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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Medicare Advantage Special Needs Plans: Issue Brief

Special Needs Plans (SNPs) are a specialized type of Medicare Advantage plan designed to serve the health care system’s fastest growing population – frail,...
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Medicare Advantage Payments The Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage plans a monthly, per-person, fixed rate, also known as a capitated...
Issue Brief
Introduction On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Advantage 2018 Advance Notice and Draft Call Letter, which...