The Medicare Advantage field is changing as costs of care challenge payor and provider participation, and as provider directories on Medicare Plan Finder prove problematic.
Wall Street is reportedly disillusioned with the prospect of market growth since the MA industry eclipsed 50% of the Medicare market share. According to Modern...CMS Rules
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the proposed home health prospective payment system rule for 2026, which would substantially cut Medicare payments to home health agencies.
The prospective payment system update calls for a 6.4% cut to home health payments in 2026, or roughly $1.135 billion....Arizona News
Last Tuesday, the U.S. House of Representatives passed a budget blueprint that includes $880 billion in spending cuts for programs overseen by the House Energy and Commerce Committee. While the expectation is that cuts will impact Medicaid, there is little specificity on what they would mean for the program and the shape of the...
A new report by healthcare research firm ATI Advisory determined that the Centers for Medicare and Medicaid Services (CMS) is not doing enough to reconcile incongruities between the Medicare and Medicaid programs for dually eligible beneficiaries in long-term care.
The ATI Report found that the over one million full benefit...
Value-based care is now a ubiquitous term across the medical industry, primarily led by Medicare payment models that prioritize quality of care above overall cost. But some are questioning the concept's utility and expanse over the Medicare market.
Legislation proposed in both the U.S. House of Representatives and Senate would...National News
It is now incredibly well established that Medicare Advantage is popular among seniors and gaining new members every year, so quickly in fact that it is expected to represent half of the Medicare market by 2026. The question on everyone's minds now is: What will Medicare Advantage do with all this success, and how can it improve to...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that takes aim at prescription drug costs in Medicare Advantage (MA) and Medicare Part D plans. The agency said the rule would reduce out-of-pocket costs for beneficiaries and improve price transparency as well as "market competition in the Part D...
A new analysis by ATI Advisory for Better Medicare Alliance is the fourth in a series of data briefs over 2021 that examine Medicare coverage arrangements related to demographics, outcomes, and spending in the dual eligible population. The research compiled by this series suggests that dual eligible beneficiaries are more likely to...
This week, the Centers for Medicare and Medicaid Services (CMS) is learning from prior models and plans to make adjustments within Medicare Advantage for dual eligibles and hospice care. In other MA news, Anthem and UnitedHealthcare were penalized for failing to meet the medical loss ratio (MLR) threshold of 85%.
CMS is moving forward...National News
According to a new study, Medicare Advantage enrollment has doubled since 2010 and outperforms Traditional Medicare in most metrics. Black people and dually-eligible beneficiaries are also outpacing the growth of white people and non-dual eligibles in Medicare Advantage enrollment. In other news, stakeholders are requesting that the...
