New RUPRI Report: Evaluating Medicare Advantage Benchmark Setting Methodology on Rural Counties

Dan Shane PhD; Edmer Lazaro, DPT, MSHC; Fred Ullrich, BA; and Keith Mueller, PhD

This brief explores how the process for setting benchmark payments for Medicare Advantage plans may create different incentives across rural and urban counties.

Key Findings:

• Rural counties are less likely to rank in the lower Medicare Fee for Service (FFS) spending quartiles that receive a higher percentage of the county benchmark: 41 percent of rural counties are categorized in combined quartiles 1 and 2 versus 59 percent for urban counties.
• Global caps (maximum benchmark payments based on pre-Affordable Care Act (ACA) county FFS spending) on benchmark payments  are much more likely in rural counties, particularly those in the lower-spending quartiles, reducing incentives for supplemental benefits or reduced cost sharing.

Additional products:

• Medicare Advantage Plan Growth in Rural America: Opportunities for Beneficiaries https://www.ruralhealthresearch.org/projects/1004
• Medicare Advantage Plan Growth in Rural America: Availability of Supplemental Benefits https://rupri.public-health.uiowa.edu/publications/policybriefs/2024/MA_Plan_Growth.pdf

Contact Information:

Keith J. Mueller, PhD; ke***********@***wa.edu
Director, RUPRI Center for Rural Health Policy Analysis
University of Iowa College of Public Health
Office: 1.319.384.3832

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