Medicare Advantage organizations (MAOs) may be improperly issuing denials for skilled nursing and post-acute care, according to two related reports by the Department of Health and Human Services Office of Inspector General.
In the first, MAOs were found to have overturned nearly all prior authorization denials for skilled nursing...White Papers, E books, Reports and more
Institutional Special Needs Plans (I-SNPs), a special type of special needs plans offered through Medicare Advantage that serve qualified patients who reside in community settings or living facilities, are correlated with better outcomes for mortality and certain quality outcomes compared to Medicare fee-for-service (FFS) and non-I-SNP...
As the Centers for Medicare and Medicaid Services (CMS) weighs the expansion of Medicare Advantage (MA) coverage through automatic enrollment, it's worth asking if the program is meeting the needs of U.S. seniors at a responsible cost to the American taxpayer. Providers say no, and are calling for Congressional action to solve some of...
A new KFF issue brief highlights the growing affordability pressures facing Medicare beneficiaries, even as Medicare remains the primary source of coverage for older Americans, reporting that half of Medicare beneficiaries lived on incomes below roughly $43,000 per person in 2024, and nearly a quarter rely on Social Security as many...National News
Industry leaders and health sector lobbies are lining up to support the Medicare Advantage Improvement Act (MAIA) of 2026, a bipartisan bill that addresses structural issues within Medicare Advantage.
The bill focuses on critical issues with billing and coverage like prior authorization, payment timing, and billing transparency. The...National News
Humana will move forward on cutting supplemental benefits offered in its Medicare Advantage in response to a lower-than-expected base payment increase in federal reimbursement and a difficult first quarter due to a lower 2026 Medicare Advantage Star Rating.
Earlier this month, the Centers for Medicare and Medicaid Services (CMS)...National News
Medicare Advantage is entering a more contested phase, with federal scrutiny intensifying, insurers pulling back from markets and plans moving to stabilize provider relationships as payment policy shifts. That tension has direct implications in Arizona.
Meanwhile, this week, at a House Energy and Commerce Committee hearing April 21,...News
As Arizona continues to align Medicaid and Medicare for dual-eligible members, new research is sharpening focus on how those integrated plans are paid. About 130,000 duals are enrolled in nine plans across the state, with UnitedHealthcare’s Dual Complete accounting for roughly half of that enrollment, according to April CMS...
Last Thursday, the Centers for Medicare and Medicaid Services finalized a rule that overhauls the Star quality rating system for Medicare Advantage programs, cutting several measures, including the health equity index. The changes are anticipated to net insurers $18.6 billion over the next ten years.
In lieu of the health equity...
The report finds that more than 14 million seniors rely on Medigap to fill gaps in fee-for-service Medicare, which does not cap out-of-pocket spending and requires cost sharing for hospital and physician services. Enrollment in Medigap has grown steadily in recent years, with 43% of fee-for-service Medicare beneficiaries purchasing...
The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
CMS is launching a new Healthcare Advisory Committee to provide non-binding recommendations on federal policy and program administration, with a focus on improving care delivery and system performance.
As promoted by the Health & Human Services and the Centers for Medicare & Medicaid Services (CMS), the committee will...Available To All
The proposition of Medicare Advantage as a program relies on the assumption that private insurance companies are better situated to control costs and deliver medical coverage than a sprawling government bureaucracy. After nearly a quarter of a century, the results remain unclear, with obvious advantages and disadvantages to both forms of...Arizona News
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...
