Health Cost Guidelines - 65 and over

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The Health Cost Guidelines—Ages 65 and Over are used to adjust national average costs to specific geographic areas and to rate Medicare Advantage, Medicare Supplement, and retiree medical plans. They provide a basis for calculating prescription drug claim costs, and allow for modifying costs based on age/gender mix, geographic area, trends, and other rating factors.

With the Ages 65 and Over Guidelines, you can:

  • Access rating sections specific to the unique pricing aspects of Medicare populations, such as Medicare Advantage, Medicare Supplement, and employer-based retiree medical benefits.
  • Evaluate or limit provider reimbursement relative to Medicare-allowed charge levels, using the most recent Medicare payment systems in the ratings system.
  • Project future claim costs with the Retiree Medical Rating Model (RMRM), an automated spreadsheet developed for use with the employer-based retiree medical rating section. The RMRM utilizes user input to determine expected claim costs for plans offered to typical employer-based Medicare populations.
  • Analyze prescription drug costs and benefits.
  • Automate the entire prescription drug rating process.
  • Model unit price variation and the effectiveness (expected versus nominal) of higher stated plan copays with cost-per-prescription continuance tables.

The Ages 65 and Over Guidelines feature:

  • Managed Care Rating Structure
  • Medicare Supplement Rating Structure
  • Retiree Medical Rating Structure
  • Prescription Drug Rating Structure
  • Basic Tables
  • Starting Claim Costs
  • Trend Factors
  • Area Factors
  • Claim Probability Distributions

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The products we sell are the tools we use

As the premier health management consulting firm, the Health Cost Guidelines are used daily by our own in-house actuarial consultants for insight into the key drivers of healthcare costs and utilization.

The Health Cost Guidelines Suite includes the following products:

Contact your Milliman consultant or the Health Cost Guidelines Manager at if you are interested in licensing any of these products.

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