Quote:
Originally Posted by blueash
This is not how MA plans work. They are not between you and Medicare. In fact Medicare is not involved with you once you join a MA plan. Medicare contracts with the MA insurance company and pays that company every month a fixed amount per enrollee who otherwise would have been on traditional Medicare but opted for MA instead.
The amount given to the MA company is rate based on costs in the region, the health of the insured group etc. For almost all MA plans, they are given more than the expected amount Medicare would pay but the MA plans are offering additional benefits including removing CMS from claims processing. MA plans do get a higher monthly payment if the patients are sicker which is why your MA doctor lists every single thing you ever might have had in your diagnosis list.
But the MA plan is not waiting to be paid by Medicare. They have the monthly capitation which is well over 1000 per person and they make money if your care costs less than that amount, and lose if you are more costly. |
Very good post. For a healthy person in 2025 MA Plans will receive an $1191.56 capitalization payment each month per enrollee. They get that whether you go to a doctor or not. As per the rate book.
2025 | CMS