{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:43:54Z","timestamp":1777668234883,"version":"3.51.4"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Economics"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Medicare Advantage (MA) enrollment more than doubled from 2013 to 2023, raising concerns about risk selection, spending, and the continued use of traditional Medicare (TM) spending as a benchmark for MA payment. This study examines trends in selection into MA from 2009 to 2020 using administrative and survey data from the Medicare Current Beneficiary Survey. For each survey year, we estimate a regression model of Part A and B spending among TM enrollees based on demographic characteristics, self\u2010reported health status, limitations in activities of daily living, and enrollee group type (e.g.,\u00a0dual eligible, institutionalized, disabled). We apply this model to MA enrollees to estimate their predicted TM spending. We find that since 2017, MA enrollees have had higher predicted costs than TM enrollees\u20145\u20136% higher from 2017 to 2020\u2014driven largely by the growing share of dual eligibles in MA. Within enrollee group type, however, we observe little evidence of differential selection. We further use the model results from just our baseline year, 2009, to predict\n                    <jats:italic>both<\/jats:italic>\n                    MA and TM spending in each subsequent year. We find that although MA enrollee characteristics did not trend observably healthier or sicker over this period, TM enrollees' characteristics appear to have shifted in ways associated with lower predicted spending over time. These findings suggest that the nature of selection into MA has qualitatively shifted over recent years and raises further questions about how well the current risk adjustment system reflects appropriate differences in risk as the enrollee characteristics in these groups continue to diverge.\n                  <\/jats:p>","DOI":"10.1002\/hec.70091","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T04:11:11Z","timestamp":1773115871000},"page":"978-994","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Selection Into Medicare Advantage"],"prefix":"10.1002","volume":"35","author":[{"given":"Anuj","family":"Gangopadhyaya","sequence":"first","affiliation":[{"name":"Department of Economics Quinlan School of Business Loyola University Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bowen","family":"Garrett","sequence":"additional","affiliation":[{"name":"Health Policy Division Urban Institute  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/00469580211064118"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010015\u20101063\u20101"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.104.10.3335"},{"key":"e_1_2_11_5_1","unstructured":"Centers for Medicare and Medicaid Services.2024. \u201cReport to Congress: Risk Adjustment in Medicare Advantage December 2024.\u201dhttps:\/\/www.cms.gov\/files\/document\/report\u2010congress\u2010risk\u2010adjustment\u2010medicare\u2010advantage\u2010december\u20102024.pdf."},{"issue":"7","key":"e_1_2_11_6_1","first-page":"e215","article-title":"Predicting High\u2010Cost Privately Insured Patients Based on Self\u2010Reported Health and Utilization Data","volume":"23","author":"Cunningham P. J.","year":"2017","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_11_7_1","volume-title":"Favorable Selection in Medicare Advantage? What the Evidence Tells Us","author":"Garrett B.","year":"2024"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13591"},{"key":"e_1_2_11_9_1","volume-title":"Do People Who Sign up for Medicare Advantage Plans Have Lower Medicare Spending?","author":"Jacobson G.","year":"2019"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.0768"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.3792038"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.5600\/mmrr.004.02.a06"},{"key":"e_1_2_11_13_1","volume-title":"Medicare Advantage Enrolls Lower\u2010Spending People, Leading to Large Overpayments","author":"Lieberman S.","year":"2023"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20100009.2011.00629.x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.1344"},{"key":"e_1_2_11_16_1","volume-title":"Report to Congress: Medicare Payment Policy","author":"MedPAC","year":"2023"},{"key":"e_1_2_11_17_1","volume-title":"Report to Congress: Medicare Payment Policy","author":"MedPAC","year":"2024"},{"key":"e_1_2_11_18_1","unstructured":"MedPAC.2025.Report to Congress: Medicare Payment Policy. Report to Congress: Medicare Payment Policy. Medicare Payment Advisory Commission.https:\/\/www.medpac.gov\/wp\u2010content\/uploads\/2025\/03\/Mar25_MedPAC_Report_To_Congress_SEC.pdf."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0345"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1162\/ajhe_a_00001"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0272"}],"container-title":["Health Economics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.70091","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hec.70091","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.70091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:49:22Z","timestamp":1777448962000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hec.70091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/hec.70091"],"URL":"https:\/\/doi.org\/10.1002\/hec.70091","archive":["Portico"],"relation":{},"ISSN":["1057-9230","1099-1050"],"issn-type":[{"value":"1057-9230","type":"print"},{"value":"1099-1050","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"2025-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}