What Are 0.01 and 0.1 RAF Worth in Medicare Advantage?
Under CY2026 CMS factors, a 0.01 change in raw RAF is worth about $105.83 per member per year at a $1,000 base rate and 100% of premium — about $1.06M a year per 10,000 members. A 0.1 change is worth ten times that. The formula, a lookup table and a quick calculator below show how it scales for your contract.
That number decides whether a coding initiative gets funded, whether a risk contract is profitable and whether margin targets are met, so it is worth getting exactly right.
How RAF Scores Affect Medicare Advantage Payments
The value of a RAF change depends on five contract-specific inputs: the risk-adjustable base rate (see CMS rates), the number of members, the payment year's CMS normalization factor, the 5.9% MA coding pattern adjustment, and the % of premium your organization receives under a provider contract.
The formula for the value of a 0.01 change in raw RAF is:
Value of 0.01 RAF = Base rate PMPM × 0.01 ÷ normalization factor × (1 − 5.9%) × % of premium × members × 12
Multiply by 10 for a 0.1 change. If your RAF is already payment-adjusted (as on MMR files), drop the normalization and coding terms. For every variable in detail, see the Medicare risk adjustment revenue model guide.
The Revenue Impact of a 0.1 RAF Change
Annual value of a 0.1 change in raw RAF by membership and base rate, assuming 60% of premium and CY2026 CMS factors (normalization 1.067, coding adjustment 5.9%).
| MA Lives | $900 PMPM | $1,000 PMPM | $1,100 PMPM | $1,200 PMPM | $1,300 PMPM |
|---|---|---|---|---|---|
| 5,000 | $2.86M | $3.17M | $3.49M | $3.81M | $4.13M |
| 10,000 | $5.71M | $6.35M | $6.98M | $7.62M | $8.25M |
| 25,000 | $14.29M | $15.87M | $17.46M | $19.05M | $20.64M |
| 50,000 | $28.57M | $31.75M | $34.92M | $38.10M | $41.27M |
| 100,000 | $57.15M | $63.50M | $69.85M | $76.20M | $82.55M |
What is RAF worth for your contract?
0.01 RAF is worth about $2,645,736 a year
Open the full RAF revenue calculator →Looking for a single patient's RAF score? Use RAFScoreCalculator.com.
Revenue Impact Across Member Populations
The scenarios below use a $1,100 base rate, 100% of premium and CY2026 CMS factors.
Small Contract: 5,000 MA Lives
At 5,000 lives, 0.01 RAF is worth about $582,062 a year and 0.1 RAF about $5.82M. A chart review initiative that lifts average RAF by 0.03 would add about $1.75M a year.
Mid-Size Contract: 25,000 MA Lives
At 25,000 lives, 0.01 RAF is worth about $2.91M a year and 0.1 RAF about $29.10M. At this level, fractional RAF changes from documentation improvement or prospective coding become multi-million-dollar decisions, and CFOs typically build dedicated risk adjustment financial models.
Large Contract: 100,000 MA Lives
At 100,000 lives, 0.01 RAF is worth about $11.64M a year and 0.1 RAF about $116.41M. A 0.10 difference in average RAF is worth that much every year, before any change in medical cost.
Why the Answer Changes: Key Variables
- Base rate: county rates vary widely by geography, and a higher base rate raises the value of every RAF point.
- % of premium: a provider group receiving 60% of premium gets 60% of the value. See the MA risk contract profitability model.
- CMS normalization and coding adjustment: together they reduce the value of each raw RAF point by about 11.8% in CY2026 and 12.8% in CY2027. See CMS normalization factors.
- Payment year: each Rate Announcement moves the base rate and the CMS factors; see what the 2027 Rate Announcement means in dollars.
- Accepted, not suspected, HCCs: RAF value only materializes for documented, submitted and accepted HCCs. See the HCC revenue impact model.
Compounding RAF Changes Over Multiple Years
RAF improvements persist when chronic conditions are recaptured every year. An organization that lifts average RAF by 0.03 with 25,000 members, a $1,100 base rate and 60% of premium gains about $5.24M a year (CY2026 factors), or about $15.72M over three years if the lift is sustained. Build this into every risk adjustment pro forma and Medicare Advantage revenue forecast.
Using This Number in Practice
The per-RAF value converts RAF lift into revenue for every coding program ROI; program cost is the denominator. A $3 million chart review program expected to lift average RAF by 0.02 across 25,000 members at a $1,100 base rate and 100% of premium returns about $5.82M over a full payment year (12 months, CY2026 factors), or 1.94× the cost. It also anchors sensitivity analysis in risk adjustment pro forma models.
Most importantly, it turns clinical and coding metrics into the dollar language that boards, investors and plan partners understand.
Common Mistakes When Estimating RAF Value
The most common mistake is ignoring CMS normalization and the coding adjustment, which overstates value by about 13.4% under CY2026 factors (14.7% under CY2027); the opposite mistake is applying them to a RAF that is already payment-adjusted. Another is applying one per-member value across community, institutional and new-enrollee segments, which use different risk models and coefficients.
Timing matters too: RAF changes from this year's coding usually affect revenue in the following payment year. For two-sided risk contracts, the per-RAF value also sets the size of Medicare downside risk exposure.
Using a RAF Revenue Calculator for Precision Modeling
The only number that matters is the one for your contract. The RAF revenue calculator takes your members, base rate, payment year and % of premium and shows the value of 0.01 RAF, annual revenue and a sensitivity table from −0.10 to +0.10, with a downloadable PDF.
FAQ: RAF Financial Impact Explained
How much is 0.01 RAF worth per member per year?
Under CY2026 CMS factors, 0.01 of raw RAF is worth about $105.83 per member per year at a $1,000 base rate and 100% of premium: $1,000 × 0.01 ÷ 1.067 × (1 − 5.9%) × 12. Multiply by members and your % of premium for your contract.
How much is 0.1 RAF worth per member per year?
At a $1,100 base rate and 100% of premium, 0.1 of raw RAF is worth about $1,164.12 per member per year under CY2026 factors; at 60% of premium it is about $698.47.
Does a higher RAF mean more profit?
Not by itself. Each 0.01 of documented raw RAF adds about $105.83 of revenue per member per year at the reference assumptions, but profit depends on medical cost, administration and your contract terms (% of premium, risk share, caps). The conditions behind a higher RAF also tend to cost more to treat. Test the whole contract in the contract P&L calculator.
Does the value of a RAF change vary by contract size?
The per-member value does not, but the total scales with membership. At a $1,100 base rate and 100% of premium (CY2026), 0.1 raw RAF is worth about $5.82M a year for 5,000 members, $29.10M for 25,000 and $116.41M for 100,000. Run your own contract in the RAF revenue calculator.
How do normalization and the coding adjustment affect RAF value?
Raw scores are divided by the CMS FFS normalization factor (1.067 in CY2026, 1.079 in CY2027) and reduced by the 5.9% MA coding pattern adjustment. Together they cut the value of each raw RAF point by about 11.8% in CY2026 and 12.8% in CY2027. If your RAF is already payment-adjusted (as on MMR files), do not apply them again. See CMS normalization factors by year.