20 years inside a Medicare Advantage insurer, and who actually pays

Medicare Advantage covers more than half of seniors, and the debate over what it really costs is stuck in two camps. Timothy Bulat, a senior consulting actuary who spent nearly two decades leading Medicare Advantage analytics inside a major insurer, raises a question the loudest voices keep avoiding: who actually pays for the program, and is the value being shared fairly? This episode is based on his article "The truth about Medicare Advantage funding and costs," published on KevinMD. You will hear how plans simultaneously manage costs well and extract excess taxpayer dollars through coding intensity and favorable selection, why headlines about Medicare Advantage being "in retreat" are overblown, and which specific policy levers (risk adjustment reform, benchmarking, slowing annual payment growth) the Biden and Trump administrations have already started using. Listen for the distinction Timothy draws between a funding cut and a smaller increase, and why that distinction matters for every clinician dealing with prior auth.

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