Studies from Mahendra Sanapati and Colleagues Yield New Information about Managed Care (Escalating Growth of Spending on Medicare Advantage Plans: Save Medicare from Insolvency and Balance the Budget): Managed Care

2025 OCT 03 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A new study on Managed Care is now available. According to news reporting originating from Evansville, Indiana, by NewsRx correspondents, research stated, “The U.S. health care system faces escalating costs and inefficiencies, with Medicare projected to reach insolvency by 2036. Despite this, Medicare Advantage (MA) plans continue to receive preferential funding, resulting in overpayments, rising patient out-of-pocket expenses and limited accountability, instead of being a tool to achieve lower spending and increase quality.”

Our news editors obtained a quote from the research, “Physicians endure payment cuts, sequestration, and denied services, threatening access to care. To analyze MA plans’ growth, costs, and policy implications and assess their impact on Medicare solvency, physician reimbursement, and patient care quality. A comprehensive policy and financial analysis using data from Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, Congressional Budget Office, peer-reviewed literature, and federal reports from 1997-2025. We reviewed legislative history, financial trends, and quality metrics of Medicare and MA programs. Specific focus was placed on benchmarks, rebates, risk adjustments, favorable selection, coding intensity, and patient access barriers. Data on enrollment trends, geographic variation, and out-of-pocket costs were analyzed. MA enrollment grew from 6.9 million (16% of Medicare beneficiaries) in 2014 to 33.6 million (54%) in 2024. Payments to MA plans exceed fee-for-service (FFS) Medicare by 22%, translating to $84 billion annually, plus $15 billion in quality bonuses. Out-of-pocket maximums surged 859% since 1999, and inappropriate care denials affect 13%-18% of cases. Risk adjustment and coding practices inflate payments, undermining program sustainability. The present investigation relies on secondary data from government agencies and published literature; real-time administrative and clinical data from MA plans were unavailable due to reporting gaps. Originally intended to reduce costs, MA plans have driven higher expenditures, limited access, and increased patient burdens.”

According to the news editors, the research concluded: “Policy reforms-including alignment of MA payments with FFS Medicare, elimination of favorable selection and upcoding incentives, and enforcement of coverage requirements-are critical to preserving Medicare solvency and ensuring equitable patient care.”

This research has been peer-reviewed.

For more information on this research see: Escalating Growth of Spending on Medicare Advantage Plans: Save Medicare from Insolvency and Balance the Budget. Pain Physician, 2025;28(5):359-376. Pain Physician can be contacted at: Am Soc Interventional Pain Physicians, 81 Lakeview Dr, Paducah, KY 42001, USA.

The news editors report that additional information may be obtained by contacting Mahendra Sanapati, Pain Management Centers of America, Evansville, IN. Additional authors for this research include Laxmaiah Manchikanti, Paul J. Hubbell Iii, Ann Conn, Mayank Gupta, Ramarao Pasupuleti, Alaa Abd-Elsayed and Alan D. Kaye.

Publisher contact information for the journal Pain Physician is: Am Soc Interventional Pain Physicians, 81 Lakeview Dr, Paducah, KY 42001, USA.

(Our reports deliver fact-based news of research and discoveries from around the world.)