Medicare Advantage plans and privately managed Medicaid plans are paid fixed per-enrollee rates by the government and are permitted to retain funds they do not spend on patient care.
high
policy
Describes the common capitation-style payment model used by the U.S. government for Medicare Advantage and many Medicaid managed care contracts.
Insurers offering Medicare Advantage and Medicaid managed care plans are required to maintain adequate numbers of contracted health care professionals to serve patients in each geographic region they cover.
high
regulatory
A network adequacy requirement intended to ensure plan enrollees have access to providers within the plan's service area.
About 30% of Americans are enrolled in Medicare Advantage plans or in privately managed Medicaid plans.
medium
statistical
Approximate share of the U.S. population covered by privately administered Medicare Advantage or managed Medicaid products.