In California, there are thirteen counties where the Medicare Advantage capitation amount will exceed $1,000 per enrolled member. This does not include any possible bonuses based on quality scores OR for any Part D Prescription drug benefits included in the Medicare Advantage plan. The lowest capitation amount is $841.14 in Imperial County and the highest is $1,158.97 in Inyo County. These figures are from the Medicare RateBook2020 that lists the capitation amounts for all counties in the United States.
The rallying cry in the 2020 presidential primaries is Medicare For All. But Original Medicare is the sort of health insurance that the Affordable Care Act set out to ban from the market place. Original Medicare has no annual caps on the maximum out-of-pocket a consumer must pay for either hospitalization or outpatient services. People can incur multiple Part A hospitalization deductibles during the year. The 20 percent coinsurance for medical services can mean some tests, imaging, and procedures can cost the consumer hundreds of dollars. Plus, there is no prescription drug coverage.
A five star Medicare Advantage will be paid $890 in Sacramento County, $947 in San Francisco County, $951 in Los Angeles County and $856 in San Diego County per month by the Centers for Medicare and Medicaid for each enrolled member. The data and calculations that go into determining the monthly reimbursement or capitation rate for Medicare […]
Orange County Health Authority’s CalOptima OneCare Medicare Advantage plan was served a notice of immediate sanctions by the Centers for Medicare and Medicaid Services (CMS) on January 24, 2014. The immediate sanctions mean that CalOptima can’t market or enroll new members into their OneCare Special Needs Plan until the sanctions are lifted. CMS cited “widespread and systemic failures impacting CalOptima’s enrollees’ ability to access health care services and prescription medications” as a summary for issuing immediate sanctions.
Medicare Advantage plans have been encouraged by the Centers for Medicare and Medicaid Services (CMS) to include $0 copay prescription costs for medications that work to reduce heart attacks and strokes in the plans for 2014. Some plans will be including $0 copay drugs that fight high cholesterol and high blood pressure.
Medicare special election or enrollment notice for individual enrolled in a 3 start rated Medicare Advantage plan can switch to a higher rated plan, 2013
When we look at what has been called “cuts” to Medicare, it is evident that the changes to Medicare spending are on the provider side, not the beneficiary side.
All the necessary information is on the Medicare Advantage application (Social Security #, address, EFT) to steal a senior’s identity or start a scam. Is this how we protect our seniors, with easy access to their personal information?
It is vital that communities find a way to create and sustain affordable senior housing and programs. Seniors contribute in so many different ways from volunteering at local schools, being role models and mentors for children and adding to the tapestry we call community.
The Center for Medicare and Medicaid Services publishes a variety of documents outlining how much they reimburse Medicare Advantage and Part D Prescription Drug plans. Below is the monthly reimbursement rate for Medicare Advantage plans known as the capitation rate. This is only for California counties. The capitation amount is only for the medical portion of the Medicare Advantage health plan. There is a separate amount if the plan includes prescription drug coverage.