Oakland, Calif.-based Kaiser Permanente is suing nine liability insurers for breach of contract, alleging they have refused to cover any portion of its $556 million settlement with the federal government resolving False Claims Act allegations tied to Medicare Advantage billing…
Medicare Advantage
Medicare Advantage now covers about 55% of eligible beneficiaries nationwide — more than 35 million people — but health systems are confronting a question that until recently felt almost taboo: What happens when participation in the country’s fastest-growing Medicare program…
One in 10 Medicare Advantage enrollees were forced to disenroll from their health plan heading into 2026 due to insurer exits from the market, a tenfold increase from historical averages, according to a study published Feb. 18 in JAMA. The…
Almost 35.5 million people were enrolled in a Medicare Advantage plan as of Feb. 1, up about 3% from 34.4 million at the same time last year, according to CMS data analyzed by Becker’s. Growth during the annual enrollment period…
When San Diego-based Scripps Health walked away from nearly all of its commercial Medicare Advantage contracts Jan. 1, 2024, the move drew widespread attention across the industry. Medicare Advantage enrollment was still climbing nationally and many health systems were doubling…
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A handful of insurers are boasting Medicare Advantage membership gains following the annual enrollment period. Annual enrollment ran from Oct. 15 to Dec. 7, setting the stage for 2026 numbers. However, despite membership growth among some carriers, the Medicare Advantage…
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…
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…