CMS moves $1.5 trillion a year with 6,000 employees. It does almost none of the actual work. A contractor market of $7-8.5B a year does it for them.
Maximus leads five-year contract totals at nearly $4B. But the most surprising #2: a nonprofit Blue plan in South Carolina, through three affiliated entities, pulling $718M in fiscal 2025 alone.
The entire Medicare Administrative Contractor tier traces back to the 1965 statute that barred the government from running claims directly. Palmetto, Noridian, Novitas - all fossil records of that one political deal.
Most clarifying data point: only 16% of fiscal 2025 CMS contract spend is coded as government health insurance programs. The rest is IT and professional services. CMS is a federal tech buyer that happens to run Medicare.
Subscribe to www.onhealthcare.tech for free and paid articles, podcasts, and more.
