What is the cost of MA plans to Medicare?

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boater07
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What is the cost of MA plans to Medicare?

Post by boater07 » Sat Jul 13, 2019 12:32 pm

MA plans appear to be very popular and heavily advertised by the insurance co's[ many at no cost]
I doubt co's give anything away by choice and hence the payout by medicare to assume all risk must
cover their expenditures more or less.
As I understand, co's bid for the payout from Medicare. I would be curious to know how that cost
compares to Medicare's own health payouts.
To rephrase, what is the total cost of MA plans vs Heath coverage to SS. Hope this makes sense?

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boater07
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Re: What is the cost of MA plans to Medicare?

Post by boater07 » Sat Jul 13, 2019 1:36 pm

With all the talk about national healthcare, I thought this would be a way to compare govt vs private.
On further reflection, I realize the total outlay would be meaningless w/o membership count in each.

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TexasPE
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Re: What is the cost of MA plans to Medicare?

Post by TexasPE » Sat Jul 13, 2019 9:35 pm

Per this link

https://insuremekevin.com/how-much-does ... qus_thread

in California cost to the govt is ~$1,000/ month. if I am interpreting the table correctly.
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boater07
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Re: What is the cost of MA plans to Medicare?

Post by boater07 » Sat Jul 13, 2019 9:49 pm

Thank you. Not a simple answer to the issue I'm concerned about.
What is more efficient?

cas
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Re: What is the cost of MA plans to Medicare?

Post by cas » Sun Jul 14, 2019 5:01 am

boater07 wrote:
Sat Jul 13, 2019 12:32 pm
As I understand, co's bid for the payout from Medicare. I would be curious to know how that cost
compares to Medicare's own health payouts.
To rephrase, what is the total cost of MA plans vs Heath coverage to SS. Hope this makes sense?
Kaiser Family Foundation recently (June 2019) published one of their data analysis papers on Medicare Advantage, slicing and dicing lots of data and producing graphics and discussion on various aspects of the program:

https://www.kff.org/medicare/fact-sheet ... advantage/

Maybe the "Medicare Payments to Medicare Advantage Plans" section of that analysis might have the information you are looking for. (You have to scroll down a way.) Is this the type of information you were looking for?
Today, Medicare pays plans based on a bidding process. Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted. The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs). [ . . .]

If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which is designed to be used to provide supplemental benefits to enrollees. Payments to plans are then adjusted based on enrollees’ risk profiles.

[ . . .]

In 2019, Medicare payments to Medicare Advantage plans (including bonus payments) are roughly equal to the per capita costs in traditional Medicare, 100.4 percent, on average, according to the Medicare Payment Advisory Commission. The Secretary of Health and Human Services applies a downward adjustment to payments each year (5.9% in 2019) to help account for differences in the intensity of coding for health conditions by Medicare Advantage plans relative to traditional Medicare. Evidence indicates that beneficiaries who choose to enroll in Medicare Advantage plans have lower spending and use fewer services – before they enroll in Medicare Advantage plans – than similar beneficiaries who remain in traditional Medicare. This suggests that basing payments to plans on spending of those in traditional Medicare may systematically overestimate the expected costs of Medicare Advantage enrollees.

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dodecahedron
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Re: What is the cost of MA plans to Medicare?

Post by dodecahedron » Sun Jul 14, 2019 7:03 am

boater07 wrote:
Sat Jul 13, 2019 9:49 pm
Thank you. Not a simple answer to the issue I'm concerned about.
What is more efficient?
This is very hard to determine because the population that selects an MA plan is different (in general, healthier) than the population that stays with traditional Medicare. There is some adjustment in payment formulas for observable differences in health status at time of initial selection, but not all such differences are easy to observe.

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