A federal judge has vacated a CMS rule that would have allowed the agency to claw back billions of dollars in alleged Medicare Advantage overpayments, siding with Humana in a closely watched legal battle. On Sept. 25, the U.S. District…
Medicare Advantage
CMS has formally terminated UCare’s Medicare Advantage contracts after the insurer declined to sign agreements for 2026. The move impacts about 158,000 MA members in Minnesota and western Wisconsin, where UCare is the second-largest MA carrier with 26% market share.…
In one of the largest shifts in the Medicare Advantage landscape in recent years, Health Care Service Corporation has nearly quadrupled its Medicare Advantage membership after closing on a $3.3 billion acquisition of Cigna’s Medicare business in March. The deal,…
Higher utilization contributed to Medicare Advantage’s $5.7 billion underwriting loss in 2024, a marked reversal from serving as a source of earnings in the last five years, said an AM Best news release covering a Sept. 23 report. “Changes to…
Aetna is expanding a program that aims to reduce readmissions for its Medicare Advantage members to ten hospitals by the end of 2025. The insurer is currently implementing the clinical collaboration program at Merriam, Kan.-based AdventHealth Shawnee Mission, Houston Methodist,…
Advertisement
As Medicare Advantage directory data are incorporated into the Medicare plan finder, CMS is launching a special election period for beneficiaries to leave their current plan if incorrect information is present, a Sept. 12 CMS memo said. This window applies…
Patients who get primary care from older adult-focused, value-based care organizations are more likely to use these services regularly, according to a study published in NEJM Catalyst: Innovations in Care Delivery, a digital journal published by The New England Journal…
The National Committee for Quality Assurance identified the standout MA plans for each state, evaluating based on nearly 50 factors that include patient experience and clinical performance. The ratings were released Sept. 16 and are based on 2024 data from…
Three Medicare Advantage plans scored a full five stars in this year’s health plan rankings from the National Committee for Quality Assurance. An additional 17 plans, including six more Kaiser Foundation Health Plans from around the country, scored 4.5 stars…
Aetna’s new “level of severity inpatient payment” policy will take effect in less than two months, and the American Hospital Association said it is “deeply concerned.” Aetna’s policy, set to go into effect Nov. 15, will approve inpatient stays without…