CareFirst BlueCross BlueShield has secured a two-week pause in its 2026 Medicare Advantage star ratings lawsuit, pointing to a ruling against the government last month that found widespread flaws in how the ratings are calculated. On May 27, a federal…
Medicare Advantage
Medicare Advantage continued to grow in 2026, but at a slower pace than prior years, as enrollment shifts among major insurers and a surge in special needs plans reshaped the program’s makeup, according to a KFF analysis published June 5.…
The North Carolina State Health Plan will raise out-of-pocket costs and copays for its Medicare Advantage offering in 2027. The board of trustees voted on the changes June 5. The medical out-of-pocket maximum will increase from $4,000 to $4,500 for…
CMS has issued more than two dozen fines against Medicare Advantage, Part D and special needs plans since January 2025, largely because of inadequate benefits administration or claims processing errors that caused enrollees to overpay for medical services and prescription…
Two health plan vendors providing in-home and mobile health services, along with the founder of one of the firms, have agreed to pay a combined $56.5 million to resolve federal allegations that they submitted false diagnosis codes to inflate Medicare…
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Albuquerque, N.M.-based Presbyterian Healthcare Services will end most of its Medicare Advantage plans in 2027 and lay off about 150 health plan and administrative employees, a spokesperson for the health system confirmed to Becker’s. The changes will affect about 30,000…
CMS is suspending enrollment for a Maryland Medicare Advantage institutional special needs plan operated by Provider Partners Health Plans after the insurer lost all contracted long-term care facilities in the plan’s network and then disenrolled some members without their consent.…
The HHS Office of the Inspector General estimates $462 million in CMS overpayments to Medicare Advantage plans stemming from some unsupported acute stroke diagnosis codes. In a May report, the OIG reviewed a sample of 97 MA beneficiaries. The entire…
Elevance Health has cleared an initial hurdle to avoid CMS enrollment and communications sanctions over some of its Medicare Advantage plans — but still faces two deadlines. In February, CMS alleged that Elevance had submitted data corrections for unsupported diagnosis…
Insurers are facing a June 1 deadline to submit their 2027 Medicare Advantage bids to the federal government, including their benefits. In recent years, MA plans have been under pressure amid rising medical costs and utilization. While the federal government…