Providing services under Medicare or Medicaid can impose on health plans financial risks and costs that are greater than those related to providing services to the commercial population. Reasons that an health plan's financial risks and costs for providing services to Medicare and Medicaid enrollees tend to be higher include

Question

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All of the above reasons contribute to higher financial risks and costs for health plans when providing services to Medicare and Medicaid enrollees. The ability for enrollees to disenroll on a monthly basis means that health plans must continuously strive to provide high-quality care and customer service in order to retain members. Additionally, the high prevalence of chronic illness in these populations requires more careful care coordination and case management, which can be costly. Finally, the initial costs associated with enrolling new members and providing them with education and screening services can also be significant.

Providing Services Under Medicare or Medicaid Can Impose on Health