Author: Rylee Wilson

Changes in CMS' risk model for Medicare Advantage and rising medical costs among the Medicare population could lead to changes in benefit design, payer executives told investors in second-quarter earnings calls. 

Centene posted $1.06 billion in net income in the second quarter of 2022, and leaders said the effects of Medicaid redeterminations are within their expectations. 

Alignment Healthcare posted a $23.7 million dollar loss in the second quarter of 2023, up from a $6.6 million loss in the same time period last year. 

Though payers are hesitant to offer broad coverage of weight loss drugs, 4 in 5 adults say insurers should cover drugs like Ozempic or Wegovy for adults diagnosed as overweight or obese, according to a survey from KFF. 

Centene had the highest Medicaid membership of the largest payers in the second quarter of 2023. The company also lost the most members during the redeterminations process. 

Cigna is expecting smaller margins in its individual insurance business because of higher-than-expected risk adjustment payments, Cigna Group executives told investors on an Aug. 3 call. 

Payers are cracking down on prescriptions for expensive GLP-1 drugs like Ozempic and Wegovy, but these drugs could provide a boost to the pharmaceutical benefit sides of payers' businesses, executives told investors. 

The Blue Cross Blue Shield Association is backing a bill that would eliminate restrictions on same-day billing for mental health services for children on Medicaid. 

Medicaid redeterminations are continuing, with more than 3.7 million people removed from the program since April, according to KFF. Recent survey results show many enrollees say their health plan has not reached out to them about how to renew their…

Humana had the largest Medicare Advantage membership growth in the second quarter of 2023, and UnitedHealthcare continues to have the largest member base, according to the companies' earnings reports.