Oregon regulators have placed ATRIO Health Plans under state supervision after the Medicare Advantage insurer racked up more than $52 million in operating losses in 2025 and fell into a “hazardous financial condition.” The April 13 order gives the state…
Medicare Advantage
Medicare Payment Advisory Commission insights, Congressional reports and enrollment data have all been released in the early months of 2026. Some methodology has been questioned by insurers and CMS, even directly on the Congressional floor. Despite the challenges, here are…
The day after CMS released its final 2027 Medicare Advantage and Part D payment rule, Chris Klomp, director of Medicare and deputy administrator at the agency, sat down with Health Tech Nerds Radio podcast to walk through what changed, what…
CMS is raising Medicare Advantage payments by 2.48%, or more than $13 billion, according to its finalized 2027 rate announcement. The agency said April 6 that when estimated risk score trends in MA are accounted for, the final rate amounts…
The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative. Seven BCBSA recommendations: 1. CMS should notify…
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CMS published its final 2027 Medicare Advantage and Part D rule on April 2, enacting changes to star ratings, supplemental benefits administration, Part D coverage, and a series of deregulatory provisions. The rule is effective June 1 and applies to…
CMS awarded its Medicare Advantage independent review entity contract to C2C Innovative Solutions, according to a March 31 CMS letter published by the AMA. C2C secured the contract Feb. 26. Effective May 1, C2C will review appeals of adverse reconsiderations,…
CMS has granted Elevance Health’s request for more time to resolve the ongoing dispute over Medicare Advantage risk adjustment data reporting, pushing back a possible start date on enrollment sanctions by two months. In a March 18 statement, Elevance said…
A bipartisan group of four senators is advocating for stricter provisions under the proposed No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act to address insurer upcoding, according to a March 30 letter sent to CMS Administrator Mehmet Oz,…
Medicare Advantage now covers about 55% of eligible beneficiaries (about 35 million people) and costs the federal government a projected $76 billion more in 2026 than traditional fee-for-service Medicare would, according to a March report by the Medicare Payment Advisory…