If you have Medicare, you’re probably aware that there are risks associated with enrolling in the program. It’s a third-party payer system with limitations, which means it doesn’t directly cover all services. Instead, it sets standards for costs that providers can meet. If you have any concerns about your eligibility for risk adjustment or how your risk adjustment will affect your medical bills, you’ll want to know more about what this means for you and your Medicare plan. Here is some information on finding the risk adjustment information in your plan and understanding how it works.
Contents
What is risk adjustment?
Risk adjustment is the process of assessing the risk to Medicare that comes from enrolling in the program. In other words, it’s a way to even out the risk of medical bills across the entire program by shifting costs from one part to another. When you enroll in Medicare, you’re given a risk adjustment score. This number reflects your expected cost to Medicare. The higher your risk adjustment score, the higher the cost to the Medicare program. The lower your score, the less medical bills cost for the program.
How is Medicare Risk Adjustment Calculated?
Medicare uses two primary factors to determine your risk adjustment score. These factors are your age and your expected health. The program also considers other factors that impact your risks, such as your sex, race, and state of residence. The age factor, which represents a large portion of your score, depends on your age when you enroll in Medicare. If you enroll when you’re 65, your age will be 9. If you’re 70 or older, Medicare will use an 8. Scores range from 1 to 10. Individuals under age 65 have a default score of 2. The health factors are the number of chronic conditions you have, such as diabetes, cancer, and heart disease; and the expected need for health services. These factors increase or decrease your score by up to 10 percent.
How to Find Your Risk Adjustment Information
As we mentioned above, your medicare risk adjustment information will be available in your Medicare Summary Notice. This document comes to you each time you receive services through Medicare. The Summary Notice includes information about your plans, such as your premium amount, coverage details, and amounts charged. Your risk adjustment information is found in your Part B section, directly after your service dates and amount. It might be listed as “risk adjustment and risk assessment data” or something similar.
Final Words
The Medicare program is a valuable resource for millions of Americans. It provides vital healthcare benefits, including prescription drugs and hospital stays. As a third-party payer system, however, it also comes with risks. Most of these risks can be managed if you know what to look for. Start by understanding risk adjustment, how it works, and how it affects your Medicare plan. With this information, you can manage your risk and make the most of your plan.