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…
Medicare Advantage
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:
CareFirst BlueCross BlueShield is suing CMS over its 2026 Medicare Advantage star ratings, alleging improper calculations cost the insurer an estimated $32 million in quality bonus payments. The lawsuit, filed Jan. 20 in the U.S. District Court for the District…
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Maryland is losing its longstanding rate-setting power for Medicare fee-for-service under CMS’ “achieving healthcare efficiency through accountable design” payment model. Commercial insurers are going to bear the brunt, needing to tackle about half of the state’s necessary savings and covering…
Clover Health CEO Andrew Toy is feeling bullish about his company’s AI positioning. “We are absolutely, in my mind, the AI leader in Medicare Advantage,” he said Jan. 15 at the J.P. Morgan 2026 Healthcare Conference in San Francisco. Clover…
Alignment Healthcare has California roots, but its CEO, John Kao, is confident about planting seeds for growth elsewhere. Mr. Kao weighed in on Alignment’s strategy Jan. 14 during the J.P. Morgan 2026 Healthcare Conference in San Francisco. Just days before,…
Clover Health reported 53% year-over-year growth in Medicare Advantage PPO membership, according to a Jan. 14 news release from the insurer. The growth translated to roughly 153,000 members, building on positive traction from 2025. The company is now expecting to…
UnitedHealthcare has launched a six-month pilot program aimed at cutting Medicare Advantage payment processing times in half for independent rural hospitals in four states. The Rural Payment Acceleration Pilot will reduce average MA payment timelines from less than 30 days…