CMS awarded its Medicare Advantage independent review entity contract to C2C Innovative Solutions, according to a March 31 CMS letter published by the AMA. C2C secured the contract Feb. 26. Effective May 1, C2C will review appeals of adverse reconsiderations,…
Medicare Advantage
CMS has granted Elevance Health’s request for more time to resolve the ongoing dispute over Medicare Advantage risk adjustment data reporting, pushing back a possible start date on enrollment sanctions by two months. In a March 18 statement, Elevance said…
A bipartisan group of four senators is advocating for stricter provisions under the proposed No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act to address insurer upcoding, according to a March 30 letter sent to CMS Administrator Mehmet Oz,…
Medicare Advantage now covers about 55% of eligible beneficiaries (about 35 million people) and costs the federal government a projected $76 billion more in 2026 than traditional fee-for-service Medicare would, according to a March report by the Medicare Payment Advisory…
For insurers that remain committed to their Medicare Advantage businesses, special needs plans have been a major growth driver. KFF estimated that almost half of MA enrollment growth from 2024 to 2025 stemmed from these tailored plans. In 2025, SNPs…
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Pennsylvania has opened a special enrollment window for 5,400 UnitedHealthcare Medicare Advantage members affected by the contract dispute with Allentown-based Lehigh Valley Health Network, giving impacted beneficiaries until April 30 to switch plans. The state said March 16 that it…
HSS’ Office of Inspector General estimates that BCBS Alabama received at least $7 million in Medicare Advantage overpayments, according to a March audit report. From a sample of 271 enrollee-years, 247 had medical records that did not align with diagnosis…
About 82% of the more than 16,000 available public comments on the 2027 Medicare Advantage proposed rate notice share the perspective and language of a letter from the Medicare Advantage Majority, a group with undisclosed funding sources and founders, according…
Anthem Blue Cross Blue Shield and UnitedHealthcare offer the best mobile provider search tools among major Medicare Advantage insurers, according to a February report from Corporate Insight shared with Becker’s. The report evaluated tools available on iOS and looked at…
The Medicare Payment Advisory Commission estimated Medicare Advantage payments will be 14% greater than fee-for-service Medicare in 2026, according to a March 12 report from the congressional agency. That 14% equates to an extra $76 billion for MA, with the…