Higher utilization contributed to Medicare Advantage’s $5.7 billion underwriting loss in 2024, a marked reversal from serving as a source of earnings in the last five years, said an AM Best news release covering a Sept. 23 report. “Changes to…
Author: Elizabeth Casolo
Ambetter from Home State Health, a Centene subsidiary, will return $87.5 million in ACA rebates to Missouri members, according to a statement from the insurer. The rebates stem from failing to meet medical loss ratio requirements under the ACA, which outlines…
UnitedHealthcare is set to pay $359 million in ACA-required rebates for 2024, sending checks that are slated to arrive by Sept. 30, according to a news release from the insurer. Last year, commercial payers were estimated to have spent $1.1…
Tension between providers and managed care organizations is no secret. MCO scrutiny and provider hesitancy around value-based care are among the challenges. Earlier this month, behavioral health-focused Magellan Health appointed Steven Pratt, MD, as chief medical officer. He sat down…
Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. Not all of the introduced bills have been heard in committee. Here are eight proposals introduced in 2025…
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Louisiana’s Office of Group Benefits is cutting back its reliance on CVS Caremark as its pharmacy benefit manager for state employees, according to Sept. 18 meeting documents. Liviniti and SilverScript Insurance Co., under CVS Health, are now forging emergency contracts…
Cincinnati-based health system TriHealth is negotiating its agreement with UnitedHealthcare as its current contract is set to expire at the end of the year, the system told Becker’s. TriHealth confirmed it sent a letter to patients addressing the potential changes…
Gov. Kelly Ayotte prevented New Hampshire’s Executive Council from moving forward with a four-year, $27.5 million benefits contract with Anthem Health Plans of New Hampshire to cover current and retired state employees, according to Sept. 17 meeting records. The state’s…
The Congressional Budget Office found permanently expanding ACA enhanced premium tax credits prior to the federal government’s Sept. 30 fiscal year end would boost the insured population by 3.8 million people over the next decade, while increasing the deficit by…
Patients who get primary care from older adult-focused, value-based care organizations are more likely to use these services regularly, according to a study published in NEJM Catalyst: Innovations in Care Delivery, a digital journal published by The New England Journal…