Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
724 signals
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Developments in CBO's Projections for Medicare Part D
CBO provides current information about the budgetary effects of drug provisions in the 2022 Reconciliation Act; the effects of drug price negotiation, inflation rebates, and the Medicare Part D redesign; and ongoing updates to CBO's models.
Policy / Regulatory Changes · 68 signals · last 30 days -
How ACA losses, weak volumes are pressuring for-profit hospitals
Executives at HCA, Tenet and other for-profit systems discussed challenges ahead on second-quarter earnings calls.
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Hospice’s Bad Reputation Amid Fraud Crisis Will Hurt Patients, Industry Experts Warn
While acknowledging that changes must be made to the hospice industry, health policy researchers and providers worry that negative attention and the potential for overly punitive regulations could put patients at risk.
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Humana to exit more Medicare Advantage plans in 2027
The insurer is laser-focused on reaching margin targets, and will sacrifice some plans with lower returns next year to do so, CFO Celeste Mellet said.
HumanaHumana · 13 signals · last 30 days -
Protecting Healthcare Payments: New Strategies to Reduce Fraud Risk
Learn how health plans can strengthen payment integrity, reduce fraud risk and balance payment speed with security in this Healthcare Insider podcast.
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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 Office of Personnel Management, "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act through an Office of Personnel Management Health Benefit Plan". The matching program provides CMS and State Admi...
Policy / Regulatory Changes · 68 signals · last 30 days -
ACA subsidy fallout favors insurers, pressures hospitals’ payer mix
The expiration of the ACA’s enhanced premium tax credits appears to be playing out positively for several insurers, while some of the nation’s largest hospital operators are absorbing a wave of newly uninsured patients who continue to seek care. The enhanced credits, which lowered exchange premiums for millions of enrollees, lapsed at the end of […] The post ACA subsidy fallout favors insurers, pressures hospitals’ payer mix appeared first on Becker's Payer Issues | Payer News .
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GuideWell taps Health Net CEO to lead commercial business
GuideWell, the parent organization of Florida Blue, named Brian Ternan as its executive vice president of commercial business. Mr. Ternan has more than 35 years leading health coverage, GuideWell said in a July 28 LinkedIn post. According to his LinkedIn profile, Mr. Ternan was most recently president and CEO of Centene’s Health Net. He also […] The post GuideWell taps Health Net CEO to lead commercial business appeared first on Becker's Payer Issues | Payer News .
Centene FloridaCentene · 11 signals · last 30 days -
‘Visits and screenings are not translating into surgeries’: Systems divided on elective surgery slowdown
Deferred elective surgery was a through-line of second-quarter earnings calls at four of the country’s largest for-profit hospital operators. But their executives do not agree on what is driving the slowdown, or whether it represents lost demand at all. Nashville, Tenn.-based HCA Healthcare, Franklin, Tenn.-based Community Health Systems and Dallas-based Tenet Healthcare all reported softness […] The post ‘Visits and screenings are not translating into surgeries’: Systems divided on elective...
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Medicare drug plan subsidy to expire
Since 2025, Medicare Part D enrollees have had access to extra subsidies to defray higher premiums.
Policy / Regulatory Changes · 68 signals · last 30 days -
More than 1 in 3 employers who know about ICHRA are exploring or planning adoption: 8 notes
More than one-third of employers with awareness of individual coverage health reimbursement arrangements are actively preparing for or evaluating them, according to a July 28 survey. The Employee Benefit Research Institute and Morgan Health, a JPMorganChase division, conducted the survey, channeling responses from 984 employers. The Blue Cross Blue Shield Association, Centene’s Ambetter Health and […] The post More than 1 in 3 employers who know about ICHRA are exploring or planning adoption:...
CenteneBlue CrossCentene + Blue Cross Blue Shield plans · 31 signals · last 30 days -
Whole-Person Cancer Care: Integrating Behavioral Health to Support Employees and Improve Outcomes
Join experts from Optum and Calm Health to explore how integrating behavioral health into oncology support can help improve patient engagement, enhance the care experience and support better health outcomes.
OptumUnitedHealthcare · 35 signals · last 30 days -
Boston Scientific plans job cuts in global restructuring
Boston Scientific expects its global restructuring program to include up to $300 million in employee termination benefits.
