Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
722 signals
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The thread running through payers’ and for-profit systems’ Q2 earnings
Payers and for-profit health systems alike are feeling the fallout from changes to the ACA environment, according to second-quarter 2026 earnings. Centene’s exchange membership fell by more than 2 million, Cigna announced plans to exit ACA exchanges entirely in 2027, and HCA Healthcare pointed to a $1 billion-to-$1.2 billion ACA-related headwind as the reason it […] The post The thread running through payers’ and for-profit systems’ Q2 earnings appeared first on Becker's Payer Issues | Payer...
CignaCenteneCigna + Centene · 21 signals · last 30 days -
United States v. Anthem, Inc.
Case 1:20-cv-02593-ALC-KHP Document 560 Filed 08/06/26 Page 1 of 29 UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW Y ORK UNITED STATES OF AMERICA, Plaintiff, No. 20 Civ. 2593 (ALC) (KHP) v. ANTHEM, INC., Defendant. THE GOVERNMENT’S MEMORANDUM OF LAW IN OPPOSITION TO DEFENDANT’S OBJECTION TO CERTAIN DISCOVERY ORDERS OF THE MAGISTRATE JUDGE Original document
AnthemElevance Health · 11 signals · last 30 days -
Blue Cross of Idaho awaits clarity as school benefit trust’s reserves run dry
Blue Cross of Idaho is caught in the middle as the trust responsible for covering schools’ benefits confronts a shortfall. A letter from the Idaho School Benefit Trust informed participating schools and districts of “extremely high” medical claims during the 2025-2026 benefit year, “much higher than they have ever been,” it read. The trust funds […] The post Blue Cross of Idaho awaits clarity as school benefit trust’s reserves run dry appeared first on Becker's Payer Issues | Payer News .
Blue Cross IdahoBlue Cross Blue Shield plans · 20 signals · last 30 days -
UnitedHealthcare eyes more Medicare Advantage exits
Medicare Advantage carriers keep fleeing areas where they aren't meeting financial targets.
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
Payers ranked by Q2 2026 profits
Health insurers released their second-quarter earnings from mid-July through early August, with all but Elevance Health posting year-over-year profit gains. Earnings for the major payers coincided with the release of the Fortune Global 500. UnitedHealth Group moved up to become the fourth-largest company in the world. The second-quarter profit ranking aligned with the companies’ order […] The post Payers ranked by Q2 2026 profits appeared first on Becker's Payer Issues | Payer News .
UnitedHealthElevanceUnitedHealthcare + Elevance Health · 45 signals · last 30 days -
7 recent Medicare Advantage fraud settlements
Federal enforcement around Medicare Advantage risk adjustment and billing has ramped up over the past two years, producing multimillion-dollar settlements with insurers, provider groups, and the vendors that handle their diagnosis coding. The combined value of the settlements comes to roughly $950 million, though some amounts were structured around the defendants’ ability to pay. In […] The post 7 recent Medicare Advantage fraud settlements appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
CVS earnings boosted by Aetna as Caremark membership slips
Net income soared and revenues increased across all segments for CVS Health.
CVS HealthAetnaCVS Health / Aetna · 10 signals · last 30 days -
AHA urges CMS to prioritize hospitals, providers with Rural Health Transformation Program funding
The AHA Aug. 5 provided comments to the Centers for Medicare & Medicaid Services on the distribution of funding for the Rural Health Transformation Program. The program will fund $50 billion to rural providers from fiscal year 2026 to FY 2030. The AHA urged CMS to prioritize direct support for rural hospitals and providers, specifically by lifting a 15% funding cap it imposed on provider payments and a 20% cap imposed on infrastructure and capital improvement funding for years two through fiv...
Policy / Regulatory Changes · 67 signals · last 30 days -
District court rules AHA can file amicus brief in case challenging Aetna’s ‘level of severity’ policy
The U.S. District Court for the Eastern District of Pennsylvania Aug. 5 granted a motion for the AHA and the Hospital and Healthsystem Association of Pennsylvania to file an amicus brief submitted in June in support of Jefferson Health’s challenge to Aetna’s “level of severity” reimbursement policy. The policy is a reimbursement for “low severity” inpatient stays that Aetna said will be “comparable” to observation rates. Aetna moved to have Jefferson Health’s case decided in arbitration rathe...
Aetna PennsylvaniaCVS Health / Aetna · 10 signals · last 30 days -
CVS raises guidance as it posts nearly $3B in profit, $106B in revenue for Q2
CVS Health is raising its guidance for the year as it blew past Wall Street analysts' expectations in the second quarter.
CVS HealthCVS Health / Aetna · 10 signals · last 30 days -
CVS falls after preliminary 2027 guidance disappoints
The upbeat results signal that CVS Health is making progress on turning around its health insurance subsidiary Aetna.
