• UnitedHealth Group Scrutinized for Alleged Antitrust Practices

    February 28, 2024 - The Department of Justice (DOJ) is investigating antitrust allegations against UnitedHealth Group, with a specific focus on the ties between UnitedHealthcare and Optum, according to a Wall Street Journal article that broke the story. Optum’s physician group acquisitions are at the center of DOJ’s inquiries as well as how the...

  • HCSC Announces $3.3B Cigna Medicare Business Acquisition

    February 2, 2024 - HCSC, an independent licensee of the Blue Cross Blue Shield Association, intends to seal the acquisition of Cigna’s Medicare businesses for $3.3 billion, the payer announced. The purchase includes the major payer’s Medicare Advantage plans, Medicare Supplemental Benefits plans, Medicare Part D plans, and CareAllies—which is a...

  • CMS Proposes 3.7% Increase in Medicare Advantage Plan Payments

    January 31, 2024 - Medicare Advantage plan payments will increase by 3.7 percent or $16 billion in 2025, CMS proposed in the Calendar Year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs. The proposed payment increase reflects a 2.44 percent effective growth rate, a 0.15 decrease in star ratings from the upcoming...

  • CMS Finalizes Payer Requirements to Streamline Prior Authorization

    January 17, 2024 - CMS has finalized requirements for payers to streamline the prior authorization process and improve the electronic exchange of health information to help limit patient care disruptions. The CMS Interoperability and Prior Authorization Final Rule includes policies for Medicare Advantage organizations, Medicaid and the Children’s Health...


Today's Top Stories

Humana and Baptist Health reach contract agreement for in-network coverage

Kentucky-based Baptist Health Medical Group and Humana have reached a new contract agreement, restoring in-network coverage for Medicare Advantage and commercial patients. The multi-year agreement...

Wellcare partners with tech company to improve value-based primary care

Wellcare, the Medicare brand of Centene Corporation, has partnered with a technology company to improve access to value-based primary care. The company, Pearl Health, focuses on physician enablement...

Continuous Medicaid eligibility during PHE improved postpartum coverage

The continuous Medicaid eligibility requirement during the COVID-19 public health emergency was associated with increased postpartum Medicaid enrollment and reduced uninsurance, according to a study...

2024 Medicare Advantage premiums remain low and stable

The average Medicare Advantage premium has remained low and stable, with many beneficiaries choosing plans with a zero-dollar monthly premium, according to data from eHealth, Inc. eHealth’s...

Medicare Advantage enrollment increased by 1.7 million beneficiaries

Medicare Advantage enrollment has increased by 1.7 million beneficiaries since 2023, with for-profit health plans dominating the market, a Chartis report revealed. Among 65.9 million Medicare-eligible...

Few Physicians Participate in Both Medicaid and Marketplace Plans

Less than three in ten primary care physicians participating in Medicaid also participated in an average marketplace network, raising concerns about continuity of care for beneficiaries disenrolled...

Utilization Restrictions on Medicare Part D Drugs Increased, Study Finds

Utilization restrictions on Medicare Part D drugs, including prior authorization and formulary restrictions, increased over time between 2011 and 2020, according to a Health Affairs study. Pharmacy...

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