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I'm still several years away from 65, but can you elaborate on that a little more. What I'm confused about is the last sentence. Why would your primary care physician be incentivized to control care because Anthem or United get a fixed payment whether or not someone goes to the doctor? I can see why the insurer would be incentivized to manage the amount of care, but I am confused why the PCP would be incentivized to do it.MA plans are capitated plans, i.e. insurers receive a fixed fee from CMS, per member. In other words, your MA insurer gets paid the same amount whether you go to the doctor a lot or not at all. So the incentive for your PCP is to closely manage, i.e. reduce, the amount of care you get.
Thanks you for that. One additional question. Is the PCP limited to the fixed amount, or can they still bill insurance for office visits, tests, etc.? If they are limited to the fixed amount, then I can definitely see where they are incentivized to manage the amount of care.It depends on the doctor of course, but the PCP gets the fixed fee regardless of the amount of times he/she sees the patient and how long they spend with the patient. The incentive can be to not give the patient the amount of time/care they need.
Started with an Advantage plan - and if you’re perfectly healthy, no dental or vision issues, then you’re good.
However if there are any issues and I found this with my dental, then supplemental might be your best option.
Thanks you for that. One additional question. Is the PCP limited to the fixed amount, or can they still bill insurance for office visits, tests, etc.? If they are limited to the fixed amount, then I can definitely see where they are incentivized to manage the amount of care.
You are young—until you stop breathing.Please keep going. This old(er) man is listening/ reading. I still work and have health care I can keep but could retire any time. (My wife is already at Medicare age.) Thanks!
I get medical bills all the time. There are 3 standard plans under Medicare: A, B, and D. For some reason the government farms out administering the plans to private insurers. I'm not sure of the name of my insurer. It switched a few years ago, and I simply don't remember. I just hand some care provider my card.My grandmama is 96 and on a supplemental plan. I don't remember off the top of my head what she pays a month for it, but she never gets a bill when she goes to the doctor or for her prescriptions. Its all just covered for her.
I don't see how it's to the advantage of the MA provider to reduce your care so that you're not as healthy & thus need even more care tomorrow. Why do they want you hospitalized? Senseless thinking as I see it.MA plans are capitated plans, i.e. insurers receive a fixed fee from CMS, per member. In other words, your MA insurer gets paid the same amount whether you go to the doctor a lot or not at all. So the incentive for your PCP is to closely manage, i.e. reduce, the amount of care you get.