---
type: source
title: "Medicare Advantage Will Be Overpaid by $1.2 Trillion (2025-2034)"
author: "Committee for a Responsible Federal Budget (CRFB)"
url: https://www.crfb.org/blogs/medicare-advantage-will-be-overpaid-12-trillion
date: 2025-03-26
domain: health
secondary_domains: []
format: report
status: null-result
priority: high
tags: [medicare-advantage, overpayment, fiscal-impact, coding-intensity, favorable-selection, trust-fund]
processed_by: vida
processed_date: 2026-03-11
enrichments_applied: ["medicare-fiscal-pressure-forces-ma-reform-by-2030s-through-arithmetic-not-ideology.md", "medicare-trust-fund-insolvency-accelerated-12-years-by-tax-policy-demonstrating-fiscal-fragility.md", "CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md", "value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
extraction_notes: "Two major claims extracted: (1) the $1.2T overpayment projection with equal split between coding and selection, and (2) the structural nature of favorable selection as a legal plan design feature rather than fraud. Four enrichments applied to existing MA/Medicare fiscal claims. The favorable selection mechanism is the less-discussed half of the overpayment equation and deserved its own claim as curator notes suggested. No entity data in this source—pure policy analysis and fiscal projections."
---

## Content

### Headline Projection
- **$1.2 trillion** in MA overpayments over 2025-2034 (based on MedPAC data)
- Two equally large drivers: coding intensity ($600B) and favorable selection ($580B)

### Breakdown by Impact Channel
**Coding Intensity ($600B total):**
- Medicare HI Trust Fund impact: $260 billion
- Beneficiary premium costs: $110 billion
- MA plans see 10% net payment increase from coding intensity even after 5.9% CMS adjustment

**Favorable Selection ($580B total):**
- Medicare HI Trust Fund impact: $250 billion
- Beneficiary premium costs: $110 billion
- 11% increased MA costs vs FFS in 2025 from favorable selection alone
- Causes: prior authorization and plan networks discouraging care-seeking (healthier people self-select into MA)

### Policy Options
- CBO estimates reducing benchmarks could save **$489 billion**
- Raising minimum coding adjustment from 5.9% to 20% could reduce deficits by **over $1 trillion**
- Both would substantially extend Medicare trust fund solvency

### Fiscal Context
- Combined trust fund impact: ~$510 billion over decade
- Combined beneficiary premium impact: ~$220 billion
- MA overpayments are one of the largest single drivers of Medicare spending growth

## Agent Notes
**Why this matters:** Translates MedPAC's technical findings into fiscal policy language. The $1.2T number is the scale at which MA's payment structure becomes a Medicare solvency issue. Combined with the trust fund insolvency acceleration (now 2040 due to Big Beautiful Bill), this creates a fiscal collision course.
**What surprised me:** The symmetry between coding intensity and favorable selection as overpayment drivers. Policy debate focuses on upcoding fraud, but favorable selection is almost exactly as large — and it's structural, not illegal. MA plans benefit from attracting healthier members and there's no fraud to prosecute.
**KB connections:** [[proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures]]
**Extraction hints:** Claim about the fiscal unsustainability of unreformed MA — $1.2T over a decade is not a pricing error, it's a structural transfer from taxpayers to MA plans.

## Curator Notes
PRIMARY CONNECTION: [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
WHY ARCHIVED: Quantifies the fiscal stakes of MA reform — connects insurance market structure to Medicare solvency timeline.
EXTRACTION HINT: The favorable selection mechanism deserves its own claim — it's the less-discussed half of the overpayment equation.


## Key Facts
- MA overpayments: $1.2 trillion over 2025-2034 (MedPAC data via CRFB)
- Coding intensity overpayments: $600B total ($260B trust fund, $110B beneficiary premiums)
- Favorable selection overpayments: $580B total ($250B trust fund, $110B beneficiary premiums)
- MA plans see 10% net payment increase from coding intensity despite 5.9% CMS adjustment
- Favorable selection causes MA costs to run 11% higher than FFS in 2025
- CBO estimate: reducing MA benchmarks could save $489B
- CBO estimate: raising coding adjustment from 5.9% to 20% could reduce deficits by >$1T
