This week, Medicare Advantage insurers are innovating new ways to enter markets and boost margins as J.D. Power finds that plans are struggling to keep their members satisfied.
Over the past two years, Medicare Advantage plans have pivoted from customer satisfaction to shoring up their bottom lines as rising costs and plan usage rates...
The Center for Medicare and Medicaid Innovation (CMMI) was created by the Affordable Care Act of 2010 to creatively work through issues of healthcare quality and rising health costs through demonstrations of payment mechanisms that prioritize health outcomes, commonly referred to as "value-based care." The expectation has been that at...
Medicare Advantage enrollment is shifting rapidly as Humana and other major insurers withdraw from subpar markets en masse. This could spell coverage losses for up to hundreds of thousands of Medicare beneficiaries.
Across the board, Medicare Advantage (MA) enrollment has continued to rise into 2026 with an additional 1.1 million...
This week, the Department of Health and Human Services (HHS) announced that it will target fraud in the Medicaid and Medicare Advantage programs, and more MA insurers filed suit seeking to increase their star ratings bonuses.
The HHS Office of Inspector General announced it had generated $5.6 billion in "monetary impact" from...White Papers, E books, Reports and more
As Medicare Advantage (MA) enrollment surpasses Original Medicare, a new Milliman white paper argues that life sciences companies should no longer view the two programs as interchangeable when developing market access strategies for physician-administered Part B drugs.
Researchers found that each program creates markedly different...National News
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...
