MAPD Rate Question

[wislndixie]

I'm a newbie to med supps and have learned a great deal here on this forum. I'd like to ask a question about mapd rates. I'm in Alabama and we have a strong MAPD from BC/BS. The rates in 4 counties are 0 premium. In about 35 counties, the rate is $99 per month and in 4 other counties the rate jumps to $279 per month for the same MAPD across the board. Can someone explain why there is such a disparity in rates between counties? I have to believe it has something to do with Medicare paying lower capitation rates in those counties, but don't know why..
Thanks,
Mike

 

[GreenSky]

I'm a newbie to med supps and have learned a great deal here on this forum. I'd like to ask a question about mapd rates. I'm in Alabama and we have a strong MAPD from BC/BS. The rates in 4 counties are 0 premium. In about 35 counties, the rate is $99 per month and in 4 other counties the rate jumps to $279 per month for the same MAPD across the board. Can someone explain why there is such a disparity in rates between counties? I have to believe it has something to do with Medicare paying lower capitation rates in those counties, but don't know why..
Thanks,
Mike

The capitation rates are one reason. The contract with providers likely is much higher is some counties - especially with hospitals.

Insurance companies can't just do what Medicare does and dictate their reimbursement rates on a take it or leave it basis. So they negotiate individually.

Also, utilization varies with area. With fewer doctors in an area, emergency room use may be higher than in other areas.

Rick

 

[The Rabbi]

It has a lot to do with the number of seniors in a county. In my area, Miami gets the most money from Medicare so they have the lowest copay MAPDs. The next county has higher copays and the third county has still higher copays. In the high senior tri county area of SE Florida, the MAs are zero premium but upstate, they will charge a premium for an HMO.