Centene executives are hoping to unlock healthy food as a Medicare Advantage benefit more broadly. In a May 11 Health Affairs article, Centene leaders and a University of California, San Francisco, professor made the case for CMS to expand access…
Medicare Advantage
One federal lawsuit has set off a chain reaction in the Medicare Advantage world, reshaping star ratings and quality bonus payments — and which plans come out on top. Typically, on the one-to-five star-rating scale, four stars is the threshold…
Walgreens will begin supporting eligible Medicare beneficiaries through the new Medicare GLP-1 Bridge program at about 8,000 pharmacies when the initiative launches July 1. More than 56 million patients in the Medicare network may be eligible for the program, according to a June 25…
Earlier in June, the HHS Office of Inspector General published two reports shedding light on post-acute care denials and overturned appeals from Medicare Advantage organizations. AHIP is pushing back. “The reports ignore serious, well-documented concerns about wide variations in the…
Clover Health’s PPO, the company’s largest contract covering 97% of members, already secured a Medicare Advantage star ratings boost from 3.5 to 4.5 stars following litigation. Now, the insurer’s smaller HMO contract is also seeing a bump. According to a…
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Nationally, roughly 1% of U.S. physicians have opted out of Medicare entirely, according to 2025 data from KFF. While 1% appears to be a marginal number upon first glance, a closer look at where those exits are happening, and what is accelerating the…
Fairview Health Services will stop scheduling patients with UnitedHealthcare Medicare Advantage plans effective Jan. 1, 2027. The Minneapolis-based health system said frequent coverage changes, denials and payment issues have made it harder for patients to access care. “We understand this change creates…
In fiscal year 2024, Medicare Advantage patients remained in the hospital 11.2% longer on average than those in traditional Medicare, according to a June 15 report from the Medicare Payment Advisory Commission. MedPAC advises Congress on the Medicare program. Its…
Two June 8 reports from the HHS Office of Inspector General highlighted post-acute care denials and overturned appeals from Medicare Advantage organizations. Both reports focused on June 2024, looking across 19 MA organizations. The first report found the three largest…
CMS elevated Clover Health’s Medicare Advantage star rating from 3.5 to 4.5 for its largest contract, according to a June 9 regulatory filing. Clover’s PPO covers 97% of its members, and the litigation did not include Clover’s HMO contract, which…