The Future of Medicare Advantage in the New Administration
This Feature Article is brought to you by AHLA's Payers, Plans, and Managed Care Practice Group.
- May 01, 2025
- David Ault , Ropes & Gray LLP
- William Shefelman , Ropes & Gray LLP
As President Donald Trump settles into his second term, he inherits a popular Medicare Advantage (MA) program that continues to grow but faces numerous challenges that may shape the future of the managed care alternative to traditional fee-for-service Medicare. Medicare Advantage, also known as Medicare Part C, was established as part of the Balanced Budget Act of 1997 offering Medicare beneficiaries an alternative to traditional Medicare by allowing them to receive their benefits through private health insurance plans. Today, the majority of Medicare beneficiaries obtain their benefits through an MA plan, and the Centers for Medicare & Medicaid Services (CMS) projects the federal government will make between $500 billion and $600 billion in MA payments to private health plans in 2025. The growth of MA has brought about heightened scrutiny from policymakers, regulators, and stakeholders. Issues such as overpayments, coding behavior, and the use of prior authorization, increasingly driven by the use of Artificial Intelligence (AI), have become focal points of debate.
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