CVS HealthAetnaCVS Health / Aetna · 10 signals · last 30 days -
CVS Health profit triples in Q2
CVS Health brought in nearly $3 billion in profit for the second quarter of 2026, up from $1 billion during the same period in 2025. Total revenue was $106.1 billion for the quarter, a 7.3% year-over-year increase. The company lifted its adjusted EPS guidance range from $7.30 to $7.50 to $7.90 to $8.10. Aetna Revenue […] The post CVS Health profit triples in Q2 appeared first on Becker's Payer Issues | Payer News .
CVS HealthAetnaCVS Health / Aetna · 10 signals · last 30 days -
Payers ranked by digital experience|2026
In 2026, Aetna offers the best digital experience among major insurers on both desktop and mobile, according to new research from Corporate Insight shared with Becker’s. Corporate Insight’s “2026 Commercial Health Plan Experience Benchmark,” published Aug. 5, evaluated 24 commercial payers across more than 240 desktop and mobile functions. The report identifies overall health plan […] The post Payers ranked by digital experience|2026 appeared first on Becker's Payer Issues | Payer News .
AetnaCVS Health / Aetna · 10 signals · last 30 days -
Medicare Advantage provider to pay $14.1M to settle false diagnosis code allegations
Jacksonville, Fla.-based management services organization Complete Health Partners Holdings has agreed to pay $14.1 million to settle allegations that it violated the False Claims Act by causing false diagnosis codes to be submitted to boost Medicare Advantage payments. The settlement resolves allegations that between 2020 and 2023, Complete Health submitted diagnosis codes under Hierarchical Condition […] The post Medicare Advantage provider to pay $14.1M to settle false diagnosis code alleg...
Policy / Regulatory Changes · 67 signals · last 30 days -
Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
Policy / Regulatory Changes · 67 signals · last 30 days -
Cigna, UnitedHealthcare pitch ‘level-funded’ plans to employers
"Level-funded" plans allow employers to balance the upsides of self-insured and fully insured health benefits.
UnitedHealthcareCignaUnitedHealthcare + Cigna · 44 signals · last 30 days -
Alabamians to vote on four statewide constitutional amendments in November
The Alabama Fair Ballot Commission on Tuesday approved language to describe four statewide constitutional amendments that will be on the statewide ballot in November. The amendments, all approved by the Legislature this spring, range from methods to filling a vacancy in the lieutenant governor’s office to requiring schools to regularly play the National Anthem. The […]
Anthem AlabamaElevance Health · 11 signals · last 30 days -
Sentara moves to end Anthem contracts in Virginia
Nearly 380,000 patients could go out of network with the health system if the commercial, Medicare and Medicaid contracts lapse.
Anthem VirginiaElevance Health · 11 signals · last 30 days -
MRI is standard for diagnosing prostate cancer in most western countries. But most U.S. men don’t get them
Pre-biopsy MRI is standard outside the U.S., but the latest data show such scans were done in only about a third of U.S. prostate cancer cases in 2022.
SCANSCAN Health Plan · 11 signals · last 30 days -
Privacy Act of 1974; Matching Program
In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of the re-establishment of a matching program between CMS and the Department of War for "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act through a Department of War Health Benefits Plan."
Policy / Regulatory Changes · 67 signals · last 30 days -
Amid spending growth scrutiny, CMS unveils toolkit for states to safeguard autism care
The toolkit does not establish new federal requirements or endorse any single treatment approach to applied behavior analysis (ABA). Instead, CMS says it gives states practical tools to ensure every child gets individualized, evidence-based care.
Policy / Regulatory Changes · 67 signals · last 30 days -
Clover Insurance Company v. Department of Health and Human Services et al.
Medicare Advantage Star Ratings litigation. The post Clover Insurance Company v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .
Policy / Regulatory Changes · 67 signals · last 30 days -
Complete Health to pay $14.1M in Medicare Advantage coding misuse allegations settlement
The settlement resolves allegations from 2020 to 2023 that the company submitted HCCs that were "not clinically valid" or not supported by medical records or treatment plans.
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS decision leaves Arkansas’ Medicaid expansion program in jeopardy
CMS verbally confirmed its denial of the waiver enabling Arkansas’ Medicaid expansion program, the Arkansas Health and Opportunity for Me program, leaving more than 200,000 residents in limbo. Republican Gov. Sarah Huckabee Sanders’ office confirmed the update to Becker’s Aug. 4. The governor is expecting a formal notice in writing shortly. A spokesperson for the […] The post CMS decision leaves Arkansas’ Medicaid expansion program in jeopardy appeared first on Becker's Payer Issues | Payer N...
Policy / Regulatory Changes · 67 signals · last 30 days -
The Facts About Medicare Spending
This interactive provides the facts on Medicare spending. Medicare, which serves 70 million people and accounts for 14 percent of the federal budget and 21 percent of national health spending, is at the heart of discussions about health expenditures and affordability. Explore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, a...
Membership Movement · 5 signals · last 30 days