Medicare Advantage's diagnosing tactics made insurers like UnitedHealthGroup $33 billion richer

Doctor on the couch with an elderly patient looking at chart (Credit: Getty Images)

Ever since the high-profile murder of UnitedHealthcare CEO Brian Thompson last year, health insurers have faced heavy scrutiny and heightened resentment from the public. Now a new study might fan those flames. That’s because it found that differential coding patterns between Medicare Advantage (MA) and Traditional Medicare (TM) plans led to MA plans receiving an estimated $33 billion in extra revenue—with $13.9 billion, or 42% of the total, going into the coffers of UnitedHealth Group.

Those findings, from the year 2021, add specific context to past research that found evidence of Medicare Advantage plans having a higher diagnostic “coding intensity” than traditional Medicare, meaning they record more health condition diagnoses than traditional Medicare for comparable beneficiaries. Because of that, Congress’s Medicare Payment Advisory Commission had estimated, Medicare spends 13% more for MA enrollees than it would if they were enrolled in traditional Medicare—with that difference accounting for $50 billion in MA overpayments in 2024.