Elevance Health has set aside $935 million to cover potential costs tied to its ongoing risk adjustment data dispute with CMS, which threatens the insurers’ ability to enroll new members into some of its Medicare Advantage plans. CFO Mark Kaye…
Medicare Advantage
As a growing number of hospitals and health systems walk away from Medicare Advantage contracts, Cleveland Clinic is moving in the opposite direction, betting that the path forward runs through the payer’s side of the table, not away from it.…
CMS is holding off on its voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model pilot for Medicare Part D, the agency confirmed to Becker’s April 21. Under BALANCE, CMS would negotiate lower GLP-1 prices for Medicaid programs…
UnitedHealthcare is considering participation in CMS’ voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model, according to UnitedHealth Group’s April 21 earnings call. BALANCE involves negotiated lower GLP-1 prices for Medicaid programs and Medicare Part D plans, along…
Oregon regulators have placed ATRIO Health Plans under state supervision after the Medicare Advantage insurer racked up more than $52 million in operating losses in 2025 and fell into a “hazardous financial condition.” The April 13 order gives the state…
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Medicare Payment Advisory Commission insights, Congressional reports and enrollment data have all been released in the early months of 2026. Some methodology has been questioned by insurers and CMS, even directly on the Congressional floor. Despite the challenges, here are…
The day after CMS released its final 2027 Medicare Advantage and Part D payment rule, Chris Klomp, director of Medicare and deputy administrator at the agency, sat down with Health Tech Nerds Radio podcast to walk through what changed, what…
CMS is raising Medicare Advantage payments by 2.48%, or more than $13 billion, according to its finalized 2027 rate announcement. The agency said April 6 that when estimated risk score trends in MA are accounted for, the final rate amounts…
The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative. Seven BCBSA recommendations: 1. CMS should notify…
CMS published its final 2027 Medicare Advantage and Part D rule on April 2, enacting changes to star ratings, supplemental benefits administration, Part D coverage, and a series of deregulatory provisions. The rule is effective June 1 and applies to…