Cigna's Medicare Advantage business may have a potential buyer, and Washington is ramping up scrutiny on prior authorization and transparency in the program.
Here are eight Medicare Advantage stories Becker's has reported since Nov. 17.
- SelectCare of Texas, a Centene subsidiary, received an estimated $5.1 million in net Medicare Advantage overpayments in 2015 and 2016, according to an audit from HHS' Office of Inspector General.
- Optum patients who are enrolled in fully accountable Medicare Advantage plans — where Optum takes full financial and clinical responsibility — have better health outcomes than patients enrolled in traditional Medicare, according to UnitedHealthcare CEO Brian Thompson.
- The sale of Cigna's Medicare Advantage business would remove one hurdle in the company's reported goal to merge with Humana, and Health Care Service Corp. might be part of that equation.
- Concerns about Medicare Advantage denials are on the rise in Washington, Politico reported. Lawmakers are putting pressure on CMS to increase oversight of prior authorizations in the program, and experts said scrutiny is likely to ramp up in 2024.
- The Hospital Insurance Trust Fund would be solvent until 2048 if traditional Medicare utilization levels were similar to those under Medicare Advantage, according to research published in October by AHIP and conducted by Avalere.
- Some Medicare Advantage plans, including UnitedHealthcare and Aetna, are not planning to comply with new CMS guidance requiring plans to follow traditional Medicare's standards for coverage decisions, the American Hospital Association alleged.
- CMS paid Medicare Advantage organizations an estimated $16.6 billion in improper payments in fiscal year 2023, the agency reported.
- Fewer Medicare Advantage beneficiaries are choosing no-premium plans for 2024, according to eHealth's snapshot report that tracks MA and Part D plans selected by beneficiaries in the first half of the current annual enrollment period.