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Capitation payment: A health care provider (either an individual or organization) receives a fixed amount per year, per enrollee for which he or she agrees to provide a predefined comprehensive health care package.
Mark Farrah reports show that Aetna averaged about $302 per month per enrollee in 2016, and that GuideWell averaged about $412.
A risk pool program might also force the enrollees to pay more for coverage, offer them fewer choices than private plan enrollees get, and expose them to the risk of fluctuations in outside risk pool program support, the analysts say.
The model will test the hypothesis that giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to targeted groups of enrollees with CMS-specified chronic conditions in order to encourage the use of services that are of highest value to them, will lead to higher-quality and more cost-efficient care.
But, whether intended or not, plans with certain kinds of designs ended up attracting significant healthier enrollees than did other plans, Cosgrove writes.
Models were estimated on recent and established enrollees who had been uninsured just before enrolling in SCHIP that included all the demographic and socioeconomic control variables from the core model, a dummy variable for whether the child was a recent or established enrollee, and a set of terms that interacted that dummy variable with the child's health status, age, and race/ethnicity/ primary language, the parent's educational attainment, and the child's state of residence.
However, estimates do not include adjustments for undercounting of persons reported as dual enrollee by Medicare, but not linked to Medicaid (e.
If the Medicare fee-for-service program offered enrollees the kind of annual out-of-pocket spending cap that Affordable Care Act-compliant private major medical plans now provide, "the addition of an annual cap would reduce the need of some beneficiaries to purchase supplemental insurance," James Cosgrove, a GAO director, writes in a new GAO report.
Plans that improve the quality of care they deliver to enrollees will see higher updates and can grow and enhance the benefits they offer to enrollees.
The latter question is of major importance, because the Medicaid expansions will accomplish little if they merely shift enrollees from one form of public coverage to another or, worse for policy purposes, displace private insurance.
Thus, the average claims cost of a new enrollee was $111 in the first month of enrollment compared with $139 for late enrollees and $153 for immediate enrollees.