In one of the largest shifts in the Medicare Advantage landscape in recent years, Health Care Service Corporation has nearly quadrupled its Medicare Advantage membership after closing on a $3.3 billion acquisition of Cigna’s Medicare business in March. The deal,…
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Higher utilization contributed to Medicare Advantage’s $5.7 billion underwriting loss in 2024, a marked reversal from serving as a source of earnings in the last five years, said an AM Best news release covering a Sept. 23 report. “Changes to…
Ambetter from Home State Health, a Centene subsidiary, will return $87.5 million in ACA rebates to Missouri members, according to a statement from the insurer. The rebates stem from failing to meet medical loss ratio requirements under the ACA, which outlines…
UnitedHealthcare is set to pay $359 million in ACA-required rebates for 2024, sending checks that are slated to arrive by Sept. 30, according to a news release from the insurer. Last year, commercial payers were estimated to have spent $1.1…
Tension between providers and managed care organizations is no secret. MCO scrutiny and provider hesitancy around value-based care are among the challenges. Earlier this month, behavioral health-focused Magellan Health appointed Steven Pratt, MD, as chief medical officer. He sat down…
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Louisiana’s Office of Group Benefits is cutting back its reliance on CVS Caremark as its pharmacy benefit manager for state employees, according to Sept. 18 meeting documents. Liviniti and SilverScript Insurance Co., under CVS Health, are now forging emergency contracts…
Aetna is expanding a program that aims to reduce readmissions for its Medicare Advantage members to ten hospitals by the end of 2025. The insurer is currently implementing the clinical collaboration program at Merriam, Kan.-based AdventHealth Shawnee Mission, Houston Methodist,…
Traditional claim processing is plagued by interoperability issues, leading to manual data exchange and lack of transparency. Real-time, automated data exchange between health plans and providers can help. By sharing eligibility, claim and payment data upfront, providers can identify and…
The National Committee for Quality Assurance has once again named the highest-quality and most effective health plans in the country, with Blue Cross Blue Shield of Massachusetts remaining at the top. On Sept. 16, the NCQA released its 2025 ratings…
As Medicare Advantage directory data are incorporated into the Medicare plan finder, CMS is launching a special election period for beneficiaries to leave their current plan if incorrect information is present, a Sept. 12 CMS memo said. This window applies…