With Medicare Advantage soon to become the dominant form of Medicare coverage, it is important to assess beneficiaries’ experiences and MA’s sustainability.
www.commonwealthfund.org
I don't have an answer, but I have a hypothesis.
1. NYP is such a large system that they can leverage the MA insurance companies. "Finance bros, NYPD, school teachers etc. want a plan that get's them care at NYP. If you want to be able to include us in network, this is what you have to pay."
2. The MA plan kind of shrugs at this sort of stuff because of the old mandated loss ratio.
Per the link above:
Medical loss ratios. Since 2014, Medicare Advantage and Part D prescription drug plans have been required to have “medical loss ratios” no lower than 85 percent. This means that plans’ administrative expenses and profits, or margins, can be no higher than 15 percent of the total revenues that plans receive from the federal government (in the form of payments) and enrollees (in the form of premiums).
The higher the total cost of care, the larger the absolute acceptable margin. The math may dictate that: all those premiums from such and such sector of our community more than make up for the excess negotiated cost of service and the total increase in cost allows for a larger profit in terms of absolute number).
Just the usual f@3k@5y that large organizations participate in.
