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...National News
Centene reported underwhelming Q1 numbers and Molina picks up Cigna's Medicaid share of the Texas market. Also, questions about what happened with the Berkshire Hathaway-Amazon insurance venture, Haven? And how will social determinants of health impact commercial health insurance?
Centene
Insurance giant Centene's first quarter profits...National News
Aetna has agreed to pay $1 million to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services. It will also adopt a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.
June 2017: Aetna submitted a breach...Arizona News
The state and federal filings include the individual and small group markets offering ACA qualified health plans; rate change increases impact at least one plan for each insurer.
In the individual market, Oscar Health Plan and Health Net of Arizona all proposed average lower rates in 2021 while BCBSAZ and Cigna asked for average...Arizona News
The volume of telehealth claim lines increased more than 8,335% in April 2020 compared to April 2019 as the pandemic continues to drive utilization.
Mental health diagnoses drove visits, followed by joint and soft tissue conditions and hypertension, suggesting more privately insured patients turned to telehealth to manage chronic...Arizona News
This week, four major insurers announced plans to alleviate financial burdens on patients for COVID-19 treatments.
In addition to sweeping pledges made by most companies to waive bills for coronavirus testing two weeks ago, Cigna, Humana, Aetna and UnitedHealthcare (UHC) introduced plans that would waive consumer costs entirely or...Arizona News
Arizona's Medicare Advantage market continues to climb with a 38 percent saturation rate; latest numbers following the annual enrollment period shows UnitedHealthcare's AARP branded product still reigns supreme.
According to data from the Centers for Medicare & Medicaid Services, UnitedHealthcare/Pacificare's AARP plan reprised...Arizona News
Insurance giant Aetna announces a partnership with caregiver marketplace CareLinx to give its Medicare beneficiaries access to a national caregiver network providing at-home caregiver services as a benefit under its 2019 individual Medicare Advantage (MA) plans.
The partnership is currently only relevant to Aetna Medicare members...Arizona News
Last week the Department of Justice gave CVS and Aetna approval for their $69 billion merger on the condition that Aetna sells off its Medicare Part D prescription drug business. Insurers cozying up with the pharmaceutical industry is a growing trend, think: OptumRx and UnitedHealth, or the recent Cigna-Express Scripts...Arizona News
On Monday the Justice department gave the $52 billion merger between Cigna and Express Scripts a green light. The health insurance giant and massive pharmacy benefits manager aim to cut costs of care.
The deal passed a shareholder vote toward the end of August but the DOJ's vote was the last major obstacle to clear, all that...
