HealthPayerIntelligence News

Medicare Advantage Plans Rejected 2M Prior Authorization Requests in 2021

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Medicare Advantage plans denied 2 million prior authorization requests in 2021 and just 11 percent of those requests were appealed, according to an issue brief from the Kaiser Family Foundation...

Health Savings Account Balances, Contributions Grew in 2021

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The average health savings account (HSA) balance increased in 2021, with most account holders contributing more money than they withdrew, according to a report from the Employee Research Benefit...

Overview of the 2024 Medicare Advantage Advance Notice, Payer Reactions

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CMS released the 2024 Medicare Advantage Advance Notice with changes for Medicare Advantage plans and Medicare Part D, stirring up concerns among some large payer organizations. “Medicare...

Aetna Funding Improves Healthcare Access for Domestic Violence Survivors

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Aetna’s Children’s Health Insurance Program (CHIP) organization, Aetna Better Health Kids, has contributed $50,000 to help increase access to trauma-informed, affordable healthcare for...

GAO: CMS Lacks Encounter Data for MA Supplemental Benefits

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Nearly all Medicare Advantage plans offered supplemental benefits in 2022, but CMS received limited encounter data from the plans, a report from the Government Accountability Office (GAO) found. GAO...

HHS Approval Boosts Access to Care for Incarcerated Medicaid Beneficiaries

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The US Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has approved a section 1115 demonstration in California to help improve access to...

Proposed Rule Adds Contraceptive Coverage Pathway, Cuts Moral Exemption

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Under a newly proposed rule, the Biden administration would remove the moral exemption for health plan coverage of birth control while keeping the religious exemption intact, a fact sheet from the US...

HHS Finalizes Medicare Advantage Risk Adjustment Data Validation Program Rule

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The US Department of Health and Human Services (HHS) has released a final rule that aims to introduce more oversight into the Medicare Advantage risk adjustment data validation and payment...

CMS Announces ACA Special Enrollment Period during PHE Unwinding

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CMS announced that there will be a special enrollment period on the Affordable Care Act marketplace for individuals who lose their Medicaid coverage due to the public health emergency...

Cigna’s Integrated Health Plan Reduced Care Costs for Employers

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Employers saved more than $1,400 per member per year when employees enrolled in Cigna’s integrated health plan that coordinates medical, pharmacy, and behavioral benefits, according to a study...

65% of Beneficiaries Were Uninsured After Medicaid, CHIP Disenrollment

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Almost two-thirds of beneficiaries were uninsured for part or all of the year following disenrollment from Medicaid or the Children’s Health Insurance Program (CHIP), an issue brief from the...

BCBSA: 6 Policy Changes Could Save $767B in Healthcare Spending

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In a report and briefing, Blue Cross Blue Shield Association (BCBSA) recommended policy solutions that could help bring runaway healthcare spending under control, saving $767 billion across 10...

Medicaid Expansion Tied to Reduced Postpartum Hospitalizations

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Medicaid expansion was associated with a reduction in postpartum hospitalizations during the first six months after delivery, according to a Health Affairs study. Federal policy requires Medicaid to...

2023 Affordable Care Act Marketplace Enrollment Breaks Historic Records

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Affordable Care Act marketplace enrollment broke the previous all-time high by surpassing 16.3 million signups for the 2023 plan year, CMS and the Department of Health and Human Services (HHS)...

Employer-Sponsored Health Plans Face High Costs for SUD Treatment

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Employer-sponsored health plans paid $35.3 billion to cover substance use disorder treatments in 2018, a recent study published by JAMA Network Open found. The researchers used Merative MarketScan...

Elevance Health Will Acquire BCBSLA, Improve Care Access in LA

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Elevance Health has announced plans to acquire Blue Cross and Blue Shield of Louisiana (BCBSLA), with the payers aiming to improve care access, quality, and affordability for Louisiana...

FCC Allows Use of Automated Calls, Texts for Coverage, Enrollment Info

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The Federal Communications Commission (FCC) has issued guidance allowing federal and state governmental agencies to send automated calls and text messages providing individuals with information about...

The Role of Affordable Care Act Premium Tax Credits in the Payer Industry

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The Affordable Care Act marketplace premium tax credits were introduced in 2010 and continue to play an integral role in US health insurance. A Google search on premium tax credits will demonstrate...

Medicare Pays Medicare Advantage Plans 6% More Than FFS Medicare

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Medicare Advantage enrollment as a share of overall Medicare enrollment continued to rise in 2022, but payment inequity calls for serious reforms, according to a presentation from MedPAC. The Medicare...

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