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Promoting transparency and alignment in Medicare Advantage. American College of Physicians; 2017. Accessed at www.acponline.org\/sites\/default\/files\/acp-policy-library\/policies\/promoting_transparency_and_alignment_in_medicare_advantage_2017.pdf on 27 March 2025."},{"key":"r2-ANNALS2504309","unstructured":"Freed M, Biniek JF, Damico A, et al\n                      . Medicare Advantage 2025 spotlight: a first look at plan offerings. KFF; 2024. Accessed at www.kff.org\/medicare\/issue-brief\/medicare-advantage-2025-spotlight-a-first-look-at-plan-offerings\/ on 26 March 2025."},{"key":"r3-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services\n                      . Contract year 2025 Medicare Advantage and Part D final rule (CMS-4205-F). Accessed at www.cms.gov\/newsroom\/fact-sheets\/contract-year-2025-medicare-advantage-part-d-final-rule-cms-4205-f on 27 March 2025."},{"key":"r4-ANNALS2504309","unstructured":"UnitedHealthcare.\n                      Original Medicare vs. Medicare Advantage: how do they compare? Accessed at www.uhc.com\/news-articles\/medicare-articles\/medicare-advantage-compare on 27 March 2025."},{"key":"r5-ANNALS2504309","unstructured":"Patel YM, Guterman S.\n                      The evolution of private plans in Medicare. The Commonwealth Fund; 2017. Accessed at www.commonwealthfund.org\/publications\/issue-briefs\/2017\/dec\/evolution-private-plans-medicare on 27 March 2025."},{"key":"r6-ANNALS2504309","unstructured":"Jacobson G, Damico A, Neuman T, et al.\n                      Medicare Advantage 2017 spotlight: enrollment market update. KFF; 2017. Accessed at www.kff.org\/medicare\/issue-brief\/medicare-advantage-2017-spotlight-enrollment-market-update\/ on 27 March 2025."},{"key":"r7-ANNALS2504309","unstructured":"Escovitz A, Pathak DS; Ohio Pharmaceutical Seminar.\n                      Health Outcomes and Pharmaceutical Care: Measurement, Applications, and Initiatives. Pharmaceutical Products Pr; 1997. Accessed at https:\/\/catalog.nlm.nih.gov\/discovery\/fulldisplay\/alma998416273406676\/01NLM_INST:01NLM_INST on 27 March 2025."},{"key":"r8-ANNALS2504309","unstructured":"O\u2019Neill Hayes T.\n                      Primer: the Medicare Advantage star rating system. American Action Forum; 2015. Accessed at www.americanactionforum.org\/research\/primer-the-medicare-advantage-star-rating-system\/ on 27 March 2025."},{"key":"r9-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      What Part A covers. Accessed at www.medicare.gov\/providers-services\/original-medicare\/part-a on 27 March 2025."},{"key":"r10-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      What Part B covers. Accessed at www.medicare.gov\/providers-services\/original-medicare\/part-b on 27 March 2025."},{"key":"r11-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      What\u2019s not covered? Accessed at www.medicare.gov\/providers-services\/original-medicare\/not-covered on 27 March 2025."},{"key":"r12-ANNALS2504309","unstructured":"Lockett E.\n                      What to know about Medicare supplemental insurance (Medigap). Healthline Media. 24 February 2025. Accessed at www.healthline.com\/health\/medicare\/what-is-medigap on 27 March 2025."},{"key":"r13-ANNALS2504309","unstructured":"Malzone L.\n                      State-by-state Medicare information and resources. Accessed at www.medigap.com\/faqs\/state-by-state-medicare-information-and-resources\/ on 27 March 2025."},{"key":"r14-ANNALS2504309","unstructured":"Ramsay C, Jacobson G, Findlay S, et al.\n                      Medicare Advantage: a policy primer. The Commonwealth Fund; 2024. Accessed at www.commonwealthfund.org\/publications\/explainer\/2024\/jan\/medicare-advantage-policy-primer on 27 March 2025."},{"key":"r15-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14264"},{"key":"r16-ANNALS2504309","unstructured":"Pe\u00f1a MT, Mohamed M, Biniek JF, et al.\n                      How do dual-eligible individuals get their Medicare coverage. KFF; 2023. Accessed at www.kff.org\/medicare\/how-do-dual-eligible-individuals-get-their-medicare-coverage\/#163b0005-c339-499f-b992-447cf28a8564 on 27 March 2025."