Do you know why Medicaid plans are predominant on the ACA’s (Affordable Care Act) Exchanges? A recent study states that it is because of the Medicaid-managed care insurers’ business models that they are surviving with high bids.
The research was based on the examination of factors that led Medicaid to expand its growth in ACA exchanges. Medical billing services also asked this question, and now we know why!
The ever-increasing ratio can be observed by the fact that this year, Medicaid plans covered 255 out of 502 rating regions. It is also a possibility that Medicaid insurance policies are not obsolete because they offer lower premiums and steady or lower premium raises.
Researchers say that it all lies in the Medicaid-managed care plans’ business model. Many Medicaid insurers have their prior connections with medical billing companies and healthcare organizations. Their strengthened relationships have garnered fruitful results in the market. Another fact that works in their favor are the ability to bring Medicaid volume (patients) to healthcare providers. Ultimately, the companies to whom physicians outsource medical billing services generate revenue for them.
Why Are Healthcare Providers So Interested in Medicaid plans?
Physicians or billing services also have an advantage. They can negotiate ACA and Medicaid plans and look for a lower administrative cost than the other commercial or private healthcare insurance plans.
Medicaid insurers focus more on the existing plans and less on designing alternative plans. The strategy is to take popular plans to the next level rather than launching a new model that doesn’t work well.
Why Medical Billing Services Still Lack Confidence over Medicaid Plans?
Medicaid insurers are not lucky in terms of managing the technology incorporation and the flux to cover several healthcare plans. They also have strict health utilization measures, which is the problem of their growth. Moreover, the tough prior authorization measure and other requirements make it difficult to work out.
Having said that, when the ACA marketplace started, an obvious assumption was against the Medicaid plans that they could lack the infrastructure and experience to manage the payment network. However, they have been doing exceptionally well, but they didn’t manage to take the spotlight off the commercial healthcare plans.
Healthcare leaders also say that most of the Medicaid insurers can’t participate vigorously as a high-end business, despite their reasonable performance in the market.
