10 Dec 2024 3:21 pm
Medicare advantage programs are extremely profitable to health insurance corporations, or they would not offer them.EDC4ALL! » 10 Dec 2024, 2:28 pm » wrote: ↑ they are providing MORE benefits than Original Medicare.....one would think it would cost more. Why doesn't Original Medicare have a cap on a patients medical bills, but they require Medicare Advantage plans to have one?
"Medicare pays insurers a set amount per enrollee per month, which varies depending on the county in which the plan is located, the health status of the plan’s enrollees, and the plan’s estimated costs of covering Medicare Part A and Part B services.
The plans use these payments to pay for Medicare-covered services, and in most cases, also pay for supplemental benefits, reduced cost sharing and lower out-of-pocket limits, which are attractive to enrollees. Plans are able to offer these additional benefits, often without charging an additional premium for Part D prescription drugs or supplemental benefits, because they receive an additional $2,329 per enrollee above their estimated costs of providing Medicare-covered services. This portion of plan payments, also called the rebate, has increased substantially in the last several years, more than doubling since 2018. At the same time, Medicare Advantage plans can use cost management tools, such as prior authorization requirements, which can impose barriers to receiving care, and limited networks of providers, which can restrict beneficiary choice of physicians and hospitals. More than half (56%) of Medicare Advantage beneficiaries are enrolled in HMO plans that typically do not cover out-of-network services.
While data on Medicare Advantage plan availability, enrollment and plan offerings is robust, the same cannot be said about service utilization (especially for supplemental benefits) and out-of-pocket spending patterns (though some of this data is starting to be collected), which would allow assessment of how well the program is meeting its goals in terms of value and quality and help Medicare beneficiaries compare coverage options. As enrollment in Medicare Advantage and federal payments to private plans continue to grow, greater transparency and more comprehensive information will become increasingly relevant for people with Medicare program oversight."
Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization | KFF