RAF calculator

What is a RAF score?

A Risk Adjustment Factor score is the number CMS assigns to a Medicare Advantage enrollee to scale the plan's monthly payment for that person. It combines demographic factors (age band, sex, Medicaid and disability status, institutional status) with the coefficients of the CMS-HCC categories the enrollee's documented diagnoses map to, after hierarchies drop the lower-severity categories in the same family. A score of 1.0 represents the expected cost of an average Medicare fee-for-service beneficiary.

How is a RAF score calculated?

1. Start with the demographic coefficient for the member's segment (community or institutional, aged or disabled, dual status).
2. Add the coefficient of every payment HCC that survives the hierarchies, plus any qualifying disease interaction and HCC count terms.
3. Divide by the normalization factor CMS publishes for the payment year.
4. Apply the MA coding pattern adjustment.

For payment year 2026 the CY2026 Rate Announcement sets the 2024 CMS-HCC model (V28) normalization factor at 1.067 and the coding pattern adjustment at 5.90 percent. A code-level coefficient is a reference for one category; the member total is what the model software produces from the complete diagnosis set and member context.

What is the average RAF score for Medicare beneficiaries?

By construction, 1.0. CMS calibrates the CMS-HCC model on fee-for-service claims so that the average fee-for-service beneficiary scores 1.0, then re-normalizes every payment year so the average stays at 1.0 as raw scores drift upward. That is what the normalization factor above does. A plan's or a member's score is read against that 1.0, not against another plan.

What is a normal RAF score?

There is no fixed "normal." A score above 1.0 means the member is expected to cost more than the average fee-for-service beneficiary; below 1.0, less. The score moves with the age band, dual and institutional status, and the number and severity of documented HCCs, so two members with the same diagnoses can score differently on demographics alone. Compare a member's score to that member's prior year and to the documentation, not to a rule of thumb.

Are HCC score and RAF score the same?

No. An HCC is one category in the model, and each payment HCC carries one coefficient. The RAF score is the member's total after the demographic factor, every surviving HCC, interactions, normalization, and the coding pattern adjustment. When someone says "HCC score" they usually mean a single category's coefficient, which is a reference, not a member total.