Medicare Advantage insurers are struggling to maintain strong projections of growth following the news of very meager reimbursement rate reductions.
The Centers for Medicare and Medicaid Services (CMS) anticipates that the 0.16% reduction in the MA benchmark rate in 2025 will come as an effect of modifications to the diagnostic coding...
Yesterday the Centers for Medicare and Medicaid Services reported 745,263 MA plans were sold in Arizona during the Annual Enrollment Period (AEP) that concluded December 7, 2023. The Hertel Report put together some highlights of this year's MA market.
With nearly 1.5 million Medicare eligibles, Arizona's MA market is thriving and...
A new audit conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that between 2015 and 2016, insurer Aetna received $25.5 million in Medicare Advantage overpayments. Also, plans are developing new offerings that aim to target the needs of specific demographics.
The OIG audit...
On October 6, 2023, the two organizations reached a new multi-year contract agreement. The updated contract terms include an effective date of August 7, 2023, ensuring patient families receive in-network coverage since that date.
Phoenix Children’s will continue to offer comprehensive pediatric healthcare services for Aetna...Arizona News
Citing an increasingly common complaint of problematic claim denials, Arizona's revered pediatric health system terminated its agreement with Aetna as of August 7, 2023. As the two parties continue to negotiate, all Phoenix Children’s providers, including Phoenix Children’s Hospital, Phoenix Children’s Medical Group, Phoenix...
Get the latest on the national and local Arizona trends in Medicare Advantage - a lucrative and popular product now responsible for privatizing the healthcare needs of half the eligible Medicare beneficiaries in the country. We also included Arizona's PDP market info.
What's Inside
No Stopping Medicare Advantage
2023...
New research shows 83% of entries in provider directories from America's leading insurers were inaccurate.
Most providers listed in directories from Aetna, Elevance, Cigna, Humana, and UnitedHealth had inaccuracies, but specialty information was much more likely to be accurate. Only 27.9% of physicians had consistently accurate...
Employers are increasingly moving retirement plans to Medicare Advantage health coverage, but the retirees in question are often upset with these moves.
The City of New York recently attempted such a pivot, which led to a high-profile fight in the courtroom and public politics. Perhaps most surprisingly, the City and some unions...
As the COVID-19 public health emergency winds down, insurers of Medicaid managed care plans are bracing to lose membership.
Centene is expecting it will lose 2.2 million Medicaid members during the redetermination process over the next year. According to Modern Healthcare, the company had 16 million Medicaid members at the end of...
Every year, ahead of the Medicare Advantage open enrollment period, the Centers for Medicare and Medicaid Services (CMS) publish Medicare Part C and Part D Star Ratings to give Medicare beneficiaries a metric by which to assess plans. Last week, CMS released the 2023 Star Ratings for qualifying MA plans.
Medicare Advantage plans are...
If insuretech startups promised one thing, it was that they had a bulletproof plan to game the insurance market, attract a ton of enrollees to their plans and produce hand-over-fist returns for their investors. After several quarters of substantial losses, investors are losing interest and companies like Oscar Health, Clover Health and...
Arizona's Medicare Advantage market continues to grow in Arizona with 48% penetration. UnitedHealthcare dominates enrollment in the state with its AARP branded offerings including the only 5-star plans in Arizona. Humana and Centene were the only two insurers to knock UnitedHealthcare off its No. 1 spot in a handful of Arizona...
Optum, a subsidiary of UnitedHealth Group, has spent the last several years building out a provider network and expanding into ambulatory surgical centers. As the company moves to expand into primary care, it faces two major legal hurdles: a challenge from the U.S. Department of Justice (DOJ) to acquire a data analytics firm and a class...
The Centers for Medicare and Medicaid Services (CMS) released its star ratings for Medicare Advantage Part C and Part D star ratings last Thursday, ahead of Medicare open enrollment, which begins October 15. Medicare Advantage (MA) plans get a star rating from one to five each year based on performance metrics including patient...
It's just a couple bucks, nonetheless MA plans in 2022 are advertising an average monthly premium of $19, far more than the average MA premium in Arizona at $11.64. But, it all adds up, last year 26.9 million were enrolled in MA nationally; Arizona's MA market enrollment stands at about 636,000, as of Sept. 1, 2021.
National MA...
The Centers for Medicare & Medicaid Services (CMS) released key information for Medicare Advantage and Part D prescription drug plans in advance of the 2022 annual open enrollment period (OEP). Marketing and advertising for most MA plans starts October 1 with plan sales beginning October 15 and ending December 7, 2021.
Arizona...
This month has been busy for insurance fraud claims both big and huge, from the U.S. Department of Justice (DOJ) intervening on a False Claims Act suit to the State of Pennsylvania's Medicaid program finding fault with Aetna to former players in the National Football League (NFL) defrauding the NFL Player's association retirement health...
This week a large amount of analysis on how the Affordable Care Act, insurance rates and private insurance faired during the ongoing COVID-19 pandemic. Also, due to increased enrollment during the special enrollment period and the need for health insurance spurred by pandemic-related job loss has encouraged insurance giant...National News
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) ran an audit on Aetna's Medicare Advantage (MA) business according to parent company CVS Health. The HHS OIG has cracked down on inaccurate adjustment scores submitted by MA plans including Humana and Anthem.
Aetna's MA reimbursement is...Arizona News
VillageMD is expanding its primary care presence in partnership with Walgreens throughout Texas and has announced expansion of its Arizona venture in partnership with the Hatfield Medical Group of Arizona. Amazon has reportedly approached several potential insurance partners to expand its coverage of services.
VillageMD is continuing...