As for-profit Medicare Advantage health plans rapidly expand across the nation and pick up a large share of the population’s enrollment, non-profit Medicare Advantage plans will have to adjust...
Although utilization has started to return to normal levels, payers have continued making a profit during the third quarter of 2020, a Kaiser Family Foundation brief discovered.
“In this brief,...
Despite the many unknowns, a diverse group of experts and leaders in the industry have identified five payer industry trends for 2021 that range from strengthening value-based care partnerships to...
Humana has announced a new value-based primary care services model for Medicare Advantage members using the CMS Primary Care First model.
“The creation of this model comes at a critical time....
As the 116th Congress comes to a close, America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) urged legislators to provide COVID-19 relief, calling for access to...
Medicare Advantage quality of care exceeded traditional Medicare, particularly in preventive care, a recent Better Medicare Alliance study revealed.
“The hallmark features of Medicare...
Many Medicare beneficiaries are transitioning from another Medicare plan to Medicare Advantage, with the migration driven in part by the opportunity for prescription coverage under Medicare Advantage,...
CMS does not anticipate coronavirus-related expenditures including deferred care to impact 2022 healthcare spending, but the pandemic might impact Medicare Advantage risk scores in contract year 2023,...
Over the last couple of years, Medicare Advantage supplemental benefits have seen a great deal of reinterpretation that has led to their expansion and evolution, a Milliman brief commissioned by Better...
Kaiser Foundation Health Plan of Washington will pay over $6.3 million for submitting invalid Medicare Advantage diagnoses, according to the Department of Justice (DOJ).
“When insurance...
McLaren St. Luke’s has filed an anti-trust lawsuit against ProMedica Health System to prevent it from retracting Paramount commercial and Medicare Advantage health plan coverage.
According to...
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...
Chronic condition special needs plans were created to serve the complex needs of patients with conditions such as end-stage renal disease (ESRD), and a new study published in JAMA Network Open...
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...
While the coronavirus pandemic has forced positive change elsewhere in the healthcare industry, Medicare home healthcare policies still have room to improve, a Commonwealth Fund study discovered.
As...
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...
Responses from families and friends of deceased Medicare Advantage members indicate that Medicare Advantage plans have room for improvement on end-of-life care, a study published in JAMA Network Open...
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...
As health plans consider how to meet the new Medicare Advantage Star Ratings programs, they will need to design surveys and advanced analytics tools to support their member experience improvement...
