- Fresno Unified chose a Medicare Advantage program for its health care plan for retirees in 2023.
- That year, contract disputes between payers and providers spiked, with Medicare Advantage programs dropping since.
- Those programs face issues with capped reimbursement rates, high prior authorization demands, and a risky enrollee pool.
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When the board behind health insurance decisions for Fresno Unified teachers voted to move away from the district’s self-funded model for retirees and to Aetna’s Medicare Advantage plan, they did so at a time Medicare Advantage plans faced upheaval in the marketplace.
Fresno County is set to lose the most Advantage plans this year among California counties with a net loss of 11 plans, according to Investopedia.…