Last week, the U.S. Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy released an overview of the state of Medicare Advantage enrollment and program spending. This is the first such report since the Medicare to Medicare Advantage enrollment ratio hit 50-50.
The...White Papers, E books, Reports and more
A new study shows that dually eligible Medicare Advantage enrollees received poorer clinical care than those who were not dually enrolled.
The Centers for Medicare and Medicaid Services (CMS) Office of Minority Health (OMH) released a report this week based on analysis of Healthcare Effectiveness Data and Information Set (HEDIS),...White Papers, E books, Reports and more
The Medical Group Management Association (MGMA) published a report last week on the issues brought about by Medicare Advantage (MA) plans' use of prior authorization.
MGMA surveyed 600 medical groups on the use of PA and found that it contributes to increased costs and delays or denials of care. Groups overwhelmingly reported that...
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...
Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms.
The rule stipulates that once a health plan grants prior authorization for a service, the approval will...
Lawmakers and stakeholders are still very upset with the U.S. Department of Health and Human Services' (HHS) plan to cut payments to the Medicare Advantage (MA) program and to enforce regulations against MA plans that have benefitted financially from improper overpayments. This week, HHS Secretary Xavier Becerra defended the rule in two...
This week, some of the insuretech companies that spent the past year struggling are trying to change their fortunes. Oscar Health brings on a seasoned, experienced CEO with a new goal and Bright Health is making some desperate stock moves.
Mark Bertolini, former CEO of Aetna and hedge fund Bridgewater Associates was appointed CEO of...
Last week, LeadingAge published a white paper that describes the difficulties Medicare Advantage members face accessing payment for post-acute care services.
The white paper, "Fulfilling the Promise: Medicare Advantage," identifies the issues that many beneficiaries face when attempting to access benefits, such as delays, unnecessary...
The Medicare Payment Advisory Committee (MedPAC) submitted its
March 2023 Report to Congress which included its 2024 payment recommendations for Medicare fee-for-service (FFS), Medicare Advantage (MA) and the Medicare prescription drug program (Part D). This year's report is likely to please no one as the committee took aim at claims of...
In December, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require all health plans, including Medicare Advantage plans, to limit prior authorization deliberations to seven days. On Monday, the public comment for that rule closed.
Many providers believed that the rule doesn't go far enough,...National News
In the Kaiser Family Foundation's analysis, 2021 Medicare Advantage earned the highest per-person, average gross margin of $1,730 per enrollee in 2021, similar to the pre-pandemic years 2018 and 2019 and more than double the gross margins reported across the individual, group and Medicaid managed care markets. Medical Loss Ratios (MLR)...
Health insurance lobbyists and plans have put a ton of work into defending the Medicare Advantage (MA) program from proposed cuts and rule changes by the Centers for Medicare and Medicaid Services (CMS), but this week traditional Medicare gets community support of its own. And one insurer breaks from the pack to support the rule...
It was a big week for studies and reports on Medicare Advantage, both positive and negative for the industry as a whole.
The Better Medicare Alliance recruited ATI Advisory to conduct a study on how much Medicare Advantage beneficiaries save by comparison to beneficiaries with traditional Medicare. It found that MA enrollees save a...
Medicare Advantage's unprecedented market growth is attributable in part to the high volume of dually eligible beneficiaries in special needs plans (D-SNPs), but some plans are concerned that the proposed advanced notice will hurt vulnerable beneficiaries enrolled in these plans.
According to data released by the Centers for Medicare...
While the Centers for Medicare and Medicaid Services (CMS) are moving forward with tighter regulations on the Medicare Advantage (MA) program, the Heritage Foundation argues that freeing MA from the constraints of Medicare Fee-For-Service (FFS) payment rates and making it the default Medicare enrollment system would offer a solution to...
The atmosphere around the future of Medicare Advantage has been fraught since the announcement of the final rule on Risk Adjustment Data Validation (RADV).
The rule's new methodology will be applied to plans dating back to 2018, and the Centers for Medicare and Medicaid Services (CMS) anticipates it will recoup nearly $50 billion for...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
While regulators, insurers and administrators make progress on rectifying the issues of prior authorization (PA), new data shows that a record number of prior authorization requests were made to Medicare Advantage (MA) insurers in 2021.
Beneficiaries enrolled in traditional Medicare are rarely subject to prior authorization, but...
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will increase the amount federal authorities can recoup from Medicare Advantage organizations (MAOs) that were overpaid due to incorrect diagnostic coding.
The Medicare Risk Adjustment Data Validation (RADV) final rule means that CMS will also stop...
Medicare Advantage officially has 30 million enrollees. But with great patient volume comes great responsibility according to the Centers for Medicare and Medicaid Services (CMS), which has pledged tougher audits while finalizing tougher rules for MA plans.
The announcement that MA had crossed the 30 million enrollees mark was made...
