In 2025, health plans put emerging tech to use, but also had to discover and utilize workarounds for government regulations from the current administration. For many payers, navigating the past year has helped them plan ahead for 2026. Becker’s connected with…
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Total risk adjustment payments in individual and small group insurance plans increased modestly in 2024, according to new data from CMS. The agency published its annual summary report of risk adjustment payments June 18. The risk adjustment program is designed…
CMS is stepping up efforts to audit Medicare Advantage plans, and federal lawmakers are reintroducing legislation aimed at simplifying prior authorization in the program. Here are seven Medicare Advantage updates Becker’s has reported since May 12:
Medica reported an operating loss of $216 million on $6.3 billion of revenue for 2024. The company cited “historic levels of healthcare services utilization,” across all products and geographies. The operating loss includes $40 million for the company’s premium deficiency…
Centene’s Medicare Part D enrollment is nearing 8 million members. According to CMS enrollment data from March 2025, Centene leads the nation in Medicare Part D membership with 7.92 million enrollees. The company has gained nearly 1 million members since…
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Hawaii lawmakers have introduced legislation that seeks to address growing provider concerns around the prior authorization process. The bill would require insurers to report data related to prior authorization to the state and would introduce specific timelines for the approval…
Aledade and Humana are expanding their ongoing partnership to provide care under a value-based arrangement to Medicare Advantage members at Federally Qualified Health Centers and rural health clinics across 26 states. “This expanded agreement is an important development as it…
An Ohio jury awarded Medical Mutual of Ohio over $50 million in damages on March 12 after the payer prevailed in its lawsuit against FrontPath Health Coalition and HealthScope Benefits, a subsidiary of UnitedHealthcare. FrontPath offers employee benefits solutions, and…
Ten providers recently posted job listings seeking leaders in payer contracting and relations.
The share of local Medicare Advantage plans has shrunk since 2012, while national insurers have increased their market share, a study published in the December issue of Health Affairs found.