What does Medicare pay to MA plans
- Thread starter jtmgolf00
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ValeRosso
Guru
- 523
$13k? I was told around $800 a month which is $9600/year. Not 100% certain though.
it was about $800/mo 10 years ago
So this is the real debate in Med Supp. vs MAPD. Depending on who you believe (don't believe hardly anyone in this business. The higher up the food chain the less I believe) MAPD is being reimbursed 13% -20% more per Bennie than OM. The whole reason MAPD got a seat at that table was they said they could do it cheaper than OM. How'd that turn out? Real reason Insurance Companies wanted in was to hold and touch every single dollar Goverment spent on OM, VA, Medicaid, IHS .
Why don't we go back to premise if can do it cheaper than Gov. fine . If not go pound dirt. MAPD being reimbursed significantly more than OM will be the straw that breaks Medicare as we know it! This has nothing to to do with care. It's simple math,simply that.
Why don't we go back to premise if can do it cheaper than Gov. fine . If not go pound dirt. MAPD being reimbursed significantly more than OM will be the straw that breaks Medicare as we know it! This has nothing to to do with care. It's simple math,simply that.
Last edited:
- 2,110
In 2019, the gubment paid almost $400 more per year for an advantage plan. That's per beneficiary. Also in 2019, annual payment per beneficiary was $11,844.
Doubt it's gone down any since then.
why is anybody shocked by this?
Cronyism is never good for the tax payer. The only solution is to get rid of Medicare in it's entirety.
- 6,458
Isn't that the "American Way" where ever Government Dollars will be dispensed?
Packerland
Guru
- 504
Currently, payments are determined using a risk adjustment methodology that accounts for the varied health risks among beneficiaries. This process starts with a Health Risk Assessment, where plans collect data on beneficiaries’ health status and medical history to project healthcare expenses. A risk score is then calculated for each beneficiary, reflecting their expected healthcare costs relative to the average Medicare beneficiary. Higher-risk individuals receive higher payment rates, and plans may also get subsidies and bonuses based on performance, quality measures, and cost management.
Looking ahead, several changes in government payment models are expected:
1. Risk Adjustment Updates: The government may revise the risk adjustment model, altering how payments are distributed based on beneficiaries’ health risks.
2. Value-Based Payment Initiatives: Implementing value-based payment initiatives could link Medicare Advantage payments to the quality and outcomes of care, promoting better care coordination and health outcomes.
3. Innovative Payment Models: New models may be introduced to incentivize efficiency and cost-effectiveness, focusing on better resource utilization and cost containment.
4. Addressing Social Determinants of Health: Future models might include factors like housing, nutrition, and transportation to improve health outcomes and reduce costs.
These anticipated changes will impact both Medicare Advantage plan providers and beneficiaries:
• Provider Revenue Adjustments: Providers could see revenue adjustments based on their effectiveness in managing health and achieving outcomes, with high performers receiving increased reimbursements.
• Beneficiary Access to Services: Modifications in payment models may affect the availability of services and benefits, with plans possibly focusing more on services aligned with value-based care.
• Cost Sharing and Premiums: Changes in payment models might influence the structure of cost-sharing and premium levels, affecting beneficiaries’ out-of-pocket costs and premiums.
• Provider Network Changes: Payment model shifts could also impact provider networks, with a preference for providers that align with value-based care and demonstrate better health outcomes.
In conclusion, the future of Medicare Advantage payments is expected to prioritize quality care, cost containment, and improved health outcomes, with the impact on providers and beneficiaries depending on how these changes are implemented and adapted to by healthcare organizations.
I was able to find numerous articles on this subject and blended them into one post.
The bottom line Medicare is running out of money and the sonnet we can get our hands around this issue the better for our country.
I have been mulling over a few ideas such as reducing what Medicare reimburses for a Medicare from 80% to 70% thus increasing the cost of every supplement passing that cost ultimately along to the consumer by increased Med Supplement cost.
Additionally review the reimbursement rates for MAPD plans to carriers … of course MAPD should receive more reimbursement since the carriers are taking a major burden away from the federal government.
Looking ahead, several changes in government payment models are expected:
1. Risk Adjustment Updates: The government may revise the risk adjustment model, altering how payments are distributed based on beneficiaries’ health risks.
2. Value-Based Payment Initiatives: Implementing value-based payment initiatives could link Medicare Advantage payments to the quality and outcomes of care, promoting better care coordination and health outcomes.
3. Innovative Payment Models: New models may be introduced to incentivize efficiency and cost-effectiveness, focusing on better resource utilization and cost containment.
4. Addressing Social Determinants of Health: Future models might include factors like housing, nutrition, and transportation to improve health outcomes and reduce costs.
These anticipated changes will impact both Medicare Advantage plan providers and beneficiaries:
• Provider Revenue Adjustments: Providers could see revenue adjustments based on their effectiveness in managing health and achieving outcomes, with high performers receiving increased reimbursements.
• Beneficiary Access to Services: Modifications in payment models may affect the availability of services and benefits, with plans possibly focusing more on services aligned with value-based care.
• Cost Sharing and Premiums: Changes in payment models might influence the structure of cost-sharing and premium levels, affecting beneficiaries’ out-of-pocket costs and premiums.
• Provider Network Changes: Payment model shifts could also impact provider networks, with a preference for providers that align with value-based care and demonstrate better health outcomes.
In conclusion, the future of Medicare Advantage payments is expected to prioritize quality care, cost containment, and improved health outcomes, with the impact on providers and beneficiaries depending on how these changes are implemented and adapted to by healthcare organizations.
I was able to find numerous articles on this subject and blended them into one post.
The bottom line Medicare is running out of money and the sonnet we can get our hands around this issue the better for our country.
I have been mulling over a few ideas such as reducing what Medicare reimburses for a Medicare from 80% to 70% thus increasing the cost of every supplement passing that cost ultimately along to the consumer by increased Med Supplement cost.
Additionally review the reimbursement rates for MAPD plans to carriers … of course MAPD should receive more reimbursement since the carriers are taking a major burden away from the federal government.
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