On Monday, U.S. Department of Health and Human Services (HHS) Inspector General Christi A. Grimm provided testimony to the U.S. House Committee on Energy and Commerce Subcommittee on Oversight and Investigations that included the federal government has demonstrated significant problems with risk adjustment in Medicare Advantage, raising...
The Biden administration brought down the hammer on Medicare Advantage insurers and their brokers when the Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Advantage Part D final rule last Thursday.
The rule increases regulatory scrutiny on prior authorization, network adequacy standards and marketing for...
On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
Last Friday, the Medicare Payment Advisory Committee (MedPAC) sent its recommendations to Congress, including updates for the 2025 Medicare payment systems. In its recommendations, the committee warned that Medicare Advantage policies are increasingly costly to the Medicare program.
At the top, it recommended a 1.5% raise for hospital...Arizona News
UnitedHealth Group (UHG) this week is scrambling to remain the victim in the cyberattack that knocked subsidiary Change Healthcare offline for over three weeks, preventing payment for services to providers and disrupting prior authorization requests and pharmacy business nationwide.
On Tuesday, the company announced that it is now in...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will end the Hospice Benefit Component of the Value-based Insurance Design (VBID) Model at the end of the year.
The hospice carve-in was designed to test coverage of hospice, palliative and transitional care coverage through the Medicare Advantage program. According to Hospice News,...
Home care companies are pushing back on Medicare Advantage plans in negotiations for better pay rates and service.
Companies like Addus HomeCare, Interim Healthcare and others are refusing to accept some patients enrolled in Medicare Advantage plans due to low reimbursement rates and issues with prior authorization processes. They...
A new survey from the Commonwealth Fund, a thinktank that promotes improvements in the healthcare system, found that most older Americans say they like their coverage regardless of whether they are enrolled in Medicare Advantage or Medicare fee-for-service (FFS). However, more people in Medicare Advantage plans reported delays in care...
Last week, the Private Equity Stakeholder Project (PESP) published a study on the role of private equity (PE) in Medicare Advantage. The study found that PE investment has fallen since the increase of interest rates and the implementation of stricter regulations.
The study looked at PE activity between 2016 and 2023, and analyzed...White Papers, E books, Reports and more
A new study demonstrates that Medicare Advantage members of marginalized identities overwhelmingly report ongoing discrimination in the delivery of health care.
The study, published in the American Journal of Managed Care, was conducted by Humana to test the feasibility of screening for health literacy and perceived discrimination....CMS Rules
Medicare Advantage insurers are struggling to maintain strong projections of growth following the news of very meager reimbursement rate reductions.
The Centers for Medicare and Medicaid Services (CMS) anticipates that the 0.16% reduction in the MA benchmark rate in 2025 will come as an effect of modifications to the diagnostic coding...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) revealed their proposals for Medicare Advantage plans in 2025, but the Biden administration appears to be pulling punches that it otherwise let fly in non-election years.
CMS said on Wednesday that it expects the average benchmark payment for MA plans to decrease by 0.2% in 2025...National News
A new report from the Employee Benefit Research Institute (EBRI) found that Medicare beneficiaries have massive out-of-pocket expenses that will require future retirees to save hundreds of thousands of dollars before leaving work.
EBRI built a simulation model that projected rates of return on assets in retirement that incorporated...National News
The U.S. Department of Health and Human Services (HHS) issued a request for information (RFI) from the public on improving transparency in the Medicare Advantage program.
The Centers for Medicare and Medicaid Services (CMS) is specifically asking for input on access to care, prior authorization, provider directories, supplemental...Arizona News
Cigna is one step closer to dropping its Medicare business this week after finalizing the sale of its MA plans to the Health Care Service Corp. (HCSC) for $3.3 billion, so long as federal regulators approve the deal. It is set to finalize by the first quarter of 2025.
Late last year, the insurance giant was scrambling to find...Arizona News
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will truncate the timeline for prior authorization processes to 72 hours for people who receive health coverage from insurers participating in Medicare Advantage, Medicaid managed care, or the Affordable Care Act exchange.
The CMS...
Yesterday the Centers for Medicare and Medicaid Services reported 745,263 MA plans were sold in Arizona during the Annual Enrollment Period (AEP) that concluded December 7, 2023. The Hertel Report put together some highlights of this year's MA market.
With nearly 1.5 million Medicare eligibles, Arizona's MA market is thriving and...
Another new year, another report from the Medicare Payment Advisory Commission (MedPAC) saying that Medicare Advantage is more expensive in exchange for lower quality coverage.
This year, the commission found that the federal government will pay Medicare Advantage (MA) insurers $88 billion more than it would if their share of...National News
Cigna is very ready to be done with its Medicare Advantage program, and may have finally found a buyer for its existing plans.
Last week, the Wall Street Journal reported that Cigna was in advanced talks with the Health Care Service Corp (HCSC) to sell the MA business for between $3 and $4 billion. HCSC is the nonprofit insurer that...National News
The American Hospital Association (AHA) and the Alliance of Community Health Plans (ACHP) are asking the Centers for Medicare and Medicaid Services (CMS) to finalize its 2025 Medicare Advantage and Part D proposed rule that would provide a number of reforms for the MA program.
In a lengthy letter highlighting several key points of the...