Payer

AmeriHealth Caritas, a managed care organization, is growing its Medicare Advantage offerings, focusing on its Medicare-Medicaid dual-eligible special needs plans, according to a news release shared with Becker’s. In 2026, the insurer’s MA dual-eligible offering will be available in new…

Work requirements for Medicaid eligibility are set for 2027, but states can request short-term exceptions for counties with high unemployment. By assessing county-level data in Medicaid expansion states, KFF found only 7% of counties meet the exception criteria using a…

With the release of CMS Star Ratings for 2026 and updates for the upcoming year, Medicare Advantage and Part D plans are navigating an evolving quality landscape. Adherence measures are shifting from triple- to single-weighted and will incorporate risk adjustment,…

A federal judge has vacated a CMS rule that would have allowed the agency to claw back billions of dollars in alleged Medicare Advantage overpayments, siding with Humana in a closely watched legal battle. On Sept. 25, the U.S. District…

Improving patient outcomes while curbing healthcare costs remains a shared imperative for both payers and providers. Yet achieving this balance requires more than isolated initiatives — it calls for systemic strategies that bring care coordination, quality measurement and population health…

Cancer care is at a turning point. Rapid therapeutic innovation, shifting demographics, and growing financial pressures are reshaping the oncology landscape—and payers are under increasing pressure to adapt. In a recent Becker’s Healthcare webinar, three physician-leaders discussed the latest developments…

On Sept. 25, Georgia Gov. Brian Kemp shared how CMS extended the state’s Pathways to Coverage program through 2026, despite a recent finding from the U.S. Government Accountability Office that the Medicaid work requirement program had spent over twice as…

CMS removed its enrollment sanction on eternalHealth on Sept. 10, according to a news release from the agency. In March, CMS suspended enrollment for eternalHealth’s Medicare Advantage-Prescription Drug Plan contracts after Massachusetts requested the insurer to cease marketing its products…

Counterpart Health, a subsidiary of Clover Health, is leaning more on generative AI to scale value-based care, allowing clinicians to interact with patient data through a chat function, according to a Sept. 25 news release. Counterpart Assistant, an AI-powered physician-enablement…

Oncology care company Thyme Care has raised $97 million in a Series D funding round backed by major insurers Humana and CVS Health, as well as JPMorgan’s Morgan Health division.  The round also drew support from Texas Oncology and Houston-based…