Medicare Advantage Risk Adjustment is Failing, Costing Taxpayers Billions of Dollars

New data analysis shows stark variation in risk adjustment from abusive industry practices

WASHINGTON , Sept. 3, 2025 /PRNewswire/ -- New analysis by the Alliance of Community Health Plans (ACHP) shows that gaming within the Medicare Advantage (MA) program by large national carriers persists, wasting tens of billions of taxpayer dollars each year. The examination of risk adjustment payments found that the largest national MA insurer collected up to $785 more per beneficiary than local, nonprofit plans in 2023 alone. That difference cost Medicare more than $6 billion .

Accompanying the analysis of federal data, ACHP called on the Trump Administration to immediately adopt sweeping reforms to simplify the unnecessarily complex risk adjustment program. The changes proposed by ACHP would ease