Medicare Advantage Plans Pay For Health Care Services

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MA Plans pay for Health Care Services

In 2022, Medicare Advantage plans paid an estimated average of $2350 per enrollee above their estimated costs for providing Medicare-covered services. This is called a rebate.

These federal government have helped increase Medicare enrollment and overall program expenditures. CBO estimates that, between 2021 and 2032 the net Medicare expenditures (i.e. the ones after subtracting premiums and other offset receipts) will grow in proportion to both the federal budget as well as the nation’s economy.

The average MA plan rebate has increased significantly in recent years. This trend is largely due to the fact that many MA plans are in areas with high benchmarks. For every dollar difference between benchmarks, MA plans (including profits) cost 32 cents more, and rebates are 52 cents more.

The Medicare Advantage program uses different benchmarks, reimbursement methods and regions of service for each. For this reason, it is common for the same plan to compete with other MA plans across multiple regions that have different reimbursement and benchmarks.

The MA program also covers additional benefits that are not covered by Original Medicare, such as vision, hearing and dental services. The monthly premiums and out-of-pocket limits and costs of plans could differ. These costs may be affected by restrictions on the network. In VBID, MA plans are developing to meet the needs of people by addressing social determinants of health and improving care coordination.