Payer

Medicare Advantage open enrollment is underway, and payers are expecting to see even more older adults choose the plans over traditional Medicare. 

CVS Health executives told investors Nov. 2 the company is expecting a $2 billion decline in 2024 revenues because of its lower Medicare Advantage star ratings in 2023 and the loss of its pharmacy benefits contract with Centene.

Millions of people are expected to lose Medicaid coverage when the federal public health emergency ends. This challenge presents an opportunity for states to address the issues of "Medicaid churn," researchers at New York City-based New York University and Boston-based…

Alignment Healthcare's overall losses are continuing to improve as the Medicare Advantage provider adds members and offerings. 

Centene has donated to political candidates in states where it is up for Medicaid contract selection or defending itself against overbilling accusations, sometimes through multiple subsidiaries, according to a Kaiser Health News report published Nov. 4. 

Senate Finance Committee Democrats are pushing for tighter regulation of Medicare Advantage marketing from CMS and Congress. 

More than 1 in 3 beneficiaries transition insurance 12 months before or after giving birth, a study published in JAMA Network Open Nov. 3 found. 

Around half of payers had a data breach incident over the past five years, a report from LexisNexis Risk Solutions found. 

UnitedHealth Group was the largest health insurer by national-level market share in 2021, according to a Nov. 1 analysis from the American Medical Association. 

In late October, Pennsylvania state lawmakers sent a bill aiming to streamline the prior authorization process to the governor's desk, making it one of several states that have taken steps to reform that process this year.