Payer

Two U.S. representatives have introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans. 

CMS is projecting Medicare Part D premiums to decrease by 1.8 percent in 2024, the agency said in a July 31 news release. 

Around half of beneficiaries dually-eligible for Medicare and Medicaid are enrolled in Medicare Advantage, according to a July 31 analysis from KFF. 

As demand for GLP-1s such as Ozempic and Wegovy continues to surge, payers and self-insured employers are dropping coverage for the weight loss medications left and right.

Portland, Maine-based Martin's Point Health Care has agreed to pay $22.5 million to resolve allegations that it knowingly submitted inaccurate diagnosis codes for Medicare Advantage Plan enrollees to increase reimbursements from Medicare.

Elevance Health is rebranding its Amerigroup subsidiary as Wellpoint. 

Federal and state-based insurance marketplaces received around 140,000 applications from people who previously had Medicaid coverage in April, according to data from CMS.

Centene could end 2023 with no four-star rated Medicare Advantage contracts, CEO Sarah London told investors on a July 28 call. 

CMS has approved a proposal from California to eliminate asset tests for Medicaid eligibility. 

Early data from Medicaid redeterminations is in line with Centene's expectations for membership losses, executives told investors.