CMS is redefining “compensation” to set a clear, fixed amount that agents and brokers can be paid regardless of the MA plan the individual enrolls in, a change the agency says addresses loopholes that result in commissions that create anti-competitive and anti-consumer steering incentives.
The suit filed May 15 in a federal...
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...
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...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would continue the reforms around prior authorization and marketing practices for Medicare Advantage and Part D plans. The new rule is another step in the Biden administration's efforts to crack down on the Medicare Advantage marketplace's...
Last week, Kaiser Health News (KHN) won a lawsuit with the Centers of Medicare and Medicaid Services (CMS) to compel the agency to release 90 federal audits of Medicare Advantage (MA) plans from the years 2011 through 2013.
The information contained in these audits demonstrates that overpayments have consistently been made to...Reports & Surveys
On Monday, the Commonwealth Fund, a private foundation that researches health care system solutions to promote high quality care and efficiency across health systems, published a report on how seniors choose between Medicare and Medicare Advantage.
The report found that the decision is not simple, and beneficiaries carefully weigh...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
