Payer

The CEOs of the six largest for-profit insurers have different perspectives on Medicare Advantage. 

A swirl of challenges is looming for Medicare recipients ahead of the annual enrollment period beginning Oct. 15.

Elevance Health is launching Mosaic Health, a primary care venture with private equity firm Clayton, Dubilier & Rice. 

In 2023, more than 61% of Ozempic prescriptions went to patients with commercial health insurance, and less than 10% of all semaglutide prescriptions went to Medicaid enrollees, according to a study published Aug. 2 in JAMA Health Forum.

Centene is the most likely to overturn a prior authorization denial decision when appealed, while Humana is the least likely, according to a KFF analysis.

The Medicare Advantage business is facing major challenges — government scrutiny is rising, CMS regulations and payments are tightening, the cost of care is rising and negative media coverage abounds.

Here are 11 updates on UnitedHealth Group and its subsidiaries that Becker's has reported since July 22: 

Several payers are scaling back their prior authorization requirements in an effort to ease administrative burdens on providers. 

In 38 U.S. counties, three in four Medicare beneficiaries are enrolled in Medicare Advantage, according to data from KFF. 

On average, residents of Mississippi, New Mexico and Florida spend more than 10% of their annual salaries on health insurance premiums for coverage provided by their employer, according to AHIP's 2024 "Coverage at Work" report published in July.