CMS on July 31 finalized its Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule for fiscal 2027, setting a 2.3% payment increase for acute care and long-term care hospitals and locking in the first mandatory, nationwide…
Medicare Advantage
In recent years, a handful of insurers have left the Medicare Advantage market, and others have scaled back. Medical costs and federal cost-containment efforts have affected MA’s financial viability. For example, ongoing tensions around how star ratings are calculated —…
Humana expects Medicare Advantage plan exits next year to affect around 600,000 members as the insurer continues to focus on margin recovery. “We will work to recapture a significant portion of that volume as we did in 2025,” CFO Celeste…
CMS will discontinue the Part D premium stabilization program at the end of this year, returning the standalone prescription drug plan market to what the agency called “traditional market conditions.” CMS said July 28 its analysis of 2027 bids indicated…
The Alliance of Community Health Plans is requesting that CMS continue its hold harmless methodology for 2027 Medicare Advantage star ratings, according to a July 27 letter. The trade group of nonprofit health plans called on CMS to calculate each…
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Four more Medicare Advantage prescription drug plans have received five-star ratings thanks to CMS’ recalculation. CMS initially unveiled 2026 MA star ratings in October, with 18 MA-PD contracts scoring five stars overall. On July 22, CMS released updated 2026 Medicare…
Medicare Advantage will account for 57% of overall Medicare enrollment by 2036, up from 51% this year, according to a July report from the Congressional Budget Office. Five things to know:
Oregon regulators have released ATRIO Health Plans from state supervision three months after finding the Medicare Advantage insurer was in a “hazardous financial condition.” The Oregon Division of Financial Regulation terminated the supervision July 14, saying the conditions that prompted…
A former employee of Cambia Health Solutions has accused the Portland, Ore.-based company of violating the False Claims Act by knowingly submitting inaccurate diagnosis data to CMS and failing to return Medicare Advantage overpayments. The whistleblower complaint, originally filed in…
UnitedHealth Group still expects a Medicare Advantage enrollment loss for 2026, but the company lowered its projection on a July 16 earnings call. During the company’s fourth-quarter and full-year 2025 earnings call in January, UnitedHealthcare CEO Tim Noel said he…