital Evaluation and Comparison System (HECS) tool for hospital contracting.

BLOG

Milliman Healthcare Analytics Blog

We dig deep into rich Milliman MedInsight data to bring you insights you won’t find anywhere else, plus updates on the state of regulatory affairs.

Issue Brief

Identifying high-cost members

Do you know which members are likely to drive costs in the coming years? Learn how you can find out—before it’s too late to do anything about it.

We’re here to help