As the Supreme Court deliberates the fate of the Affordable Care Act after hearing the oral arguments, payers and the public alike are processing the court case and its implications for the healthcare...
CMS announced that Medicare coverage will now extend to monoclonal antibodies for coronavirus treatment in certain cases.
Monoclonal antibodies are lab-constructed antibodies, the National Institute...
If beneficiaries were to choose the same health plan for 2021 as they did for 2020, slightly over 19 percent of Medicare Advantage beneficiaries would be enrolled in plans with a 4.5 Medicare Advantage...
Medicare Advantage plans may face a sicker population and lower payments in 2021, a recent Avalere report warned.
Avalere used Medicare Advantage claims from 2020 through June 2020 to assess the...
America’s Health Insurance Plans (AHIP) has come forth with critique of the price transparency final rule, saying that it will drive healthcare prices up and decrease industry competition.
The...
Medicare Advantage proposed policy changes may result in a 2.82 percent average change in revenue and 4.55 percent change in growth, projected the CMS calendar year (CY) 2022 Medicare Advantage and...
Automated data transfer is a key part of diminishing administrative burden and reducing health costs, but payers have not yet fully committed to the process.
The progression toward greater automation...
CMS has released the final rule for price transparency in healthcare coverage, which aims to allow the public to have greater insight into healthcare costs in order to increase value.
“This...
CMS has released its Medicare reimbursement rate and official coverage strategy for the coronavirus vaccine when one is approved.
For more coronavirus updates, visit our resource page, updated...
As payers and vendors scramble to comply with the interoperability rule, various nonprofits seek to streamline this interoperability process with innovative solutions, such as CAQH’s upcoming...
CommonWell Health Alliance announced that it is expanding its interoperability services, a move which could support payers struggling with interoperability compliance related to the new CMS...
Not only have Medicare Advantage plans continued to increase their health-related supplemental benefits for 2021 open enrollment, but this year one in three plans will also offer supplemental benefits...
The downward trend in ACA exchange premiums continued this year with the average premium for the benchmark plan dropping two percent for 2021 coverage year, although some premiums remain up to 36...
CMS has approved a Section 1332 demonstration for Georgia which, in part, moves the individual market to a private sector platform.
“I’m thrilled to support this comprehensive state-led...
CMS has released Medicare Advantage Star Ratings for 2021 and the results demonstrate a continuation of last year’s positive trends.
Medicare Advantage health plan quality steadily continued its...
Beneficiaries suffer from chronic confusion over Medicare enrollment but policymakers can take action to streamline the process and improve beneficiary experience, Better Medicare Alliance asserted in...
As Medicare Advantage plans prepare to expand their benefits in 2021, CMS expects premiums to drop 34.2 percent from 2017 levels in the new year.
“The Medicare Advantage average monthly premium...
Temporary Medicaid coronavirus flexibilities and funding may be about to expire and CMS needs to be clearer about transition guidelines in order to help states be prepared, Kaiser Family Foundation...
The Core Quality Measure Collaborative (CQMC), a partnership between America’s Health Insurance Plans, CMS, and the National Quality Forum (NQF) that establishes quality measures to promote...
CMS has issued a letter to Medicaid directors regarding how states can accelerate their Medicaid value-based care adoption, based largely on lessons learned in CMS efforts toward value-based care in...
