the official U.S. government site for Medicare

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How Medicare Advantage Plans work

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Obama administration budget proposes cuts for Medicare Advantage

Unlike standard Medicare, in which doctors and hospitals bill for each service they provide, private Medicare Advantage plans and other managed care organizations are often paid a flat monthly rate for each patient using a formula called a “risk score” that estimates the health challenges facing individual patients.

Cuts could be in store for Medicare Advantage plans

The plans have become a key source of revenue growth for insurers who sell and administer the subsidized coverage. They offer basic Medicare coverage topped with extras like vision or dental coverage or premiums lower than standard Medicare rates. There are hundreds of different plans around the country, each with its own set of variables like different deductibles, premiums and co-insurance.

Medicare Advantage Under the ACA: Replace Payment Cuts with Market

Use market-based bids for benchmark payments. Congress should delink benchmark payments from FFS and instead base payment solely on the bids that MA plans submit to the CMS to provide the traditional Medicare benefit (Parts A and B) to MA beneficiaries. There are a variety of ways to do this. For example, the new MA benchmark payment could be based on the weighted average bid of all plans in each county.[46] Under this method, each bid would be weighted by the proportion of beneficiaries enrolled in that plan in the preceding year. The benchmark payment could also be set at the levels proposed under various premium support proposals, such as the second-lowest cost plan[47] or the average of the three lowest-cost plan bids.[48] Bids would reflect the cost of providing benefits for a beneficiary in average health, and insurers would receive larger or smaller risk-adjusted payments from the government if an enrollee’s health was worse or better than average. If a plan were to bid higher than the benchmark payment, enrollees would pay the difference through increased premiums. If a plan were to bid below the benchmark payment, enrollees would receive the difference in a plan rebate.

Report: Proposed Cuts to Medicare Advantage Would Increase Costs, Decrease Choice for Seniors

“CMS proposed to modify the Employer Group Waiver Plans bidding process to provide these plans with a fair benchmark, reflective of comparable local Medicare Advantage trends and prices,” a Centers for Medicare and Medicaid Services spokesperson said. “This proposal addresses the fact that Employer Group Waiver Plans do not compete against other Medicare Advantage plans to serve a particular population.”

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