Medicare
Making Medicare work for all concerned
Milliman Medicare solutions
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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
Milliman Medicare insight
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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.
Medicare price negotiation: Anchored drug prices in uncharted waters
Maximum Fair Price (MFP) Issue Brief 2
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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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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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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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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.
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.
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.
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),
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.
Milliman Medicare products
Milliman Commercial Reimbursement Benchmarks
Medicare Reference Pricer
Milliman MACVAT (Medicare Advantage Competitive Value Added Tool)
Health Cost Guidelines Suite
MedInsight
Medicare Repricer
Milliman ACO Builder
Medicare Suggest
Milliman Advanced Risk Adjusters
ACO Care Management Impact Model
ACO Insight
Bundled Payment Reporting Interface
Milliman Medicare services
Milliman Medicare resources
Medicare Advantage Uniformity Flexibility benefit offerings
A review of the Uniformity Flexibility benefits offered during the contract year 2019 plan year.
Optimizing hospital partnerships
Learn why Health Alliance Plan relies on the MedInsight Hospital Evaluation and Comparison System (HECS) tool for hospital contracting.
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.
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.