Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
1203 signals
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Preclusion gaps tied to $72M in Medicare Advantage, Part D payments: Report
Vulnerabilities in CMS’ preclusion process contributed to Medicare Advantage and Part D plans making $72 million in payments for services linked to revoked providers from 2022 through 2024, the HHS Office of Inspector General found. Revocation ends a provider’s enrollment in traditional Medicare Parts A and B. The preclusion list bars payment to listed providers […] The post Preclusion gaps tied to $72M in Medicare Advantage, Part D payments: Report appeared first on Becker's Payer Issues | P...
Policy / Regulatory Changes · 140 signals · last 30 days -
CareSource names CFO
CareSource has named Stephanie Williams as its new chief financial officer. She succeeds Larry Smart, who will be retiring after serving as the insurer’s CFO for 6 years, according to an Oct. 1 news release. Ms. Williams first joined CareSource in 2021 as senior vice president and chief actuary – Rylan Austin will succeed her […] The post CareSource names CFO appeared first on Becker's Payer Issues | Payer News .
CareSourceCareSource · 2 signals · last 30 days -
Washington health system launches an insurance plan
Tacoma, Wash.-based MultiCare Health System is launching a health insurance plan. MultiCare Health Plan, announced Oct. 1, will operate as a wholly owned subsidiary of the 13-hospital nonprofit system. Its first product is a Medicare Advantage HMO with prescription drug benefits, which will be available for the 2027 plan year in three counties in Washington […] The post Washington health system launches an insurance plan appeared first on Becker's Payer Issues | Payer News .
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Medicare 101
This Health Policy 101 chapter explores Medicare, a federal health insurance program covering more than 68 million people, established in 1965 for people age 65 or older and later expanded to cover people under age 65 with long-term disabilities. In addition to detailing Medicare eligibility, coverage, and spending, the chapter examines the increased role of private plans in providing benefits and the financing challenges posed by increasing health care costs and an aging population.
Demographic Shifts · 3 signals · last 30 days -
Claims against Aetna dismissed in Zelis antitrust repricing case
A Massachusetts federal judge dismissed claims against Aetna on Sept. 30 in antitrust litigation over the use of Zelis’ repricing tools. The judge determined the providers’ latest complaint did not plausibly allege Aetna used the tools. The plaintiffs filed a second amended complaint in August, following a first amended complaint in June 2025. The first […] The post Claims against Aetna dismissed in Zelis antitrust repricing case appeared first on Becker's Payer Issues | Payer News .
Aetna MassachusettsCVS Health / Aetna · 14 signals · last 30 days -
Focus on HMOs, C-SNPs: A look at the Medicare Advantage landscape for 2027
With Medicare's annual enrollment period on the horizon, major insurers are offering a look at their plans for the coming year and new federal data offers a broader look at the current landscape.
Membership Movement · 18 signals · last 30 days -
Trump Administration Announces Nearly $55 Million to Expand Rural Maternal and Emergency Care, Cancer Screening, and Alabama’s Rural Healthcare Workforce
Trump Administration Announces Nearly $55 Million to Expand Rural Maternal and Emergency Care, Cancer Screening, and Alabama’s Rural Healthcare Workforce This federal investment will support 34 grants including maternal care networks and increase access to cancer screening across Alabama
Competitive / Operational Strategy · 39 signals · last 30 days -
CMS launches 340B claims data repository
The Centers for Medicare & Medicaid Services’ 340B Part D claims data repository became available Oct. 1 for voluntary data submissions. While data submissions will remain voluntary for now, the agency has proposed making data submissions mandatory starting Jan. 1, 2027. CMS has multiple resources available to support 340B entities and their third-party administrators with data submissions, including a user guide, companion guide, fact sheet and an FAQ.
Policy / Regulatory Changes · 140 signals · last 30 days -
Cigna rolls out modernization effort, expects $3B in savings
Cigna is launching a modernization and productivity initiative, expected to bring in $3 billion in savings by 2030. During the company’s Sept. 30 investor day call, CFO Ann Dennison said the multiyear program focuses on automating workflows, ensuring a future-ready workforce and optimizing supplier and vendor management. According to a news release from the same […] The post Cigna rolls out modernization effort, expects $3B in savings appeared first on Becker's Payer Issues | Payer News .
CignaCigna · 15 signals · last 30 days -
The Average Medicare Beneficiary has 28 Medicare Advantage Prescription Drug Plan Options for 2027
The average Medicare beneficiary will have 28 Medicare Advantage prescription drug (MA_PD) plans available for general enrollment in 2027. The number of plans varies widely across states.
Membership Movement · 18 signals · last 30 days -
ACHP Statement on Introduction of the MA STARS Act
ACHP applauds Rep. Mike Kelly's MA STARS Act, which centers Medicare Advantage Star Ratings on clinical quality, patient outcomes and patient experience. Source
Policy / Regulatory Changes · 140 signals · last 30 days -
Former CEO for UnitedHealth’s Optum Serve steps back into role
Retired Lt. Gen. Patricia Horoho, MSN, is stepping back into her previous role as CEO of Optum Serve, UnitedHealth Group’s federal government health services business. An Optum announcement shared with Becker’s said Ms. Horoho was Optum Serve’s founding CEO. She brought together legacy businesses and supported military service members, veterans and their families. Ms. Horoho […] The post Former CEO for UnitedHealth’s Optum Serve steps back into role appeared first on Becker's Payer Issues | P...
