[Rainger99]

Medicare Advantage plans are scaling back.

MA plans can offer these additional benefits, often without charging an additional premium for Part D prescription drugs or supplemental benefits, because in 2025, they received an additional $2,255 per enrollee above their estimated costs of providing Medicare-covered services.

That explains how Advantage Plans pay for all of the extras.

Medicare Advantage plans are scaling back

[Aces4]

Originally Posted by Rainger99

Medicare Advantage plans are scaling back.

MA plans can offer these additional benefits, often without charging an additional premium for Part D prescription drugs or supplemental benefits, because in 2025, they received an additional $2,255 per enrollee above their estimated costs of providing Medicare-covered services.

That explains how Advantage Plans pay for all of the extras.

Medicare Advantage plans are scaling back

And that is the poop hitting the fan that was predicted in earlier threads on this forum. It was nice while it lasted but not self-sustaining. The screaming high insurance costs are balanced on the non-paying population that doesn't have to worry about their healthcare.

[GoRedSox!]

While the pandemic seems like a distant memory in some ways, it wasn’t that long ago. During this time, elective procedures such as knees, hips, shoulders, etc. were often postponed. This created a domino effect and backlogged a lot of these procedures which got pushed forward. It appears in some cases that insurance underwriters underestimated costs and insurers like Humana and United Health did not make anywhere near as much on MA members as they projected. Some members became unprofitable. Now insurers are pulling out of unprofitable zip codes and shedding members, and cutting back on extra benefits or raising premiums for others. I hope the 2026 MA plans won’t lose too much in The Villages, this has to be one of the healthiest senior populations in the country.

[Publius]

Well, Medicare Advantage (MA) differs greatly among carriers like any open publicly traded contract. Big difference in standard coverage versus chronic illnesses like prescribed diabetes, lung disorders etc. Humana has cut their standard and chronic illnesses compensations. They do alot of expensive retail advertising, which cuts into their margins. What most people don't realize is that MA contracts have a monthly stipend/member from the government whether the individual uses expensive health care or not. Hence, the government pays monthly for each MA covered person enrolled to the carriers no matter if they cause expenses or not. Therefore, keeping each member healthy without expensive procedures benefits the carriers profits. Sure, it's a test program. However, it boosts DIY and primary care physicians to work harder to stay/keep individuals healthy. One must know caveat: under ANY MA contract the owner must have their primary care physician (PCP) acquire and get approved a pre-authorization from the MA contractor for any procedure outside the PCP's annual check ups. It's quite demanding at certain points, but can save enrollees hugely by following the rules. As always, doing one's homework can save (in our case) millions of dollars in life saving health care only Florida best in world medical facilities can provide!
Bon Chance, readers. Much to learn. More to share...
Yours In Service,
Publius

[Publius]

Originally Posted by Rainger99

Medicare Advantage plans are scaling back.

MA plans can offer these additional benefits, often without charging an additional premium for Part D prescription drugs or supplemental benefits, because in 2025, they received an additional $2,255 per enrollee above their estimated costs of providing Medicare-covered services.

That explains how Advantage Plans pay for all of the extras.

Medicare Advantage plans are scaling back

Well, Rainger99, while I didn't find quite the same $/member/month of any MA contract at $2,255, it does fit towards the per member monthly numbers loosely fit with government stated possibilities. The main point is: contracted MA Healthcare is prosperous IF each enrollee is kept healthy! That makes good monetary sense on any level of capitalistic venture. Plus great health in aging population here in Central Florida.

[Rainger99]

Originally Posted by Publius

Well, Rainger99, while I didn't find quite the same $/member/month of any MA contract at $2,255, it does fit towards the per member monthly numbers loosely fit with government stated possibilities. The main point is: contracted MA Healthcare is prosperous IF each enrollee is kept healthy! That makes good monetary sense on any level of capitalistic venture. Plus great health in aging population here in Central Florida.

This is the estimate from AI.

Thus, the 22% overpayment equates to roughly $2,860 per patient annually. This is an estimate, as actual payments vary by county, risk scores, and plan specifics.