Payer Issues Archives - Becker's Payer Issues

Many MA pay rate comments tied to 'dark money' | 2 states inch closer to Medicaid work rules | Court rules against Aetna in gender-affirming care case | Ill. bill takes aim at AI-driven downcoding | MA spending 14% higher than FFS: MedPAC

Many notes on MA pay rate tied to ‘dark money’ and states are inching closer to Medicaid work rules March 13, 2026 1. About 82% of public Medicare Advantage rate notice comments tied to 'dark money' group: KFF Full story…

UnitedHealth must release docs in AI denials case | NC state plan won't extend Aetna contract | MA overpayments causing Medicare costs to rise: Report | Largest MCOs by enrollment | 10 providers seeking payer talent

UnitedHealth has to hand over docs in AI denials case and NC may drop Aetna after one contract cycle March 12, 2026 1. Judge orders UnitedHealth to hand over documents in AI coverage denial case Full story 2. NC State…

Aetna to pay $118M over MA upcoding allegations | Elevance responds to MA sanction threat | Centene expects 40% ACA enrollment drop | UnitedHealthcare, AARP face new Medigap lawsuit | Minn. Medicaid eyes ouster of MCOs

Aetna is the latest to settle MA upcoding allegations and Elevance responds to CMS’ sanction threat March 11, 2026 1. Aetna to pay $118M to resolve Medicare Advantage upcoding allegations Full story 2. Elevance 'surprised and disappointed' by CMS Medicare Advantage…

Humana's highest-paid execs | Elevance to expand out-of-network penalty policy | Point32Health cutting more jobs | Part D, Medicaid plans can apply for CMS GLP-1 model | 20 payer relations execs to know

Elevance is expanding a controversial out-of-network policy and more layoffs at Point32Health March 10, 2026 1. Humana's 5 highest-paid execs in 2025 Full story 2. Elevance to expand 10% out-of-network penalty policy into California Full story 3. Consumers want care…

The new rules for regional insurer survival | What’s behind the Texas ACA boom? | Federal Medicaid fraud probe spreads | Point32Health posts $301M loss in '25 | 5 Part D enrollment updates

Regional insurer survival is getting harder + digging into why Texas is seeing record ACA enrollment March 9, 2026 1. Oregon payer CEO details the new requirements for regional insurer survival Full story 2. What's behind the ACA boom in…

CMS gets record comments on ’27 MA rates | UnitedHealth rolls back subsidiary disclosures | 15 payer leaders on most sustainable growth opps | Lilly goes direct-to-employer for GLP-1s | Regence plans report mixed '25 results

UnitedHealth is rolling back subsidiary disclosures and CMS received record comments on MA rates March 6, 2026 1. 47,000 comments on 2027 Medicare Advantage pay proposal breaks CMS record Full story 2. UnitedHealth rolls back subsidiary disclosures Full story 3.…

Mount Sinai, Anthem split | Wis. payer posts record MA growth again | How 3 insurers are tightening E/M billing oversight | BCBS Mich. posts $246M loss in '25 | 10 UnitedHealth updates

Mount Sinai and Anthem have officially split + diving into a Wisconsin payer’s record MA growth March 5, 2026 1. Wisconsin payer, backed by Cost Plus partnership, posts another year of record Medicare Advantage growth Full story 2. Mount Sinai…

No-premium MA plans face 50% cut | Ascendiun CEO launches healthcare reform movement | Medicaid swings from profit center to loss leader: Report | Aetna fined over mental health parity issues | Centene pitches CMS on Medicaid fraud reform

Insurers warn of benefit cuts under proposed ’27 MA rate and Medicaid becomes a loss leader March 4, 2026 1. Benefits coverage for no-premium Medicare Advantage plans could drop 50% under 2027 proposed rate: AHIP Full story 2. 16 health…

Cigna CEO to retire | Stability drives record growth at small MA plans | Federal bill would reverse Medicaid cuts | Insurers urge MA rate proposal revisal | Mass. drops employee GLP-1 coverage

Cigna’s longtime leader is retiring and small MA plans credit stability for record membership gains March 3, 2026 1. Cigna COO to succeed retiring predecessor as CEO Full story 2. 'We're running in when others are running out': Stability drives…

CMS to freeze Elevance MA enrollment | UnitedHealth plans layoffs, caps raises: Report | BCBS Mass. posts $223M loss | Cigna buys CarepathRx | MA enrollment falls in 7 states

CMS is freezing MA enrollment at Elevance and UnitedHealth is capping worker pay raises March 2, 2026 1. CMS to suspend enrollment into Elevance's Medicare Advantage plans Full story 2. UnitedHealth pay raises not to exceed 2% amid layoffs: Bloomberg…

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