Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
1208 signals
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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 · 142 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 · 142 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 · 142 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 · 142 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 · 48 signals · last 30 days -
Independence Blue Cross to pay $22.5M over Medicare Advantage coding
Independence Blue Cross has agreed to pay $22.5 million to resolve allegations that it used inaccurate diagnosis codes to inflate its Medicare Advantage payments, according to a Sept. 30 Justice Department news release. The government alleged the insurer violated the False Claims Act in three ways for payment years 2017 through 2021. It says the […] The post Independence Blue Cross to pay $22.5M over Medicare Advantage coding appeared first on Becker's Payer Issues | Payer News .
Blue CrossBlue Cross Blue Shield plans · 37 signals · last 30 days -
Blue Shield of California must face mental health ‘ghost network’ claims
A federal judge allowed portions of a putative class action lawsuit against Blue Shield of California and Magellan, the insurer’s contracted mental health services administrator, to move forward over allegations that they published an inaccurate directory of mental health providers, according to a Sept. 23 court order. The plaintiffs are Blue Shield subscribers who alleged […] The post Blue Shield of California must face mental health ‘ghost network’ claims appeared first on Becker's Payer Is...
Blue Shield CaliforniaBlue Cross Blue Shield plans · 37 signals · last 30 days -
Trump Administration Announces $20 Million to Expand Telehealth Access and Upgrade Healthcare Technology Across Rural North Carolina
Trump Administration Announces $20 Million to Expand Telehealth Access and Upgrade Healthcare Technology Across Rural North Carolina This federal investment will help expand virtual care, upgrade electronic health records, strengthen cybersecurity, and equip rural providers with new technology to better serve patients
Competitive / Operational Strategy · 40 signals · last 30 days -
Medicare Advantage insurers ranked by county entries, exits in 2027
Many major health insurers are pulling back from some counties in 2027, while Singh Holdings, Blue Cross of Idaho and Devoted Health boosted their footprint. CMS released data Sept. 28 on the 2027 Medicare Advantage landscape, showing which counties insurers are serving or exiting next year. MA plan options are decreasing next year in 29 […] The post Medicare Advantage insurers ranked by county entries, exits in 2027 appeared first on Becker's Payer Issues | Payer News .
Devoted Health + Blue Cross Blue Shield plans · 38 signals · last 30 days -
Elevance cracks down on hospital billing for off-campus care
The insurer said it’s trying to restrict hospitals from charging higher rates for services at off-campus outpatient departments. Hospital groups say the reimbursement cuts could threaten access to care.
ElevanceElevance Health · 16 signals · last 30 days -
Cigna unveils $3B productivity initiative, including use of AI
The company will focus on automating and modernizing processes, better managing suppliers, partners and vendors and making employees more efficient, executives said during a Wednesday investor day.
CignaCigna · 15 signals · last 30 days -
Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability
Agenda calls for faster prior authorization decisions, stronger oversight of in-home health risk assessments, a next-generation risk model and greater stability for more than 35 million beneficiaries WASHINGTON — Better … Continue reading "Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability" The post Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability a...
Competitive / Operational Strategy · 40 signals · last 30 days -
Fraud in Federal Programs: Limited Beneficial Ownership Information Available on Awardees
What GAO Found Illicit actors hide their beneficial ownership in multiple ways to fraudulently access federal awards, such as contracts, grants, and Medicare payments, and to evade payment on taxes. GAO’s review of federal cases highlights tactics illicit actors have used, such as using stolen identities, shell companies, professional enablers, and pass-through billing schemes to hide ownership. For example, from July 2019 through January 2023, three purported hospice owners stole identities...
Policy / Regulatory Changes · 142 signals · last 30 days -
Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements; Correction
This document corrects technical errors in the final rule that appeared in the August 3, 2026 Federal Register titled "Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements".
Policy / Regulatory Changes · 142 signals · last 30 days -
BCBS Association names 3 new leaders
Blue Cross Blue Shield Association has named a chief transformation officer and hired two vice presidents, the organization said Sept. 29. Lynn Merritt has been promoted to executive vice president and chief transformation officer. She will oversee people experience, corporate strategy, communications and community, and serve as chief of staff to CEO Kim Keck. She […] The post BCBS Association names 3 new leaders appeared first on Becker's Payer Issues | Payer News .
Blue CrossBlue ShieldBlue Cross Blue Shield plans · 37 signals · last 30 days -
Elevance Health rolls out new site-of-care billing policies
Elevance Health is rolling out new billing policies that aim to ensure services are paid for at the appropriate level and drive greater transparency into where patients receive care.
ElevanceElevance Health · 16 signals · last 30 days -
15 payers with Medicare Advantage enrollment caps for 2027
CMS released initial insights on the 2027 Medicare Advantage landscape Sept. 28, along with data breaking down plans. One wrinkle gaining attention: enrollment capacity limits. In April, CMS said insurers could include enrollment caps for specific plans in their 2027 MA bids, relying on existing regulatory authority. With these caps, plans cannot disenroll current members. […] The post 15 payers with Medicare Advantage enrollment caps for 2027 appeared first on Becker's Payer Issues | Payer N...
