Payer

Big insurers — from Humana to Cigna — are shying away from Medicare Advantage, exiting “unprofitable” markets, axing commission payments and even selling their businesses entirely. Now, other insurance companies have a chance to step up and gain market share,…

Almost half of Medicare Advantage enrollment growth since 2024 has been driven by special needs plans, according to an analysis from KFF. 4 notes on special needs enrollment in 2025: 1. In 2025, 21% of MA enrollees are in SNPs.…

Catastrophic health events — such as brain injuries and amputations — are life altering for patients, but these claims also weigh on insurers. From rising utilization and medical costs to expanded eligibility for catastrophic health coverage, the role of these…

Viva Health, under the University of Alabama at Birmingham Health System, said it is investigating a data breach involving 4,945 individuals’ data, according to a news release from Sept. 26 shared with Becker’s. The insurer found a file on its…

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…