},{"key":"r17-ANNALS2504309","unstructured":"Freed M, Biniek JF, Damico A, et al.\n                      Medicare Advantage in 2024: premiums, out-of-pocket limits, supplemental benefits, and prior authorization. KFF; 2024. Accessed at www.kff.org\/medicare\/issue-brief\/medicare-advantage-in-2024-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization\/ on 27 March 2025."},{"key":"r18-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      Nursing home coverage. Accessed at www.medicare.gov\/coverage\/nursing-home-care on 9 April 2025."},{"key":"r19-ANNALS2504309","unstructured":"Biniek JF, Sroczynski N, Freed M, et al.\n                      Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023. KFF; 2025. Accessed at www.kff.org\/medicare\/issue-brief\/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023\/ on 27 March 2025."},{"key":"r20-ANNALS2504309","unstructured":"Cubanski J, Neuman T.\n                      Changes to Medicare Part D in 2024 and 2025 under the Inflation Reduction Act and how enrollees will benefit. KFF; 2023. Accessed at www.kff.org\/medicare\/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit\/ on 21 April 2026."},{"key":"r21-ANNALS2504309","unstructured":"Medicare Payment Advisory Commission.\n                      Chapter 11: the Medicare Advantage program: status report (March 2025 report). Accessed at www.medpac.gov\/document\/chapter-11-the-medicare-advantage-program-status-report-march-2025-report\/ on 27 March 2025."},{"key":"r22-ANNALS2504309","unstructured":"Garrett B.\n                      Favorable selection in Medicare Advantage. Urban Institute; 2024. Accessed at www.urban.org\/sites\/default\/files\/2024-07\/Favorable%20Selection%20in%20Medicare%20Advantage.pdf on 13 August 2025."},{"key":"r23-ANNALS2504309","unstructured":"Lagasse J.\n                      Medicare Advantage beneficiaries see better health outcomes. Healthcare Finance. 8 November 2023. Accessed at www.healthcarefinancenews.com\/news\/medicare-advantage-beneficiaries-see-better-health-outcomes on 20 February 2026."},{"key":"r24-ANNALS2504309","unstructured":"Van de Water PN.\n                      Growth in Medicare Advantage raises concerns. Center on Budget and Policy Priorities; 2025. Accessed at www.cbpp.org\/research\/health\/growth-in-medicare-advantage-raises-concerns on 27 March 2025."},{"key":"r25-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.01525"},{"key":"r26-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      2025 Medicare Advantage and Part D rate announcement. Accessed at www.cms.gov\/newsroom\/fact-sheets\/2025-medicare-advantage-and-part-d-rate-announcement on 28 March 2025."},{"key":"r27-ANNALS2504309","unstructured":"Medicare Payment Advisory Commission.\n                      March 2024 report to the Congress: Medicare payment policy. Accessed at www.medpac.gov\/document\/march-2024-report-to-the-congress-medicare-payment-policy\/ on 28 March 2025."},{"key":"r28-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-25-03178"},{"key":"r29-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      CMS releases proposed 2026 payment policy updates for Medicare Advantage and Part D programs. Accessed at www.cms.gov\/newsroom\/press-releases\/cms-releases-proposed-2026-payment-policy-updates-medicare-advantage-and-part-d-programs on 18 August 2025."},{"key":"r30-ANNALS2504309","doi-asserted-by":"crossref","unstructured":"Berkman ND, Chang E, Seibert J, et al.\n                      Management of High-Need, High-Cost Patients: A \u201cBest Fit\u201d Framework Synthesis, Realist Review, and Systematic Review. Comparative Effectiveness Review, No. 246. Agency for Healthcare Research and Quality; 2021. Accessed at www.ncbi.nlm.nih.gov\/books\/NBK575195\/ on 8 April 2025.","DOI":"10.23970\/AHRQEPCCER246"},{"key":"r31-ANNALS2504309","unstructured":"Everhart T.\n                      Medicare and you: what you need to know. Healthline Media. 13 November 2024. Accessed at www.healthline.com\/health\/medicare-information\/my-guide-to-medicare\/medicare-and-you\/what-you-need-to-know on 8 April 2025."