RxHCC Model Segments: MA-PD vs PDP in the 2027 Model
Every RxHCC model splits beneficiaries into segments — demographic/institutional cells with their own coefficients. For continuing enrollees there are five: community non-low-income age 65+, community non-LI under 65, community LI 65+, community LI under 65, and institutional. New enrollees have their own non-LI, LI, and institutional tables.
What changed for CY2027
Before 2027, one set of disease coefficients applied to all beneficiaries regardless of plan type; only the normalization factor differed between MA-PD and PDP. CY2027 segments the disease coefficients by plan type — CMS found the same diagnosis predicts different drug costs in the two populations and finalized the split to improve predictive accuracy for both (CY2027 Rate Announcement, Attachment VIII).
Where the values diverge
Examples from the community non-LI 65+ continuing-enrollee segment:
| RxHCC | Label | 2027 MA-PD | 2027 PDP |
|---|---|---|---|
| RXHCC1 | HIV/AIDS | 8.304 | 9.794 |
| RXHCC30 | Diabetes with Complications | 0.429 | 0.616 |
| RXHCC83 | Rheumatoid Arthritis and Other Inflammatory Polyarthropathy | 0.139 | 0.172 |
| RXHCC186 | Heart Failure | 0.163 | 0.260 |
The full 80-category comparison is in the 2027 coefficients table with a downloadable CSV covering all five segments for both plan types.
Operational consequence
Bid, forecast, and provider-alignment models built on a single coefficient set are now wrong by construction. MA-PD plans should model on MA-PD coefficients divided by 1.109; PDPs on PDP coefficients divided by 1.005. See normalization factors for the denominator math.
Frequently asked questions
Do hierarchies differ between MA-PD and PDP?
No. The disease hierarchies (Table VIII-13) apply across all RxHCC models.
What about PACE?
PACE organizations pay on a 50/50 blend of the 2023/2024 and 2018/2019 calibrations for CY2027.