This week, Arizona Republican Congressman David Schweikert, who chairs the Joint Economic Committee (JEC), highlighted new findings from the committee suggesting Medicare Advantage (MA) payment policies may be contributing to higher premiums for seniors enrolled in traditional Medicare.
Although discussion of MA overpayments often...National News
The Centers for Medicare and Medicaid Services (CMS) issued a notice to Elevance Health that it will no longer be allowed to enroll people in Medicare Advantage plans beginning March 31. The sanctions follow what CMS calls a "substantial and persistent noncompliance" with risk adjustment data submission.
The announcement was made via...
Medicare Advantage has hit a rough patch. Across the board, insurers are cutting plans in unprofitable markets, contracting benefits and now implementing new requirements in order to curb usage. The Centers for Medicare and Medicaid Services (CMS) is only adding to the market's trouble by issuing notice that rates will remain the same in...
Nearly 787,000 Arizona beneficiaries began 2026 enrolled in Medicare Advantage (MA), according to CMS January enrollment files — only a modest increase from roughly 780,058 enrollees in June 2025. The muted membership gain suggests growth may be slowing in a national and local market that this year remains flat at about 51%...
This week, international insurance and healthcare consulting firm Milliman published its annual white paper on the state of the Medicare Advantage industry.
The annual paper relies on proprietary analysis called the Milliman Medicare Advantage Competitive Value Added Tool (MACVAT®), which evaluates the relative value of Medicare...National News
While most insurers are downsizing their Medicare Advantage market presence, Humana is doubling down and acquiring healthcare services to support its expanding network.
Last week, Humana's CenterWell Senior Primary Care, a value-based care provider, completed the acquisition of MaxHealth from Arsenal Capital Partners (Arsenal), a...
The notion that a Republican administration would be inherently favorable to Medicare Advantage (MA) is being tested. From CMS’ decision to hold MA rates flat for next year, to the DOJ's continued enforcement actions related to MA billing and the OIG's heightened scrutiny of upcoding practices, MA stakeholders are preparing for a bumpy...
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposal for the 2027 Medicare Advantage (MA) and Part D Advance Notice. The agency proposed a slight increase of 0.09%, shocking shares of publicly traded insurance companies.
The meager increase proposal comes after the Trump administration granted a generous...
A Senate report shows that UnitedHealth Group (UHG), the parent company to the nation's and Arizona's largest Medicare Advantage (MA) insurer, UnitedHealthcare (UHC), is artificially inflating the risk adjustment scores of its MA members in order to achieve higher reimbursement from the Medicare program.
The report is based on 50,000...
The Center for Medicare & Medicaid Services on Monday released a proposed rule that would formalize the most sweeping changes to the Medicare Part D benefit since its launch in 2006. According to CMS, the rule would codify key Inflation Reduction Act (IRA) reforms for 2027 and beyond, lowering out-of-pocket drug spending while aiming...
A new study shows that Medicare Advantage physician networks pale in comparison to traditional Medicare, but the Centers for Medicare and Medicaid Services (CMS) is pushing ahead with plans to make traditional Medicare look more like Medicare Advantage.
Medicare beneficiaries enrolled in both programs report that physician...Arizona News
Earlier this month, the Commonwealth Fund published its State Scorecard for Medicare Performance, which evaluates each state's infrastructure, access to hospitals, beneficiary access to non-medical supports, regional variety in plan availability, out-of-pocket costs and other critical access of Medicare delivery.
The State Scorecard...National News
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...
Last Thursday, the Centers for Medicare & Medicaid Services (CMS) released its 2026 Medicare Advantage and Prescription Drug Plan quality star ratings. In Arizona, shoppers won’t find a 5-star plan available in the state, but established carriers, including AZ Blue, CVS/Aetna, Humana, SCAN, and UHC are offering 4.5 Medicare...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring Medicare Advantage insurers submit their provider directories to the agency for incorporation into the Medicare Plan Finder Portal.
CMS announced a plan last month to assemble provider lists and add them to the plan finder ahead of the...
A new study on hospitalizations between 2017 and 2023 determined that Medicare Advantage beneficiaries are experiencing an increase in extended hospital stays following the COVID-19 pandemic.
The study, published in JAMA Internal Medicine, analyzed data from more than 89 million hospitalizations over a six-year period, including...
The Centers for Medicare & Medicaid Services (CMS) made changes this week impacting Medicare Advantage (MA) plans as they prep for AEP — while brokers were also bracing for another hit to their commissions from the program’s dominant insurer, UnitedHealthcare.
The agency decided MA members don’t need reminders about unused...
A federal judge in Texas struck down key provisions of a 2024 CMS rule that reshaped how Medicare Advantage plans compensate brokers and market products, siding with Americans for Beneficiary Choice and industry groups. The court found the rule exceeded the agency’s statutory authority and violated the Administrative Procedures Act,...National Reports & Surveys
The 2025 U.S. Medicare Advantage Study by J.D. Power shows a 29-point drop in overall consumer satisfaction with a 39-point drop in member trust, bringing the total score to 623 on a 1000-point scale. The increase in medical spending attributed to an increase in medical services utilization following the COVID-19 pandemic is driving...White Papers, E books, Reports and more
A new peer-reviewed study published by The American Journal of Managed Care (AJMC) found that Medicare Advantage (MA) plans consistently delivered higher quality care than fee-for-service (FFS) Medicare before and during the COVID-19 pandemic.
A retrospective cohort study of more than 3.1 million Medicare beneficiaries...