},{"key":"r32-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.28267"},{"key":"r33-ANNALS2504309","unstructured":"Biniek JF, Sroczynski N, Freed M, et al.\n                      Extra benefits offered by Medicare Advantage firms vary. KFF; 2022. Accessed at www.kff.org\/medicare\/issue-brief\/extra-benefits-offered-by-medicare-advantage-firms-varies\/ on 28 March 2025."},{"key":"r34-ANNALS2504309","unstructured":"Medicare Rights Center.\n                      Medicare Advantage proliferation: too much of a complicated thing. Accessed at www.medicarerights.org\/policy-documents\/medicare-sustainability-ma-proliferation on 13 August 2025."},{"key":"r35-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.54699"},{"key":"r36-ANNALS2504309","doi-asserted-by":"publisher","unstructured":"Anderson A\n                      ,\n                      Higgins A\n                      ,\n                      Jain SH\n                      ,\n                      et al.\n                      What recent changes in MA mean for affinity plans and supplemental benefits. Health Affairs Forefront. 14 February 2025. doi:10.1377\/forefront.20250210.416460","DOI":"10.1377\/forefront.20250210.416460"},{"key":"r37-ANNALS2504309","unstructured":"Wynn P.\n                      What OTC and supplemental benefits do Medicare Advantage plans provide? U.S. News & World Report. 30 December 2024. Accessed at https:\/\/health.usnews.com\/medicare\/articles\/benefits-offered-by-medicare-advantage on 28 March 2025."},{"key":"r38-ANNALS2504309","unstructured":"U.S. Senate Committee on Finance.\n                      Deceptive marketing practices flourish in Medicare Advantage. Accessed at www.finance.senate.gov\/imo\/media\/doc\/Deceptive%20Marketing%20Practices%20Flourish%20in%20Medicare%20Advantage.pdf on 28 March 2025."},{"key":"r39-ANNALS2504309","unstructured":"National Council on Aging.\n                      Misleading Medicare marketing: don\u2019t be misled during Medicare open enrollment. Accessed at www.ncoa.org\/article\/misleading-medicare-marketing-dont-be-fooled-during-medicare-open-enrollment on 28 March 2025."},{"key":"r40-ANNALS2504309","unstructured":"King R.\n                      Senate panel finds Medicare Advantage marketing complaints increase for some states. Fierce Healthcare; 2022. Accessed at www.fiercehealthcare.com\/payers\/senate-panel-finds-medicare-advantage-marketing-complaints-increase-some-states on 30 March 2025."},{"key":"r41-ANNALS2504309","unstructured":"Connolly C.\n                      ACHP letter to Senate Finance Committee on deceptive marketing practices and unchecked broker payments. Alliance of Community Health Plans; 2023. Accessed at https:\/\/achp.org\/letter-sfc-ma-marketing-broker-compensation\/ on 30 March 2025."},{"key":"r42-ANNALS2504309","unstructured":"United States Senate Committee on Finance.\n                      Wyden investigation finds rapid growth in spending on marketing middlemen among Medicare Advantage plans. U.S. Senate Committee on Finance; 2025. Accessed at www.finance.senate.gov\/ranking-members-news\/wyden-investigation-finds-rapid-growth-in-spending-on-marketing-middlemen-among-medicare-advantage-plans on 1 April 2025."},{"key":"r43-ANNALS2504309","unstructured":"Understanding Medicare seamless conversion. Healthcare Marketplace; 2016. Accessed at www.healthcaremarketplace.com\/understanding-medicare-seamless-conversion\/ on 30 March 2025."},{"key":"r44-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      Special enrollment periods. Accessed at www.medicare.gov\/basics\/get-started-with-medicare\/get-more-coverage\/joining-a-plan\/special-enrollment-periods on 30 March 2025."},{"key":"r45-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      CMS takes aim to reduce improper enrollments and promote more affordable health insurance marketplaces for millions of consumers. Accessed at www.cms.gov\/newsroom\/press-releases\/cms-takes-aim-reduce-improper-enrollments-and-promote-more-affordable-health-insurance-marketplaces on 30 March 2025."},{"key":"r46-ANNALS2504309","unstructured":"Parduhn RP.