Medicare Advantage Contract Modeler
Model what a Medicare Advantage contract pays against traditional Medicare. Enter the Medicare benchmark for the stay or episode and your MA terms — percent of Medicare, a flat per diem, or a case rate — plus the share of days the plan authorizes and pays, to see realized MA reimbursement, the variance vs. FFS, the effective rate as a percent of Medicare, and the annual impact. Everything runs in your browser — nothing is saved or sent.
EstimatorBrowser-onlyNo PHIDo not paste patient names, Medicare IDs, SSNs, full claim files containing PHI, or other protected health information. This tool is intended for de-identified examples and educational / reconciliation support. Everything runs in your browser — nothing you paste is stored, logged, or sent anywhere. Enter aggregate financial figures only — this runs entirely in your browser, and nothing is saved or sent. Do not enter patient identifiers.
Data statusEstimator
- Status
- Estimator
- Data year / effective
- Your contract terms & benchmark
- Last reviewed
- May 2026
- Last updated
- May 2026
- Primary source
- Standard revenue-cycle / managed-care modeling formulas
- Formula notes
- Medicare FFS expected = benchmark × units. MA contracted = benchmark × units × percent, or rate × units, or a flat case rate. MA realized = contracted × the authorized / paid factor. Variance = MA realized − FFS expected; MA as a percent of Medicare = MA realized ÷ FFS expected. Annual figures multiply per-stay by your volume.
- Known exclusions
- Uses the benchmark, contract terms, and volume you enter — no Medicare rates are built in
- You supply the Medicare benchmark; use the relevant rate tool to look it up
- Level-of-care tiers, carve-outs, outliers, and bad debt aren't modeled unless folded into your inputs
- The authorized / paid factor is a single haircut, not a day-by-day utilization review
- Informational only — not financial, accounting, or contracting advice
The care & the Medicare benchmark
Pick the setting and enter what traditional Medicare would pay for the stay or episode. You supply the benchmark — nothing is assumed — so use the matching rate tool (PDPM, PDGM, hospice, IRF, LTCH) to look it up.
Medicare Advantage contract terms
Pick how the MA contract actually pays — a percent of Medicare, a flat rate per unit (often a level-of-care per diem), or a case rate per stay — then add the share of days / units the plan typically authorizes and pays. Prior-authorization and concurrent-review denials are a real driver of realized MA revenue.