General Discussion
In reply to the discussion: PSA - If you enroll in Medicare Advantage, you could be stuck for life [View all]Bluepinky
(2,279 posts)Medicare Part C (also called Medicare Advantage, or MA) administers the senior subscribers medical benefits to which he/she is entitled to through Medicare. The private insurance company assigns a risk factor to the enrolled senior, and the federal government transfers money to that insurance company; the higher the subscribers risk factor, or the sicker the patient, the more money the government transfers to the insurance company. Instead of paying Medicare benefits for each individual person, the government pays the Medicare benefits to the private MA plan.
Some of the fraud instituted by the private insurance companies (MA plans) is that they assign a higher risk factor to the senior subscriber, so that on paper, the enrollee looks sicker than he/she actually is. Then, the federal government will issue more money for that subscriber to the MA plan, and that extra money is profit for that private insurance company.
Other ways the MA plan commits fraud is when they deny care to a subscriber, who would be entitled to that care under Medicare. The point is: MA is run by private insurance companies. The federal government does not oversee or manage them, so they can pretty much do what any private health insurance company does: deny care, adjust premiums and deductibles, and limit choices of doctor or hospital to maximize profits.