Medicare Advantage will account for 57% of overall Medicare enrollment by 2036, up from 51% this year, according to a July report from the Congressional Budget Office. Five things to know:
Medicare Advantage
Oregon regulators have released ATRIO Health Plans from state supervision three months after finding the Medicare Advantage insurer was in a “hazardous financial condition.” The Oregon Division of Financial Regulation terminated the supervision July 14, saying the conditions that prompted…
A former employee of Cambia Health Solutions has accused the Portland, Ore.-based company of violating the False Claims Act by knowingly submitting inaccurate diagnosis data to CMS and failing to return Medicare Advantage overpayments. The whistleblower complaint, originally filed in…
UnitedHealth Group still expects a Medicare Advantage enrollment loss for 2026, but the company lowered its projection on a July 16 earnings call. During the company’s fourth-quarter and full-year 2025 earnings call in January, UnitedHealthcare CEO Tim Noel said he…
Two senators are demanding records from the three largest Medicare Advantage insurers over their use of AI and prior authorization to deny post-acute care to seniors. In July 14 letters to UnitedHealthcare, Humana and CVS Health, Sens. Richard Blumenthal, D-Conn.,…
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Two more Medicare Advantage insurers are suing CMS over their 2026 star ratings, arguing the agency did not go far enough when it adjusted the ratings following a major court loss to Clover Health earlier this year. SCAN Health Plan…
A federal appeals court has ruled against Alignment Healthcare in its challenge to how CMS calculated the company’s 2025 Medicare Advantage star ratings, upholding a lower court’s decision that mostly sided with the agency. The July 14 ruling caps a…
Nearly 97% of UnitedHealth’s in-home Medicare Advantage diagnoses were supported by a patient’s medical record in 2025, according to a review commissioned by the company. The findings are the latest in UnitedHealth’s efforts to defend HouseCalls, the in-home care program…
Blue Cross and Blue Shield of Louisiana has lost its most recent bid challenging how CMS calculated its 2025 Medicare Advantage star rating. On June 26, the U.S. Court of Appeals for the D.C. Circuit upheld a July 2025 district…
House Democrats introduced a bill July 1 targeting Medicare Advantage overpayments. Under the bill, HHS would need to exclude or adjust diagnosis codes that “are most likely to be subject to coding variation by Medicare Advantage plans,” limiting possible upcoding.…