Medicare Services

Medicare Advantage Financial Feasibility

Reden & Anders helps you financially evaluate Medicare Advantage products. A typical Reden & Anders financial feasibility study includes actuarial estimates of medical expenses; administrative costs, including product launch, marketing, and sales; enrollment projections and timing; and pro forma financial projections for possible new products.

Actuarial estimates

The actuarial estimates for each market or service area are based on a model which summarizes the historical experience of the target populations from the CMS 5% Sample database. The data will be presented in an actuarial model format which includes utilization per thousand rates, average allowed unit costs, and pmpm costs. 

Value

  • Develop estimates of market enrollment, administrative costs, and medical expenses
  • Forecast financial outcomes
  • Project financial implications for new products

Adjustable historical

The historical cost levels can be adjusted for: expected demographics of enrollees, trend, anticipated provider reimbursement as a percentage of Medicare, utilization/care management savings, member cost sharing, if applicable, and additional costs for benefits not covered by Medicare. The corresponding MA revenue is based on the same population assumptions underlying the cost estimates.

Pro forma projections

Our pro forma projections also rely on other proprietary Reden & Anders tools such as our market projection tools, comprehensive multi-dimensional financial projection tools, and actuarial models. We incorporate other pertinent analyses to develop estimates of market enrollment, administrative costs, medical expenses, and the resulting financial outcomes.