Since the start of the Marketplace Open Enrollment Period (OEP) on November 1, the Centers for Medicare and Medicaid Services reports that 988,000 consumers currently without Marketplace coverage have chosen a 2025 health plan through the...
UnitedHealthcare CEO Brian Thompson was killed early Wednesday morning in midtown Manhattan in what is being described by the New York Police Department (NYPD) as a "brazen targeted attack."
Surveillance video footage shows the gunman approaching and shooting Thompson outside of the New York Hilton Midtown at 6:45am. The suspect then...
This week, the American Medical Association (AMA) published its annual Substance Use and Pain Care Task Force Overdose Epidemic Report.
The report covers the overdose epidemic, harm reduction efforts, naloxone access and mortality statistics. It also investigates industry response to the issues surrounding the epidemic and promotes...
Medicare Advantage insurers are confident that the second Trump administration will be helpful to their goals for growth and expanding their market share.
The MA program is bigger than ever, costing the Medicare program $500 billion for 2024 alone, despite the rise in regulatory enforcement under President Joe Biden. According to STAT...
The nursing home industry appears relieved Donald Trump was re-elected and many industry insiders are anticipating a swift rollback of the Biden administration's controversial nursing home staffing requirement.
The nursing home staffing requirement is the only major regulatory change for nursing homes after the death of 200,000...
The Medicare Advantage Part D landscape is in flux as insurers reassess their market presence and react to federal regulations. The annual enrollment period (AEP) ends this Saturday, December 7.
The AEP includes enrollment in Medicare Advantage Part D plans, standalone Medicare Advantage plans and prescription drug plans (PDPs). Like...
After a campaign season that was light on healthcare topics like Medicaid, a new issue brief from the Manhattan Institute might signal where Republicans are looking to cut spending for the public payor program.
Spending growth is the central issue of the issue brief, and it takes issue with the program's rising expenses in a vacuum....Arizona News
As the annual enrollment period for Medicare Advantage winds to a close, five plans in Arizona received an upgraded star rating from the Centers for Medicare & Medicaid Services (CMS). The agency increased stars for 12 UnitedHealth contracts and seven Centene contracts in revised ratings released Monday.
Centene gained its only...
Artificial Intelligence (AI) is reshaping health insurance utilization management (UM), influencing consumer access and experiences. This report by NORC at the University of Chicago, for the Consumer Representatives to the National Association of Insurance Commissioners (NAIC), explores AI's role in UM and its regulatory landscape.
What...
Medicare Advantage plans must "fundamentally reassess" their business due to changes in the MA Star Ratings program, according to a new report by Milliman.
The Centers for Medicare and Medicaid Services (CMS) released the 2025 Star Ratings in October, with a noted decline in ratings for Medicare Advantage Part D plans. Part D plans...
Although the topic of Medicaid was largely left out of both campaigns this election cycle, the incoming Trump administration is expected to make some major policy changes to the safety net health program now covering 69 million Americans.
Medicaid and the Children's Health Insurance Program (CHIP) are likely bargaining chips to make...
UnitedHealthcare has won its lawsuit against the Centers for Medicare and Medicaid Services (CMS) over its star ratings calculations for 2025. The agency must now recalculate its rating and immediately publish a revised score.
UnitedHealthcare (UHC) sued in September and petitioned for an expedited ruling so that revised ratings would...
The Centers for Medicare and Medicaid Services (CMS) has published new data from the 2025 Health Insurance Marketplace Open Enrollment Period (OEP). The OEP on HealthCare.gov runs from November 1 to January 15. The pace of enrollment is slower year-over-year.
Last year, 21.4 million signed up for health insurance through the ACA...
A new report by the National Association of Insurance Commissioners (NAIC) warns that advances in artificial intelligence (AI) use by insurers are outpacing state regulations.
The consumer representatives in NAIC are demanding "immediate regulatory action," Inside Health Policy reports. The report shows that insurers are using AI...
President-elect Donald Trump elevated television Dr. Mehmet Oz when he nominated the television personality to be the next administrator of the Centers for Medicare and Medicaid Services (CMS), it likely spells good news for private insurers invested in Medicare Advantage (MA).
Turns out, Dr. Oz is a major advocate for privatizing...
President-elect Donald Trump has continued his nominations for health-related positions in his second administration.
Last week, Trump nominated Fox News personality Dr. Janette Nesheiwat as America's next surgeon general. The Office of the Surgeon General is responsible for keeping the American public up to date on scientific...
Outgoing CMS leaders propose new rules to enhance transparency, accountability, and consumer protections in Medicare Advantage (MA) and Part D (PDP) plans in 2026. Key changes include covering weight loss drugs, restricting AI in prior authorization, improving provider directory access on Medicare Plan Finder, and tightening regulations...
President-reelect Donald J. Trump has spent the past week announcing his nominees for his administration's cabinet. Last Thursday, he announced he would appoint environmentalist attorney and anti-vaccine activist Robert F. Kennedy, Jr. (RFK) to be the Secretary of Health and Human Services (HHS).
Robert F. Kennedy, Jr. has been a...
On Tuesday, President-elect Donald J. Trump announced that he would appoint television personality and Medicare-Advantage-For-All proponent Dr. Mehmet Oz to be the administrator for the Centers for Medicare and Medicaid Services (CMS).
Trump announced that he would nominate the celebrity cardiothoracic surgeon to head up CMS in a...
The Government Accountability Office (GAO) released a report on the market concentration of health insurers across the country from 2020 to 2022. The Hertel Report culled from the report the Arizona leaders for the 2022 individual, small, and large group market. In Arizona BCBSAZ, Centene, UHC & CVS took 2022's top spots.
2022...Arizona News
This week, Change Healthcare's clearinghouse platform has finally been restored as the outage officially touches nearly a third of all Americans.
Change Healthcare's clearinghouse services for health care related billing and payments were backed up following the February ransomware attack that disrupted prescription transfers, claims...
Like it or not, generative artificial intelligence (AI) is part of healthcare now. Even though the industry has yet to adequately regulate these tools and the usefulness of large language models in the health care space is still unclear, providers and payers alike are using them in the process of administering care.
The Food and Drug...
The transition to value-based care has been ongoing for years. Although advances have certainly been made over the past decade, many have noticed that the switch is taking quite a while. This week, several experts and organizations weigh in on why the transition is slow, and what could speed it up.
Consistently, the leading issues...
Publications from across the healthcare sector considered the impact of expiring enhanced premium tax credits to Americans and insurers as Republicans prepare to control the executive branch and Congress in the new year. Experts predict that ACA Marketplace premiums in Arizona would increase 87% or $780 annually without the expanded...
The independent nonprofit evaluated nearly 3,000 hospitals on their ability to prevent medical errors, accidents and infections. The Hospital Safety Grade uses up to 30 performance measures to assign an “A, “B,” “C,” “D” or “F” to individual hospitals and uses a public, peer-reviewed methodology, calculated by top...
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