Policy / Regulatory Changes · 142 signals · last 30 days -
Trump Administration Announces $8.7 Million for New Ambulances and Lifesaving Medical Equipment Upgrades Across Rural Montana
Trump Administration Announces $8.7 Million for New Ambulances and Lifesaving Medical Equipment Upgrades Across Rural Montana This federal investment will replace aging ambulances and equip rural EMS agencies in Montana with ventilators, cardiac monitors, and other critical patient transport equipment
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CMS to expand IRF claim review demonstration to all facilities billing the jurisdiction that includes Alabama, Georgia, Tennessee
The Centers for Medicare & Medicaid Services announced Sept. 25 that it will expand the Inpatient Rehabilitation Facility Review Choice Demonstration to include all IRFs that bill Medicare Administrative Contractor Jurisdiction J, which generally includes Alabama, Georgia and Tennessee. The demonstration, which is currently active for IRFs in Alabama, California, Texas and Pennsylvania, subjects 100% of all Original Medicare IRF claims to either pre-claim or post-payment review. For IRFs newl...
Policy / Regulatory Changes · 142 signals · last 30 days -
CMS projects decline in MA, small increase in standalone Part D premiums for 2027
The Centers for Medicare & Medicaid Services announced Sept. 28 that it projects declines in average premiums for Medicare Advantage and Part D in 2027. Weighted average MA premiums are expected to decline 16.5% from $14.37 in 2026 to $12.00 in 2027. The total average monthly Part D premium for standalone prescription drug plans is estimated to increase by less than $1, from $35.09 in 2026 to $36 in 2027. Following application of MA rebates, average Part D premiums for MA plans with prescript...
Policy / Regulatory Changes · 142 signals · last 30 days -
HCA-affiliated St. David’s hospitals to go out of network with Cigna
Austin, Texas-based St. David’s HealthCare, a partnership between Nashville, Tenn.-based HCA Healthcare and two nonprofits, is set to go out of network with Cigna Oct. 1. St. David’s hospitals, ASCs and affiliated hospital-based physicians in Texas will no longer be available in network, the health system’s website said. “St. [David’s] HealthCare’s owner HCA is demanding […] The post HCA-affiliated St. David’s hospitals to go out of network with Cigna appeared first on Becker's Payer Issues |...
Cigna TexasCigna · 15 signals · last 30 days -
Better Medicare Alliance Responds to CMS 2027 Medicare Advantage Premiums and Plan Landscape
WASHINGTON — Better Medicare Alliance (BMA), the nation’s leading research and advocacy organization supporting Medicare Advantage, today issued the following statement in response to the Centers for Medicare & Medicaid … Continue reading "Better Medicare Alliance Responds to CMS 2027 Medicare Advantage Premiums and Plan Landscape" The post Better Medicare Alliance Responds to CMS 2027 Medicare Advantage Premiums and Plan Landscape appeared first on Better Medicare Alliance .
Policy / Regulatory Changes · 142 signals · last 30 days -
UnitedHealthcare received $24M in Medicare Advantage overpayments in Texas: OIG
UnitedHealthcare’s Medicare Advantage business in Texas received an estimated $24.4 million in overpayments during 2020 and 2021 tied to diagnoses not supported by medical records, the HHS Office of Inspector General said in an audit report published Sept. 28. The report follows an OIG audit released a week prior that estimated UnitedHealthcare’s Wisconsin MA business […] The post UnitedHealthcare received $24M in Medicare Advantage overpayments in Texas: OIG appeared first on Becker's Payer...
UnitedHealthcare · 48 signals · last 30 days -
Elevance moves to require site-of-care details on hospital claims
Elevance Health plans to require hospitals to identify the physical location where care was provided on billing forms and adjust payments for off-campus services accordingly. The insurer said Sept. 29 the new policies will apply across its commercial, Medicare Advantage and Medicaid plans and are designed to address situations where care delivered at off-campus locations […] The post Elevance moves to require site-of-care details on hospital claims appeared first on Becker's Payer Issues | Pa...
ElevanceElevance Health · 16 signals · last 30 days -
Texas investigating BCBS over possible denials, delays
Texas Attorney General Ken Paxton launched an investigation into Blue Cross and Blue Shield of Texas and its parent company, Health Care Service Corp., over potential denials and delays of medically necessary care, as well as prior authorization concerns. Mr. Paxton’s office announced the investigation Sept. 28. The office received reports that pointed to BCBS […] The post Texas investigating BCBS over possible denials, delays appeared first on Becker's Payer Issues | Payer News .
Blue Cross Blue Shield plans · 37 signals · last 30 days