As 2025 earnings reports trickled out over the last several months, they showed that many Blue Cross Blue Shield companies struggled financially last year as medical and pharmacy spending climbed and squeezed profitability. Class members began receiving payouts in May…

House Democrats introduced a bill July 1 targeting Medicare Advantage overpayments. Under the bill, HHS would need to exclude or adjust diagnosis codes that “are most likely to be subject to coding variation by Medicare Advantage plans,” limiting possible upcoding.…

Elevance Health is suing CMS over its 2026 Medicare Advantage star ratings, arguing the agency gave competitor Clover Health a favorable recalculation after losing a court case to the insurer in May. In its July 1 complaint filed in the…

The share of Medicare Advantage enrollees in plans that qualified for federal quality bonus payments dropped to 68% in 2026, its lowest point since 2018, according to a KFF analysis published July 1.  Five things to know: 1. The drop…

Blue Cross and Blue Shield of Vermont dropped its proposed Vermont Basic offering from consideration for the qualified health plan market in 2027. BCBS Vermont had pitched the product line, offering more affordable HSA-compatible plans, in May. The company said,…

UnitedHealth Group received the largest total Medicare Advantage bonus payments in 2026, pulling in $3.9 billion as total program spending reached $13.4 billion across all MA plans, according to a KFF analysis published July 1. The $13.4 billion in quality…

New Bern, N.C.-based CarolinaEast Medical Center has officially exited Blue Cross Blue Shield of North Carolina’s Medicare Advantage network while extending its participation in UnitedHealthcare’s Medicare Advantage plans through the end of the year. According to a updated payer list…

Some Wisconsin Medicaid members getting a monthly cash benefit through the state’s Supplemental Security Income program had mail containing private information sent to outdated addresses. The letters concerned an increase in benefits. The Wisconsin Department of Health Services confirmed the…

CMS plans to cut what Medicare pays hospitals for drugs bought through the 340B program and push site-neutral payment into a new category of outpatient services, two proposals that together would pull billions of dollars out of hospital outpatient revenue…

Longevity Health has earned a 5-star Medicare Advantage rating for its New Jersey Institutional Special Needs Plan, giving the payer its third 5-star contract following CMS’s recalculation of 2026 star ratings. Longevity’s I-SNP plans in Illinois and North Carolina also…