Alliance of Community Health Plans President and CEO Ceci Connolly sees momentum around risk adjustment reform picking up. “We see this administration taking very seriously the concerns over wide gaps in risk adjustment payments — gaps that are far outside…
Medicare Advantage
Molina Healthcare will exit the Medicare Advantage Part D business in 2027, the company announced alongside its fourth quarter and full year 2025 earnings report published Feb. 5. The MAPD product represents approximately $1 billion in annual premiums. Molina said…
Twenty-two groups — most healthcare related — signed a letter advocating for a bill that aims for fairer comparison between Medicare Advantage and fee-for-service, according to a Feb. 4 news release from AHIP. Reps. Aaron Bean, R-Fl., and Kevin Hern,…
CMS is planning to continue its Medicare Advantage audits and overpayment recoveries, according to a Jan. 27 memo. While federal estimates point to $17 billion in overpayments each year, the last major risk-adjustment data-validation recovery took place in payment year…
Clever Care Health Plan ushered in almost 15,000 new Medicare Advantage members — membership growth of nearly 50% — during the 2026 Medicare annual enrollment period, according to a Feb. 3 news release from the company. Clever Care offers what…
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Medicare Advantage insurers will likely continue to scale back supplemental benefits and exit certain markets if CMS finalizes its proposed 0.09% payment increase for 2027, according to a Jan. 30 analysis from Fitch Ratings. “Depending on finalized payment rate and…
As more hospitals and health systems grow frustrated with Medicare Advantage plans, Ascension is among the organizations rethinking how — and whether — to continue participating. Delays in care, high denial rates and growing administrative burdens are prompting tougher contract…
The House passed a bipartisan healthcare funding package Jan. 22. The most recent version includes a provision addressing Medicare coverage for multi-cancer early detection screenings. The bill is now in the Senate’s hands. If it passes, Medicare beneficiaries would also…
Medicare Advantage has long been viewed as a strong alternative to traditional Medicare, but the program has “deteriorated significantly” in recent years — benefitting commercial payers at the expense of patients and providers, according to Providence President and CEO Erik…
CMS proposed its 2027 Medicare Advantage and Part D capitation rates and payment policies Jan. 26, putting forth a slowdown in payment growth after a $25 billion boost for 2026. Six things to know: