Cecelia F.
I had UHC for 6 months until they…
I had UHC for 6 months until they pulled out of our county. No reason why but I would guess they were losing money here. "The primary source of revenue for Medicare Advantage plans stems from capitation payments from the Centers for Medicare & Medicaid Services (CMS). Capitation is a prospective payment system where the plan receives a fixed amount per enrolled beneficiary per month (PMPM), regardless of how much healthcare those beneficiaries actually use. This contrasts with traditional Medicare, which operates on a fee-for-service basis, paying providers for each service rendered. The CMS determines the capitation rate based on a complex formula that takes into account factors such as the beneficiary's age, gender, geographic location, and health status, as measured by Hierarchical Condition Categories (HCCs). These HCCs are essentially diagnostic codes that indicate the presence of chronic conditions. The sicker the beneficiary, the higher the HCC score, and consequently, the higher the capitation payment the MA plan receives."

