Some Medicare Advantage’s diagnosing tactics made insurers like UnitedHealthGroup $33 billion richer

Quick Summary:

Medicare Advantage plans are paid more for sicker members and less for healthier members, which provides an incentive for MA plans to report as many diagnoses as legitimately possible.

Instead, they are being told they must enroll in a Medicare Advantage plan, with its limited network of doctors and hospitals, or lose their retiree health benefits altogether.

"As a result, much of what determines which insurers are successful in Medicare Advantage is not whether the insurer is providing high quality care and doing so efficiently, but simply how aggressive it is in coding".

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Article Details

Author / Journalist: Beth Greenfield

Category: EconomyBusiness

Markets: United States

Topics: Health Insurance Study Editor's Picks UnitedHealth Group Medicare

Source Website Secure: Yes (HTTPS)

News Sentiment: Neutral

Fact Checked: Legitimate

Article Type: News Report

Published On: 2025-04-07 @ 21:05:00 (13 hours ago)

News Timezone: GMT +8:00

News Source URL: fortune.com

Language: English

Article Length: 1211 words

Reading Time: 7 minutes read

Sentences: 4 lines

Sentence Length: 303 words per sentence (average)

Platforms: Desktop Web, Mobile Web, iOS App, Android App

Copyright Owner: © Fortune

News ID: 27681535

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