Payer

Changes in CMS' risk model for Medicare Advantage and rising medical costs among the Medicare population could lead to changes in benefit design, payer executives told investors in second-quarter earnings calls. 

Centene posted $1.06 billion in net income in the second quarter of 2022, and leaders said the effects of Medicaid redeterminations are within their expectations. 

Alignment Healthcare posted a $23.7 million dollar loss in the second quarter of 2023, up from a $6.6 million loss in the same time period last year. 

Though payers are hesitant to offer broad coverage of weight loss drugs, 4 in 5 adults say insurers should cover drugs like Ozempic or Wegovy for adults diagnosed as overweight or obese, according to a survey from KFF. 

Centene had the highest Medicaid membership of the largest payers in the second quarter of 2023. The company also lost the most members during the redeterminations process. 

Norfolk County, Massachusetts has the lowest rate of uninsured residents in the country at 2.4 percent, according to new data released Aug. 3 by the U.S. Census Bureau.

Kenedy County, Texas has the highest rate of uninsured residents in the country at 46.3 percent, according to new data released Aug. 3 by the U.S. Census Bureau.

Humana ended a cataract surgery prior authorization policy for Medicare Advantage beneficiaries in Georgia that had been criticized by ophthalmology groups. 

Riverdale, Ga.-based Southern Regional Medical Center is suing Cigna, alleging the payer did not fully reimburse SRMC for medically necessary services as an out-of-network provider, The Clayton Crescent reported Aug. 3. 

Texas has the most uninsured residents in the country, while Vermont has the least, according to new data released Aug. 3 by the U.S. Census Bureau.