CMS has become more aggressive with its rollout of new payment and care delivery models. To provide healthcare leaders with an outlook for 2026, research firm ATI Advisory compiled observations from 2025 to gain a sense of CMS’ plans for…
Medicare Advantage
CMS has lifted its enrollment freeze on Gold Kidney of Florida after state regulators restored the insurer’s ability to accept new members. The agency released its intermediate sanction on Gold Kidney’s Medicare prescription drug plan, effective Dec. 15, 2025. The…
Blue Cross and Blue Shield of Alabama is dropping its Medicare fitness benefit, a spokesperson confirmed Dec. 31 to Becker’s. A spokesperson for the insurer said it reevaluates its Medicare benefits “to ensure our products are competitive and remain financially…
A federal judge has granted UnitedHealthcare and PacificSource preliminary injunctions that block Idaho from taking action against the insurers over their Medicare Advantage broker compensation practices. The insurers sued Idaho Insurance Director Dean Cameron in November after the state issued…
CMS is seeking input on whether its risk adjustment system disadvantages smaller Medicare Advantage plans, and one regional plan CEO says the answer is an emphatic yes. In its 2027 proposed MA rule, CMS said it recognizes the current risk…
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CMS is terminating its Medicare Advantage contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The agency issued a notice of termination Dec. 17 to the Franklin, Tenn.-based company,…
Facing a shifting regulatory landscape and provider tensions, some insurers have reached a crossroads with Medicare Advantage. This year proved pivotal in shaping how payers would move forward. Here are the 3 biggest trends from the year: 1. Coding intensity…
CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency expects to expand the data-collection efforts to all…
Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, published in December, reviewed high-risk diagnosis codes including acute stroke, acute…
Clever Care Health Plan is pairing its culturally competent care model with a new provider network partnership built around the lifestyle habits of the world’s longest-living populations. The partnership launches in 2026 and will connect Clever Care’s 40,000 Medicare Advantage…