Clover Health’s PPO, the company’s largest contract covering 97% of members, already secured a Medicare Advantage star ratings boost from 3.5 to 4.5 stars following litigation. Now, the insurer’s smaller HMO contract is also seeing a bump. According to a…
Medicare Advantage
Nationally, roughly 1% of U.S. physicians have opted out of Medicare entirely, according to 2025 data from KFF. While 1% appears to be a marginal number upon first glance, a closer look at where those exits are happening, and what is accelerating the…
Fairview Health Services will stop scheduling patients with UnitedHealthcare Medicare Advantage plans effective Jan. 1, 2027. The Minneapolis-based health system said frequent coverage changes, denials and payment issues have made it harder for patients to access care. “We understand this change creates…
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…
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…
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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.…
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 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…