In Medicare Advantage funding, the cumulative risk scores for enrollees are used to determine what?

• A. Copays for beneficiaries
• B. Provider network size
• C. Enrollment eligibility
• D. Future funding allocations for the plans

Answer: (D)

Understanding risk adjustment is key here. In Medicare Advantage, diagnosis data are used to assign each enrollee a health-status score. When those scores are added up across all enrollees, they inform and adjust the amount the plan will be paid—through risk-adjusted, per-member-per-month funding—to reflect the expected costs of care. So the cumulative risk scores determine future funding allocations for the plans.

Copays are set by each plan’s benefit design, not by risk scores. Network size depends on contracts and provider availability, not the risk-adjusted scores. Enrollment eligibility is based on standard eligibility rules and enrollment status, not on the risk-adjusted payments.