HealthPayerIntelligence News

Personalized Outreach Impacts ACA Enrollment Among Low Income Households

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Personalized outreach could improve enrollment in the lowest-cost Affordable Care Act plans among low-income households, a study published in Health Affairs found. Using the Covered California...

AHIP: More Medicare Beneficiaries Have Medicare Supplement Insurance

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More Medicare beneficiaries are purchasing Medicare Supplement insurance, as the share of individuals with the additional coverage option grew from 38 percent to 41 percent in 2021, an AHIP report...

Long-Term COVID-19 Symptoms Associated with Higher Unmet Needs

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Patients with a post–COVID-19 condition (PCC) faced higher unmet needs due to affordability and access to care barriers, a study published in JAMA Network Open found. Data for this study came...

Aetna Offers Virtual Care Tool for Gastrointestinal Chronic Diseases

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Aetna launched a partnership with a virtual care company to provide chronic disease management for members with digestive issues. Aetna’s partner offers a virtual care platform dedicated to...

58% of Payers Use Outcomes-Based Contracts for Prescription Drugs

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More than half of payers used an outcomes-based contract in 2022, with most preferring contracts with both claims-based and clinical outcomes, an Avalere survey found. The online survey was conducted...

How 2023 Medicare Advantage Enrollment Growth Has Shifted

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This article was originally published on 2/22/23. It has been updated to reflect corrected data from Chartis and CMS. Medicare Advantage enrollment has increased by 2.7 million beneficiaries in 2023...

Extended Medicare Advantage VBID Model Will Address SDOH, Health Equity

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CMS has extended the Medicare Advantage value-based insurance design (VBID) model for an additional five years, with plans to implement changes that address beneficiaries’ social determinants of...

Medicaid Expansion Could Prevent Coverage Loss During Redeterminations

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Total Medicaid expansion could prevent massive coverage losses in nonexpansion states as Medicaid redeterminations restart, an issue brief from the Kaiser Family Foundation found. The researchers used...

Medicare Advantage Final Rule Addresses Prior Authorization, Health Equity

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CMS has finalized a Medicare Advantage rule that aims to increase marketing oversight, streamline prior authorization requirements, and improve access to affordable prescription drugs. “The...

Out-of-Pocket Spending for Pediatric Hospitalizations Reached $3,000

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The average out-of-pocket spending per non-birth-related pediatric hospitalization was $1,313 for privately insured children, but spending varied depending on the time of the year, chronic condition...

Community Health Centers Seek Enrollment Support Amid Medicaid Redeterminations

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Community health centers serve the communities that are most likely to experience widespread coverage loss once Medicaid redeterminations are underway and they are looking for help in maintaining...

Medicare Advantage Has Lower Healthcare Use, Higher Clinical Quality

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Healthcare utilization was lower in Medicare Advantage compared to traditional Medicare, but clinical quality performance was higher in the private program, a study published in Health Affairs...

Update on the Massachusetts Medicaid Redetermination Process

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MassHealth is pursuing a multi-pronged approach to reducing coverage loss during the Medicaid redetermination process, an issue brief from Manatt Health explained. The researchers noted that...

Insurer Competition Contributes to Affordable Care Act Benchmark Premiums

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The benchmark premium on the Affordable Care Act marketplace rose between 2022 and 2023 after years of decreasing, a study from the Urban Institute found. Observing Affordable Care Act health...

Study Finds Racial Coverage Disparities Following Unemployment

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After becoming unemployed during the COVID-19 pandemic, Medicaid coverage gains helped offset private insurance losses for White individuals but not for Black and Hispanic individuals, highlighting...

HHS Finalizes 3.32% Increase in 2024 Medicare Advantage Payments

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HHS has finalized the 2024 Medicare Advantage and Part D rate announcement, which includes a 3.32 percent increase in Medicare Advantage payments. “Medicare should be providing equitable,...

Anthem Announces Virtual-First Health Plan in MO for Commercial Members

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Anthem Blue Cross and Blue Shield in Missouri (Anthem) has introduced a virtual-first health plan to facilitate access to affordable virtual care for commercial plan members. “These...

Medicaid Eligibility Status Remains Elusive as Continuous Coverage Ends

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As the era of continuous coverage under the coronavirus public health emergency draws to a close, Medicaid beneficiaries remain unsure about the future of their Medicaid eligibility. “Medicaid...

Judge Rules That Employers Do Not Have to Cover Certain Preventive Care Services

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A US district judge ruled in Braidwood Management vs Becerra that employers do not have to cover preventive care services based on recommendations from US Preventive Services Task Force (USPSTF). Six...

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