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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

White paper

Medicare Advantage institutional special needs plans: 2026 market landscape and future considerations

Institutional special needs plans: We offer four key takeaways on the market landscape and the future for this specialized type of Medicare Advantage offering.

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White Paper

State of the 2026 Medicare Advantage industry: Dual-eligible plan valuation and selected benefit offerings

We highlight changes in value-added and key-benefit trends in the Medicare Advantage market from 2025 to 2026, focusing on Dual-Eligible Special Needs Plans.

White paper

2025 Medicare FFS catheter billing anomalies and ACO implications

We detail the Medicare fee-for-service catheter billing anomalies observed during 2025 and discuss the implications for affordable care organizations.

person presenting to seated audience
White paper

CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers

We explore what the Medicare-Medicaid integration opportunity could mean for states as the CMS’s new ACO LEAD model details are released.

Article

Bleeding-related hospitalizations among direct oral anticoagulant users and nonusers in Medicare fee-for-service

Bleeding-related hospitalizations among direct oral anticoagulant users and nonusers in Medicare fee-for-service: Variation in prevalence, burden, and characteristics.

older woman with cane
White paper

Medically frail determinations under new Medicaid requirements: Experience-based insights

We offer some experience-based insights for medically frail determinations under the new Medicaid work requirements to help states implement an accurate, compliant solution.

Article

4 key takeaways from the third round of drugs selected for Medicare drug price negotiation

The Centers for Medicare and Medicaid Services announced the list of drugs selected for price negotiation for 2028. We broke down the implications.

Article

6 things life sciences companies need to know about risk adjustment

What should life sciences companies know about risk adjustment for the Medicare, Medicaid, and ACA markets?

Article

Medicare drug price negotiation: New dynamics as the tide turns to Medicare Part B

Medicare drug price negotiation: With the first cycle where Part B drugs are eligible to be selected, the implications extend far beyond simple price reductions.

White Paper

State of the 2026 Medicare Advantage industry: General enrollment plan valuation and selected benefit offerings

We highlight changes in value added and key benefit trends for general enrollment plans in the Medicare Advantage market from 2025 to 2026.

landmark legislation

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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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