In fiscal year 2024, Medicare Advantage patients remained in the hospital 11.2% longer on average than those in traditional Medicare, according to a June 15 report from the Medicare Payment Advisory Commission. MedPAC advises Congress on the Medicare program. Its…
Medicare Advantage
Two June 8 reports from the HHS Office of Inspector General highlighted post-acute care denials and overturned appeals from Medicare Advantage organizations. Both reports focused on June 2024, looking across 19 MA organizations. The first report found the three largest…
CMS elevated Clover Health’s Medicare Advantage star rating from 3.5 to 4.5 for its largest contract, according to a June 9 regulatory filing. Clover’s PPO covers 97% of its members, and the litigation did not include Clover’s HMO contract, which…
CareFirst BlueCross BlueShield has secured a two-week pause in its 2026 Medicare Advantage star ratings lawsuit, pointing to a ruling against the government last month that found widespread flaws in how the ratings are calculated. On May 27, a federal…
Medicare Advantage continued to grow in 2026, but at a slower pace than prior years, as enrollment shifts among major insurers and a surge in special needs plans reshaped the program’s makeup, according to a KFF analysis published June 5.…
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The North Carolina State Health Plan will raise out-of-pocket costs and copays for its Medicare Advantage offering in 2027. The board of trustees voted on the changes June 5. The medical out-of-pocket maximum will increase from $4,000 to $4,500 for…
CMS has taken a series of enforcement actions against Medicare Advantage plans over the last year and a half, suspending enrollment and terminating contracts over issues ranging from network adequacy to financial solvency failures. Seven updates:
CMS has issued more than two dozen fines against Medicare Advantage, Part D and special needs plans since January 2025, largely because of inadequate benefits administration or claims processing errors that caused enrollees to overpay for medical services and prescription…
Two health plan vendors providing in-home and mobile health services, along with the founder of one of the firms, have agreed to pay a combined $56.5 million to resolve federal allegations that they submitted false diagnosis codes to inflate Medicare…
Albuquerque, N.M.-based Presbyterian Healthcare Services will end most of its Medicare Advantage plans in 2027 and lay off about 150 health plan and administrative employees, a spokesperson for the health system confirmed to Becker’s. The changes will affect about 30,000…