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…
Medicare Advantage
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.…
Elevance Health is suing CMS over its 2026 Medicare Advantage star ratings, arguing the agency gave competitor Clover Health a favorable recalculation after losing a court case to the insurer in May. In its July 1 complaint filed in the…
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The share of Medicare Advantage enrollees in plans that qualified for federal quality bonus payments dropped to 68% in 2026, its lowest point since 2018, according to a KFF analysis published July 1. Five things to know: 1. The drop…
UnitedHealth Group received the largest total Medicare Advantage bonus payments in 2026, pulling in $3.9 billion as total program spending reached $13.4 billion across all MA plans, according to a KFF analysis published July 1. The $13.4 billion in quality…
New Bern, N.C.-based CarolinaEast Medical Center has officially exited Blue Cross Blue Shield of North Carolina’s Medicare Advantage network while extending its participation in UnitedHealthcare’s Medicare Advantage plans through the end of the year. According to a updated payer list…
Longevity Health has earned a 5-star Medicare Advantage rating for its New Jersey Institutional Special Needs Plan, giving the payer its third 5-star contract following CMS’s recalculation of 2026 star ratings. Longevity’s I-SNP plans in Illinois and North Carolina also…
CMS is rolling out the Medicare GLP-1 Bridge program — a demonstration designed to give eligible Medicare Part D beneficiaries access to certain GLP-1s at a fixed monthly cost — July 1. CMS officials, including CMS Administrator Mehmet Oz, MD,…