\n                      CMS cracks down on MA coverage denials and misleading ads in final rule. Healthcare Dive. 6 April 2023. Accessed at www.healthcaredive.com\/news\/medicare-advantage-prior-authorization-marketing-final-rule\/646954\/ on 30 March 2025."},{"key":"r47-ANNALS2504309","unstructured":"Chan R.\n                      Disadvantages of Medicare Advantage plans. CoverRight; 2025. Accessed at https:\/\/coverright.com\/medicare-advantage\/disadvantages\/ on 30 March 2025."},{"key":"r48-ANNALS2504309","unstructured":"Nondiscrimination in health programs and activities. Fed Regist. 2024; 89:37522-37703. Accessed at www.federalregister.gov\/documents\/2024\/05\/06\/2024-08711\/nondiscrimination-in-health-programs-and-activities on 30 March 2025."},{"key":"r49-ANNALS2504309","unstructured":"Bynon DW.\n                      5 Hidden disadvantages of Medicare Advantage plans. Accessed at www.medicare.org\/articles\/five-hidden-disadvantages-of-medicare-advantage-plans\/ on 30 March 2025."},{"key":"r50-ANNALS2504309","unstructured":"Medicare\u2019s limited nursing home coverage. ElderLawAnswers; 2023. Accessed at www.elderlawanswers.com\/medicares-limited-nursing-home-coverage-6705 on 9 April 2025."},{"key":"r51-ANNALS2504309","unstructured":"Medicare Advisors.\n                      Long-term care with Medicare Advantage 2025: your guide to what\u2019s covered. Accessed at https:\/\/medicareabc.com\/long-term-care-with-medicare-advantage-2025\/ on 9 April 2025."},{"key":"r52-ANNALS2504309","unstructured":"Hamel L, Montero A.\n                      The affordability of long-term care and support services: findings from a KFF survey. KFF; 2023. Accessed at www.kff.org\/health-costs\/poll-finding\/the-affordability-of-long-term-care-and-support-services\/ on 9 April 2025."},{"key":"r53-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-25-00280"},{"key":"r54-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1370\/afm.6"},{"key":"r55-ANNALS2504309","unstructured":"Committee for a Responsible Federal Budget.\n                      Medicare Advantage will be overpaid by $1.2 trillion. Committee for a Responsible Federal Budget; 2025. Accessed at www.crfb.org\/blogs\/medicare-advantage-will-be-overpaid-12-trillion on 30 March 2025."},{"key":"r56-ANNALS2504309","unstructured":"Committee for a Responsible Federal Budget.\n                      Reducing Medicare Advantage overpayments. Committee for a Responsible Federal Budget; 2021. Accessed at www.crfb.org\/papers\/reducing-medicare-advantage-overpayments on 30 March 2025."},{"key":"r57-ANNALS2504309","doi-asserted-by":"publisher","unstructured":"Turco MT, Seshamani M.\n                      Prioritize prior authorization reforms in Medicare Advantage. Health Affairs Forefront. 19 February 2025. doi:10.1377\/forefront.20250214.878788","DOI":"10.1377\/forefront.20250214.878788"},{"key":"r58-ANNALS2504309","unstructured":"American College of Physicians.\n                      Mitigating the negative impact of step therapy policies and nonmedical switching of prescription drugs on patient safety. American College of Physicians; 2020. Accessed at www.acponline.org\/sites\/default\/files\/acp-policy-library\/policies\/step_therapy_nonmedical_switching_prescription_drugs_policy_2020.pdf on 20 February 2026."},{"key":"r59-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.37765\/ajmc.2025.89721"},{"key":"r60-ANNALS2504309","unstructured":"Henry TA.\n                      Fixing prior auth: these critical changes must be made. American Medical Association; 2025. Accessed at www.ama-assn.org\/practice-management\/prior-authorization\/fixing-prior-auth-these-critical-changes-must-be-made on 1 April 2025."},{"key":"r61-ANNALS2504309","unstructured":"American College of Physicians.\n                      ACP calls for changes to prior authorization system that prioritize patients and physicians. American College of Physicians; 2023. Accessed at www.acponline.org\/advocacy\/acp-advocate\/archive\/april-7-2023\/acp-calls-for-changes-to-prior-authorization-system-that-prioritize-patients-and-physicians on 1 April 2025."},{"key":"r62-ANNALS2504309","unstructured":"American College of Physicians.