Social Risk Adjustment and Bonus Eligibility in Medicare Advantage Star Ratings

Did Medicare Advantage (MA) contract bonus eligibility change following the Centers for Medicare & Medicaid Services’ implementation of social risk adjustment?In this cohort study of 339 Medicare Advantage contracts observed from 2014 to 2025, 46.0% became eligible for quality bonus payments in at least 1 year due to Categorical Adjustment Index (CAI) adjustments. Each 0.10-point increase in the CAI was associated with a 0.16-point higher probability of bonus eligibility.The results of this study provide evidence on the potential role of CAI in MA contract performance; future research should assess whether alternative adjustment methods can create better comparisons of performance between MA contracts.

Corresponding Author: Andrew Anderson, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 1812 Ashland Ave, MD 21205 (aander86@jh.edu).

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