AHIP is pushing back on the proposed 2024 Medicare Advantage advance notice because it presents a dramatic rate cut that would impact beneficiaries, Matt Eyles, president and chief executive officer of...
Employer-sponsored health plans paid more than Medicare for most physician-administered drugs with the highest use and the highest spending, according to data published in JAMA Health Forum.
In...
The Department of Health and Human Services (HHS) has released three models intended to bring down prescription drug spending for consumers in Medicare and Medicaid.
“These selected models will...
Out-of-pocket costs for buprenorphine prescriptions for opioid use disorder treatment decreased between 2015 and 2020, but costs varied by payer, according to a study published in JAMA Network...
HHS announced that the coronavirus public health emergency (PHE) will end on May 11, 2023, giving states 90 days to finalize arrangements for relevant policy changes.
“We have come to this point...
Around four years passed between when CMS proposed the new rule on Medicare Advantage risk adjustment and when the Medicare Advantage Risk Adjustment Data Validation final rule was published. As stakeholders review the long-awaited final...
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...
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...
In accordance with the Inflation Reduction Act, the US Department of Health and Human Services (HHS) announced that Medicare will begin drug price negotiations for prices going into effect in 2026 and...
Medicare Advantage plans have seen better patient outcomes in chronic disease management for diabetes than fee-for-service Medicare, according to a study by Avalere.
“Medicare Advantage is...
Medicare Advantage marketing practices have drawn criticism from stakeholders and regulatory changes from policymakers, but tracking the results of these policies is difficult, researchers from the...
More than 150 million people receive health insurance through public programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), according to the latest enrollment...
In its analysis of Cigna-HealthSpring of Tennessee’s risk adjustment program payments, the Office of Inspector General (OIG) found that 195 of the 279 unique enrollee-years did not have medical...
Insulin costs vary based on insurance coverage type and coverage types that lead to high healthcare spending can force patients to ration their insulin supplies, a report from the US Department of...
The share of beneficiaries who switched from traditional Medicare to Medicare Advantage in 2020 exceeded the switching rate from Medicare Advantage to traditional Medicare, contributing to Medicare...
Over the phone, a Spanish-speaking senior explains to an Anhelo Salud (Anhelo) representative her recent history with Medicare.
During the conversation, the representative realizes that different health plans have enrolled the senior in a...
The dual eligible market is changing, creating new challenges and opportunities that health plans should take into account when considering entering the market, experts from Manatt Health found in a...
SCAN Group and CareOregon have announced that they will combine under the name HealthRight Group (HealthRight).
“For far too long, America’s not-for-profit managed care organizations have...
The CMS proposed rule to streamline the Medicaid eligibility process could potentially prevent coverage losses for around a third of dual eligible beneficiaries, according to data from the Kaiser...
Medicare Advantage premiums rose to $7 per month on average for 2023 open enrollment season, an eHealth survey uncovered.
For the past four years, Medicare Advantage plan premium costs have been...
