CMS is stepping up efforts to audit Medicare Advantage plans, and federal lawmakers are reintroducing legislation aimed at simplifying prior authorization in the program. Here are seven Medicare Advantage updates Becker’s has reported since May 12:
Payer
Santa Clara Family Health Plan is pushing back against Santa Clara County’s move to transition its Medi-Cal infrastructure to a “single plan” model, calling the move a “hostile takeover,” the Mercury News reported May 22. Santa Clara Family Health Plan…
Hospitals and medical practices faced slower payment processing from insurers in 2024 compared to 2023 even as prior authorization denial rates fell, according to new revenue cycle data from Kodiak Solutions. The data was derived from more than 2,100 hospitals…
Urbana, Ill.-based Carle Health will shut down its insurance businesses at the end of 2025. In a statement shared with Becker’s on May 22, Carle Health said Health Alliance and FirstCarolinaCare will exit all lines of business, including Medicare Advantage,…
Aetna Better Health of Illinois paid $20.4 million in value-based incentive payments to 16 community health centers. The funding is intended to improve quality of care in underserved communities, according to a May 20 news release. Three things to know: …
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Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:
Florida would see the largest increase in its uninsured population if ACA premium tax credits are not extended, and Medicaid work requirements and other changes are implemented, according to KFF. Lawmakers are considering a reconciliation package that would implement Medicaid…
Evernorth, the Cigna Group’s health services arm, will cap out-of-pocket costs for Zepbound and Wegovy, two GLP-1 drugs, at $200. Members can save up to $3,600 a year compared to purchasing the drugs directly or through consumer programs, according to…
Arkansas Blue Cross & Blue Shield reported a $226.2 million net loss in 2024 and a 15% increase in claims exceeding $1 million. President and CEO Curtis Barnett told Arkansas Business in May that members under 40 are generating seven-figure…
Eight Medicare plans have been recognized for high achievement or significant improvement in medication safety and appropriate use by the Pharmacy Quality Alliance. The awards are based on CMS’ 2025 Medicare Part D Star Ratings, where only 1.3% of the…