Payment

Plans must cover the same benefits as Traditional Fee-For-Service (FFS) Medicare, and these payments are risk adjusted to reflect the specific characteristics and anticipated cost of providing care to each beneficiary. Within this capitated payment, plans, providers, and community-based partners must work together to effectively care for the beneficiary. The goal of managing within a fixed payment is to encourage coordinated care that emphasizes prevention, customized care, and innovation to improve outcomes and prevent avoidable adverse events.

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Fact Sheet
Key Facts: Over 3.5 million retirees nationwide, 20% of Medicare Advantage beneficiaries, are in EGWPs. Retiree enrollment continues to grow, nearly doubling since 2010. •...
Fact Sheet
Key Facts: • Payment to Medicare Advantage plans are made based on bids at or below the average cost of FFS Medicare beneficiaries by county....