Insurers like UnitedHealth are profiting off of the Medicare Advantage system, and it’s causing problems for both doctors and patients.
Traditional Medicare is run by the federal government, while Medicare Advantage health insurance plans are operated by private companies like UnitedHealth. These privately run plans are still subsidized by government funds. Medicare Advantage insurers are paid a set monthly amount for each of their members regardless of whether they received care that month or not. That amount is based on each patient’s personal risk score. The sicker the patient is, the higher their risk score, and the bigger the check insurers receive from the government.
This system is intended to prevent insurers from favoring healthier people over those who have illnesses, but it also leaves room for insurers to make more money by making their patients appear as sick as possible.
Watch this video to understand more about how private insurers can use this coding system to increase their profit.
Read STAT’s full investigation here.