By NextBestFitClaims, enrollment & provider systems (IT)
Extends Medicare's shared systems instead of building from scratch. For scale: HealthCare.gov cost about $2.1B through 2014 for a far simpler job, and the UK's NHS National Programme for IT spent about £10B and largely failed.
Result
$18.0B
Per resident, per year
$53
÷ 341.1M people
Per household
$136
÷ 132.2M households
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | Extend & re-platform Medicare shared claims systems (FISS, MCS, CWF) | $6B | $6.0B |
| 2 | Scale up Medicare Administrative Contractors for the whole population | 10 regions × $0.4B | $4.0B |
| 3 | Real-time eligibility API & provider portal | $1.5B | $1.5B |
| 4 | Hospital global-budget payment & encounter-data system | $1.5B | $1.5B |
| 5 | New claim types: dental, vision, hearing, HCBS | $1B | $1.0B |
| 6 | Independent verification, load & parallel testing | $1B | $1.0B |
| 7 | Cybersecurity, redundancy & offline interim-payment system | $2B | $2.0B |
| 8 | Legacy system decommissioning & data migration | $1B | $1.0B |
| 9 | Total one-time cost | $18.0B |
By year
| Year 0 | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Year 6 |
|---|---|---|---|---|---|---|
| $5.0B | $5.0B | $3.0B | $2.0B | $2.0B | $1.0B | $0.0B |
Inputs used
| Input | Kind | Value |
|---|---|---|
| Extend & re-platform Medicare shared claims systems (FISS, MCS, CWF) | estimate, medium confidence | $6.0B |
| Claims-processing regions (MAC contracts) | policy, high confidence | 10 |
| Scale-up cost per MAC region | estimate, medium confidence | $0.4B |
| Real-time eligibility API & provider portal | estimate, medium confidence | $1.5B |
| Hospital global-budget payment & encounter-data system | estimate, medium confidence | $1.5B |
| New claim types: dental, vision, hearing, HCBS | estimate, medium confidence | $1.0B |
| Independent verification, load and parallel testing | estimate, medium confidence | $1.0B |
| Cybersecurity, geographic redundancy, offline interim-payment system | estimate, medium confidence | $2.0B |
| Legacy system decommissioning & data migration | estimate, medium confidence | $1.0B |
Trade-off: Heaviest during the 18-month build and Year 1; tapering as later waves reuse the same systems.