Quote:
Originally Posted by OrangeBlossomBaby
If you want the answer to that, first consider the common sense answer, using a common hypothetical.
MA pays X dollars for patient John. Every month. No more, no less. And then John is found to have a brain tumor that is treatable with chemo, targeted radiation, months of physical and speech therapy, home health aids, and two months in rehab.
Who's gonna pay for all that? Or will John simply die because he can't afford it? Answer: Something ELSE is going to happen, besides MA simply paying out X dollars for patient John.
What is that something else? I don't know. But I'm confident it's something else.
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If a Medicare Advantage (MA) plan spends more on a particular patient than its capitation rate,
the plan itself is responsible for covering the excess cost.
That is why UHC's profits fell 19% last year.