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Seniors Paid Billions in Extra Premiums Due to Alleged Medicare Overpayments

A congressional committee finds that controversial practices like adding diagnoses in Medicare Advantage triggered higher bills

By Christopher Weaver and Anna Wilde Mathews, WSJ

Updated March 10, 2026 1:02 pm ET

The Joint Economic Committee found alleged overpayments to Medicare Advantage plans increased seniors’ 2025 Medicare Part B premiums by $13.4 billion.

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The average American senior’s Medicare premiums last year were about 10% higher, or more than $200 annually, because of alleged overpayments to private Medicare Advantage plans, congressional investigators found.

Medicare Part B premiums that most seniors pay were partly pushed up by controversial health-insurer practices such as adding diagnoses to trigger higher payments, according to the Joint Economic Committee, a bipartisan group of lawmakers that advises Congress on financial matters.

Overpayments to Medicare Advantage insurers increased Part B premiums by $13.4 billion in 2025, the committee said, a cost mostly borne by seniors. Both those enrolled in Medical Advantage plans and those in standard Medicare faced those additional costs.

The committee published the report Tuesday, after The Wall Street Journal was first to report its findings. The committee’s Republican majority staff prepared the report.

A spokesman for AHIP, the health-insurance industry trade group, said the committee’s findings were based on “fundamentally flawed data, methodology and extrapolations” and shouldn’t dictate policy.

The Centers for Medicare and Medicaid Services said it doesn’t comment on external analyses.

In Medicare Advantage, private insurers administer federal Medicare benefits for older and disabled Americans. Medicare’s Part B benefit covers doctor visits, lab tests and similar services. Part B premiums, which were typically $185 a month in 2025, are usually withdrawn from seniors’ Social Security checks. Part B premiums are pegged to spending for medical services.

Extra spending on Medicare Advantage “is not just coming out of the federal government’s budget,” said Rep. David Schweikert (R., Ariz.), the chairman of the committee. “A portion of this comes out of you.”

Medicare Advantage, which has long enjoyed support from Republicans, has faced growing bipartisan scrutiny. Among the biggest competitors in the business are UnitedHealth Group, Humana and Elevance Health.

Lawmakers and government investigators have been probing how insurers’ billing practices have contributed to Medicare Advantage costs. A congressional watchdog found Medicare Advantage costs the federal government more than traditional Medicare, partly because of insurers’ billing practices. The insurers are paid more to cover enrollees who have more health conditions, and they can boost their reimbursement by recording more diagnoses.

The average Medicare beneficiary paid $212 extra in 2025 because of Medicare Advantage “overpayments,” the committee said. Medicare recipients with higher incomes pay higher premiums, and for those people, the committee said, the extra payments could be as high as $682 a year.

Low-income Medicare enrollees often don’t have to pay the Part B premiums, which are covered by Medicaid.

The report’s calculations of Medicare Advantage “overpayments” are based on findings by the congressional Medicare Payment Advisory Commission, or MedPAC. The watchdog says Medicare Advantage plans cost substantially more than traditional Medicare to cover the same people, because of the insurers’ extra diagnoses as well as their tendency to enroll healthier-than-average Medicare recipients.

The committee used a MedPAC estimate that in 2025 Medicare Advantage cost roughly 20% more than traditional Medicare. MedPAC later signaled it would revise that estimate downward, a change the committee said in its report that would modestly reduce its estimates of excess premiums.

The Wall Street Journal reported in 2024 that insurer practices contribute to potential overpayments. For instance, insurers sent nurses to patients’ homes, where they documented diagnoses that trigger more payments.

Medicare Advantage companies said their practices improve patient care and save money.

Trump administration officials at the Medicare agency recently published estimates that Medicare Advantage costs associated with higher rates of diagnoses were lower than MedPAC’s projections.

Medicare officials nevertheless moved in January to remove some of the tools insurers use to increase their payments, such as certain behind-the-scenes reviews of medical charts that can lead to extra diagnoses. Including that change, the Medicare agency proposed holding the insurers’ rates essentially flat next year, triggering pushback by the insurers.

In an interview Friday, Medicare agency administrator Mehmet Oz said of Medicare Advantage insurers, “I don’t think they’re as overpaid as has been reported.”

Yet, he said, the Medicare Advantage payment system had at times created the wrong incentives and “we should change the rules.”