UnitedHealthOptumUnitedHealthcare · 47 signals · last 30 days -
Medicare Advantage looks stable for 2027. Underneath, it’s shifting
The Medicare Advantage market remains a bit of a paradox: it may look unchanged from a national level heading into 2027, but seniors will have fewer plans to choose from in more than half of the states and growth continues to be driven by special needs plans. The retreat continues what began in 2025, when […] The post Medicare Advantage looks stable for 2027. Underneath, it’s shifting appeared first on Becker's Payer Issues | Payer News .
Demographic Shifts · 3 signals · last 30 days -
Insurers say their 2027 Medicare Advantage offerings preserve benefits. The data tells a different story
A Leerink Partners analysis of Medicare Plan Finder shows how the largest MA carriers are cutting dental allowances and premium givebacks next year as they continue to prioritize margin recovery.
Financial / Operating Pressure · 31 signals · last 30 days -
CMS finalizes model that aims to bring most-favored nation pricing to Part B
The Trump administration has finalized a new model that aims to bring its most-favored nation pricing approach to Medicare Part B.
Policy / Regulatory Changes · 140 signals · last 30 days -
STAT+: Trump’s watered-down Medicare drug pricing rule saves 96% less than initial proposal
WASHINGTON — The Trump administration published a final rule aimed at lowering Medicare prices for drugs administered in doctor offices. It applies to only four companies. The Global Benchmark for…
Policy / Regulatory Changes · 140 signals · last 30 days -
STAT+: UnitedHealth investor lawsuit moves forward on allegations it ‘manufactured earnings’ to hide declining profits
An investor lawsuit against UnitedHealth Group will move forward after a federal judge declined the company’s motion to dismiss allegations.
UnitedHealthUnitedHealthcare · 47 signals · last 30 days -
CHOICE in Action: Texas Employers Take Advantage of New Approach to Health Benefits
CHOICE in Action: Texas Employers Take Advantage of New Approach to Health Benefits Federal leaders spotlight legacy of healthcare innovation in Texas amid wave of momentum for CHOICE Arrangement
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CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
Policy / Regulatory Changes · 140 signals · last 30 days -
11 payers exiting Medicare Advantage in 2027
Eleven payers are exiting the individual Medicare Advantage market for 2027, according to CMS data. Seven of the eleven are owned entirely or in part by health systems. Several other payers will stay in MA next year only through special needs plans, including Molina Healthcare, Horizon BCBS New Jersey, New York City-based MJHS Health System’s […] The post 11 payers exiting Medicare Advantage in 2027 appeared first on Becker's Payer Issues | Payer News .
Molina Healthcare + Blue Cross Blue Shield plans · 39 signals · last 30 days -
4 new Medicare Advantage insurers in 2027
There will be four new entrants to the Medicare Advantage market in 2027, according to CMS data. In contrast, 11 payers that sold individual MA plans in 2026 won’t offer them next year, and the largest insurers collectively are pulling out of hundreds of counties nationwide. Here are the four new MA insurers for 2027, […] The post 4 new Medicare Advantage insurers in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
CMS finalizes new drug pricing model: 7 notes
CMS has finalized the Global Benchmark for Efficient Drug Pricing (GLOBE) Model, a mandatory payment model that will tie Medicare Part B drug rebates to prices paid in 19 reference countries, according to a Sept. 30 CMS news release. Here are seven things to know: The post CMS finalizes new drug pricing model: 7 notes appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
Medicare Advantage insurers expanding, shrinking SNP footprints in 2027
While some payers are slimming down their Medicare Advantage reach, some are betting big on special needs plans. SNPs cover dually eligible Medicaid individuals (D-SNP), those with chronic conditions (C-SNP) and those needing long-term care (I-SNP). CMS released data Sept. 28 breaking down the 2027 MA landscape overall. The agency expects a slight dip in […] The post Medicare Advantage insurers expanding, shrinking SNP footprints in 2027 appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 140 signals · last 30 days -
‘You need to look into it’: Dr. Oz pitches CHOICE health plans to small businesses
CMS Administrator Mehmet Oz, MD, is urging employers to consider an alternative to traditional group health plans that allows workers to select their own individual insurance coverage. Speaking Sept. 30 at an event in Austin, Texas, Dr. Oz promoted CHOICE Arrangements, the new federal branding for individual coverage health reimbursement arrangements, as an option for […] The post ‘You need to look into it’: Dr. Oz pitches CHOICE health plans to small businesses appeared first on Becker's Pay...
Policy / Regulatory Changes · 140 signals · last 30 days -
Judge narrows California pension fund lawsuit against UnitedHealth
A federal judge has thrown out most of a securities fraud lawsuit brought by the country’s largest pension fund against UnitedHealth Group, but will let claims that the company misled investors about previous asset sales move forward. The California Public Employees’ Retirement System (CalPERS) originally sued in May 2024, alleging UnitedHealth, former CEO Andrew Witty […] The post Judge narrows California pension fund lawsuit against UnitedHealth appeared first on Becker's Payer Issues | Pay...
UnitedHealth CaliforniaUnitedHealthcare · 47 signals · last 30 days