Medicare Advantage

Most Employers Offering Retiree Health Plans Use Medicare Advantage

by Kelsey Waddill

Most large employers used to offer retiree health plans, but in 2023, only a fifth of them did, according to a KFF brief. Among those that do, many have turned to Medicare Advantage to supply these...

Lawsuit Alleges Humana Used AI to Deny Medically Necessary Claims

by Victoria Bailey

Humana is facing a class action lawsuit alleging that the payer used an artificial intelligence (AI) tool to deny Medicare Advantage beneficiaries’ claims for medically necessary care. In a...

Lawmakers Urge CMS to Improve Data Collection in Medicare Advantage

by Victoria Bailey

Four United States Senators have called on CMS to improve data collection and reporting in the Medicare Advantage program to help regulators understand how plan design impacts care quality, cost, and...

Humana’s Value-Based Care Plans Improved Health Outcomes for MA Members

by Victoria Bailey

Humana Medicare Advantage beneficiaries receiving care under value-based arrangements had better health outcomes, including fewer inpatient admissions and emergency room visits, a report from the payer...

Avoidable Hospitalizations Less Common in Medicare Advantage, Study Finds

by Victoria Bailey

Medicare Advantage beneficiaries were less likely to have avoidable hospitalizations than those in traditional Medicare, suggesting that the use of provider networks in Medicare Advantage may reduce...

What Non-Medical Supplemental Benefits Will MA Plans Offer in 2024?

by Victoria Bailey

Food and produce services are the most common non-medical supplemental benefit in Medicare Advantage for 2024, offered by 1,475 plans, a report from ATI Advisory found. In addition to offering typical...

CMS Proposals Address Anti-Competitive Practices in Medicare Advantage

by Victoria Bailey

CMS has proposed provisions to improve protections for Medicare Advantage beneficiaries, prevent anti-competitive practices, and strengthen access to behavioral healthcare services. The Contract Year...

Care Quality, Health Outcomes Better in Medicare Advantage than FFS

by Victoria Bailey

Medicare Advantage beneficiaries experience higher quality care and better health outcomes than fee-for-service beneficiaries, according to a report from Harvard and Inovalon. Researchers used...

What Cigna’s FCA Settlement Means for Other Medicare Advantage Plans

by Victoria Bailey

Cigna’s recent brush with False Claims Act violations serves as a reminder that Medicare Advantage organizations should be routinely assessing their risk and compliance activities. The Department of Justice (DOJ) announced in...

Humana Ranks High for Experience, Affordability Among MA Plans

by Victoria Bailey

Based on the 2024 Medicare Advantage star ratings, Humana received the highest ranking for overall plan quality, member experience, and low premiums, a US News & World Report analysis shared. The...

Medicare Advantage Star Ratings Fall for Second Consecutive Year

by Victoria Bailey

The average star ratings for Medicare Advantage and Medicare Part D prescription drug plans fell for the second year in a row to 4.04 and 3.11 stars, respectively, CMS data revealed. The star rating...

What Are Major Payers Offering Medicare Advantage Members in 2024?

by Victoria Bailey

As Medicare’s open enrollment period approaches, payers have announced new Medicare Advantage plan offerings for 2024.   Because Medicare Advantage plans receive flexibility to cover...

Alignment Health to Offer Medicare Advantage Plans That Address SDOH

by Victoria Bailey

Alignment Healthcare has partnered with Instacart to offer Medicare Advantage plans in 2024 that address social determinants of health, including food insecurity and transportation access. “Our...

CMS: Medicare Advantage Premiums Will See Little Change in 2024

by Victoria Bailey

Ahead of the Medicare Open Enrollment Period, CMS has announced that Medicare Advantage premiums, benefits, and plan choices will remain relatively stable in 2024.  “A top priority for CMS...

The Medicare Advantage Marketing Problem and Where It’s Headed

by Victoria Bailey

Each year, Medicare’s open enrollment period starts mid-October and is preceded by an influx of marketing materials advertising private Medicare Advantage, Medicare Part D, and Medigap plans. While marketing practices are intended to...

Medicare Advantage RADV Rule May Prompt More Legal Action from Payers

by Victoria Bailey

Payers have not reacted lightly to the Medicare Advantage Risk Adjustment Data Validation (RADV) final rule. Major payer Humana made the strongest display of disapproval by filing a lawsuit against CMS that seeks to invalidate the...

Top Reasons Behind Retail, Medicare Advantage Plan Partnerships

by Kelsey Waddill

Payers such as UnitedHealthcare, Priority Health, and Anthem have pursued Medicare Advantage plan partnerships with retail companies. What is the attraction to this type of partnership? Plans that are co-branded with retail companies are...

How the Top 4 Disruptive Insurtechs Have Evolved Since Their IPOs

by Kelsey Waddill

The insurtechs that saw the greatest success after the start of the coronavirus pandemic have faced a tumultuous path since their initial public offerings (IPOs). In 2021, four insurtechs achieved their IPO. Their goal was to disrupt the...

Beneficiaries with Cancer Spend Less Out-of-Pocket in Medicare Advantage

by Victoria Bailey

Medicare Advantage beneficiaries with cancer experienced lower out-of-pocket costs and had access to more benefits than those in Medicare fee-for-service (FFS), research conducted by ATI Advisory and...