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CMS Medicaid fraud unit flags 50 providers, $203M in payments
CMS says its “Medicaid Fraud War Room” has identified 50 high-risk providers tied to more than $203 million in Medicaid payments in its first 88 days. In a July 28 news release, CMS characterized the payments as “potentially improper,” and didn’t name any providers or states involved. The Medicaid unit, which launched in late April, […] The post CMS Medicaid fraud unit flags 50 providers, $203M in payments appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 68 signals · last 30 days -
The MolinaCares Accord Invests $50,000 to Expand Fresh for Learning and Fresh for Seniors Program
The MolinaCares Accord, in collaboration with Molina Healthcare of Illinois (“Molina”), granted $50,000 to Inclusive Public Service Communities Academy (“IPSC”) to support the Fresh for Learning and Fresh for Seniors Programs.
Molina IllinoisMolina Healthcare · 1 signal · last 30 days -
Blog explains what hospitals need to know on electronic prior authorization requirements
An AHA blog published July 28 highlights new electronic prior authorization requirements that begin Jan. 1, 2027, as a result of the Centers for Medicare & Medicaid Services’ 2024 Interoperability and Prior Authorization final rule. The blog explains why transitioning to the new process will be a significant operational change that will include coordination with health plans, electronic health record vendors and other technology partners. READ MORE
Policy / Regulatory Changes · 68 signals · last 30 days -
CMS releases 2025 report on program audits, enforcement for Medicare Advantage, Part D
The Centers for Medicare & Medicaid Services July 27 released its Contract Year 2025 Part C and Part D Program Audit and Enforcement Report, outlining key compliance issues identified through Medicare Advantage and Part D audits and enforcement activities. CMS emphasized recurring problems involving prior authorization and appeals processing, beneficiary access to medications and services, care coordination, enrollment and eligibility errors, and oversight of delegated entities. The report al...
Policy / Regulatory Changes · 68 signals · last 30 days -
Centene slides on dimming outlook for Medicaid profit margins
Centene also cut its outlook for Medicaid enrollment this year and said it lost more members in those than expected.
CenteneCentene · 11 signals · last 30 days -
STAT+: Three questions with Whoop’s new CMO
In this edition of STAT Health Tech: A chat with Whoop's new chief medical officer, an update on CMS health tech initiative, and more.
Policy / Regulatory Changes · 68 signals · last 30 days -
‘Back on track’: Centene swings to more than $1B in profit in Q2
The managed care giant raised its 2026 earnings outlook for the second time this year following the results, which its CFO called “fantastic.”
CenteneCentene · 11 signals · last 30 days -
Professional Standards Update No. 101
To alert the audit community to changes in professional standards, we periodically issue Professional Standards Updates (PSU). These updates highlight the effective dates of recently issued standards and guidance related to engagements conducted in accordance with Government Auditing Standards. PSUs contain summary information only, and those affected by a change should refer to the respective standard or guidance for details.
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STAT+: CMS evaluates one year of health tech progress, announces eight new pledge categories
One year after launching the CMS Health Tech Ecosystem, officials convened in D.C. to celebrate the Trump administration modernizing health technology.
Policy / Regulatory Changes · 68 signals · last 30 days -
Dogwood notifies attorney general’s office that HCA is in ‘potential noncompliance’ with Mission sale contract
By Ted Clifford Asheville Watchdog A report from the independent monitor tasked with supervising Mission Hospital has found two areas of “potential noncompliance” with the agreement HCA Healthcare signed when buying the hospital in 2019. The potential violations were a warning from federal regulators in October 2025 that Mission stood to lose Medicaid and Medicare […] The post Dogwood notifies attorney general’s office that HCA is in ‘potential noncompliance’ with Mission sale contract appear...
Competitive / Operational Strategy · 38 signals · last 30 days -
Industry survey finds MA enrollees have lower out-of-pocket costs than those in traditional Medicare
A new analysis finds that Medicare Advantage enrollees spend less on average than those in the traditional program, but report similar satisfaction levels.
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Big payers keep betting on services — but discipline is still the name of the game
The country’s biggest payers have been branching out beyond insurance for years — and the investments keep mounting. As insurers partake in health services, the line between coverage and care delivery blurs. But, while some bets pay off and position companies as players beyond health insurance, some companies are taking steps back. Cigna Cigna is […] The post Big payers keep betting on services — but discipline is still the name of the game appeared first on Becker's Payer Issues | Payer News .
CignaCigna · 10 signals · last 30 days