\n                      CMS releases prior authorization final rule requiring payers to provide decisions within three to 7even days. American College of Physicians; 2024. Accessed at www.acponline.org\/advocacy\/acp-advocate\/archive\/february-9-2024\/cms-releases-prior-authorization-final-rule-requiring-payers-to-provide-decisions-within-three-to on 1 April 2025."},{"key":"r63-ANNALS2504309","unstructured":"Samson LW, Tarazi W, Turrini G, et al.\n                      Medicare beneficiaries\u2019 use of telehealth in 2020: trends by beneficiary characteristics and location. Assistant Secretary for Planning and Evaluation Office of Health Policy; 2021. Report No.: HP-2021-27. Accessed at https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/a1d5d810fe3433e18b192be42dbf2351\/medicare-telehealth-report.pdf on 1 April 2025."},{"key":"r64-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1016\/j.pop.2022.04.002"},{"key":"r65-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0498"},{"key":"r66-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2024.0521"},{"key":"r67-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-24-03577"},{"key":"r68-ANNALS2504309","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.55996"},{"key":"r69-ANNALS2504309","unstructured":"Kopans D, Yoon S.\n                      CMS upends Medicare Advantage supplemental benefits data reporting for payers. DLA Piper; 2024. Accessed at www.dlapiper.com\/en-gl\/insights\/publications\/2024\/02\/cms-upends-reporting-of-medicare-advantage-supplemental-benefits on 1 April 2025."},{"key":"r70-ANNALS2504309","unstructured":"Gupta A, Jacobson G, Leonard F.\n                      How much do Medicare Advantage enrollees value and use their supplemental benefits? The Commonwealth Fund; 2025. Accessed at www.commonwealthfund.org\/publications\/surveys\/2025\/feb\/how-much-do-medicare-advantage-enrollees-value-use-supplemental-benefits on 9 April 2025."},{"key":"r71-ANNALS2504309","unstructured":"Centers for Medicare & Medicaid Services.\n                      HPMS memos archive \u2013 weekly. Accessed at www.cms.gov\/about-cms\/information-systems\/hpms\/hpms-memos-archive-weekly on 1 April 2025."},{"key":"r72-ANNALS2504309","unstructured":"Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024\u2014Remaining Provisions and Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE). Fed Regist. 2024;89:30448-30848. Accessed at www.federalregister.gov\/documents\/2024\/04\/23\/2024-07105\/medicare-program-changes-to-the-medicare-advantage-and-the-medicare-prescription-drug-benefit-program-for-contract-year-2025 on 1 April 2025."},{"key":"r73-ANNALS2504309","unstructured":"Shapiro JR.\n                      Submission of supplemental benefits data on Medicare Advantage encounter data records \u2013 reminders, other supplemental service updates, and frequently asked questions (FAQs). Accessed at www.cms.gov\/files\/document\/submissionofsupplementalbenefitsdataonmaencounterdatarecordsg.pdf-0 on 1 April 2025."},{"key":"r74-ANNALS2504309","unstructured":"Sauchik A.\n                      Understanding MSO agreements: key considerations for healthcare providers. The National Law Review. 24 March 2025. Accessed at https:\/\/natlawreview.com\/article\/understanding-mso-agreements-key-considerations-healthcare-providers on 1 April 2025."}],"container-title":["Annals of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.acpjournals.org\/doi\/pdf\/10.7326\/ANNALS-25-04309","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.acpjournals.org\/doi\/full-xml\/10.7326\/ANNALS-25-04309","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T21:03:25Z","timestamp":1784581405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.acpjournals.org\/doi\/10.7326\/ANNALS-25-04309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":74,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.7326\/ANNALS-25-04309"],"URL":"https:\/\/doi.org\/10.7326\/annals-25-04309","relation":{},"ISSN":["0003-4819","1539-3704"],"issn-type":[{"value":"0003-4819","type":"print"},{"value":"1539-3704","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}