On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
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...
The Arizona Health Care Cost Containment's (AHCCCS) procurement process ended in December when Arizona's Medicaid agency chose Centene (Arizona Complete Health) and UnitedHealthcare (UHC Community Plan) to provide integrated healthcare to Medicaid eligible Arizonans who are elderly and/or have a physical disability in the Arizona Long...
Our annual data edition focusing on the Arizona Health Care Cost Containment System (AHCCCS) covers a lot of territory and 15 pages to help readers keep tabs on the agency charged with overseeing the managed care plans contracted with the state to deliver care to about 2.2 million Arizona Medicaid members.
Correction: On Page 4 the...
Cigna will no longer pursue a deal to merge with Humana, putting an end to the potential $140 billion health insurance behemoth.
The companies were unable to reach an agreement on price or other terms, the Wall Street Journal reports. WSJ was the first to report last month that the two anticipated reaching a deal by the end of the...Arizona News
Collectively, UHC Community Plan and Arizona Complete Health Complete Care Plan will provide health care services to the approximately 26,000 members enrolled in the Arizona Long Term Care System (ALTCS) and who are elderly and/or living with a physical disability, known as the ALTCS-EPD program. It marks the first time members across...Arizona News
Modern Healthcare published its annual list of the 100 Most Influential People in Healthcare, which honors individuals throughout healthcare who have been recognized for their influence and leadership within the industry.
Peter S. Fine, CEO of Banner Health was on the list for the 10th consecutive year, ranked 93rd. Fine joined Banner...
Humana has revised its outlook, confident that its expected Medicare Advantage enrollment will increase even more than it originally anticipated in 2023. But Centene has reported the opposite, expecting to lose money in Medicare Advantage and from Medicaid redeterminations.
Centene released its first quarter (Q1) corporate reports on...
With the Great Unwinding looming at the end of spring, insurers are now speaking up about their role in Medicaid redeterminations and a special enrollment period (SEP) for enrollees who may lose coverage in the process.
In a memo released at the end of January, the Centers for Medicare and Medicaid Services (CMS) announced that the...Arizona News
It's the time of year for insurers to file their fourth quarter (Q4) earnings reports for 2022. This week, Molina, Kaiser Permanente and Oscar Health posted financial metrics.
Oscar Health beat the odds in 2022 by improving its medical loss ratio from 88.9% in 2021 to 85.3%, Modern Healthcare reports. But the healthtech company still...National News
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...Arizona News
This year's surprising exit of Bright Health on the Marketplace leaves $4 billion in ACA revenue up for grabs for brand name giants including UnitedHealthcare, Centene, Cigna, and CVS, but it's some lesser known short-term plans and Healthcare Sharing Ministries that are also gaining consumer attention with deceptive marketing touting...
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...
The insurer has a strong presence in Arizona, insuring about 400,000 Medicaid and 47,000 MA lives, and also competes under the Ambetter brand on the Health Insurance Marketplace.
According to reporting from the Phoenix Business Journal, Centene's notice to terminate its Medicaid contract with Tenet Healthcare's Abrazo Health...Arizona News
The lawsuit filed August 5 features an Arizona plaintiff and alleges the insurer has used a "churn-based strategy" that leveraged its role as a Medicaid insurer to boost enrollment in its Marketplace plans, which were allegedly in violation of network adequacy regulations, supplied beneficiaries with inaccurate provider directories, and...National News
This week in Medicare Advantage news, the home-based care industry is gearing up to assert itself amid concerns that home care services are being inadequately compensated. A new bill modeled on existing Texas law tries to limit the harms caused by prior authorization in Medicare Advantage plans. Also, Centene is concerned about its star...
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...
There were a couple of legal challenges announced this week for hospitals and health systems on the concern of paying. Hospitals accused of overcharging for procedures is a common theme in two cases while Louisiana accused UnitedHealth Group of inflating drug prices to its Medicaid program via Optum Rx by billions.
The Colorado State...
On Tuesday, Centene Corporation announced its financial results for the first quarter of 2022, which ended on March 31. The company showed strong growth out of the COVID-19 pandemic and expects to maintain momentum throughout the year, but faces investigation for its participation in state Medicaid programs, including the California...