Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
722 signals
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Her Breast MRI Was Approved, But That Didn’t Mean Her Insurance Would Pay
Stephanie Halver’s doctor recommended she get a breast MRI, partly because of her family’s cancer history. Her insurer approved the scan, but unlike mammograms, breast MRIs aren’t universally covered as zero-cost preventive care.
SCANSCAN Health Plan · 11 signals · last 30 days -
Elevance Health to pay $15M to settle nurse overtime lawsuits
A federal judge has given final approval to a $14.75 million settlement between Elevance Health and a group of nurses who alleged the insurer misclassified them as exempt from overtime pay. U.S. District Judge David Novak signed off on the deal Aug. 20 in the Eastern District of Virginia, closing out five related lawsuits that […] The post Elevance Health to pay $15M to settle nurse overtime lawsuits appeared first on Becker's Payer Issues | Payer News .
Elevance VirginiaElevance Health · 11 signals · last 30 days -
Health plan underwriting losses balloon to $10.4B: Report
Health insurers collectively lost $10.4 billion on underwriting in 2025, a dramatic deterioration from $1.7 billion the year before, according to a Mark Farrah Associates analysis. The Aug. 25 analysis compared 2024 and 2025 profitability across four segments: individual, employer-group, Medicare Advantage and managed Medicaid. The analysis is based on aggregated NAIC financial filings and […] The post Health plan underwriting losses balloon to $10.4B: Report appeared first on Becker's Payer...
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Trump Administration Announces $160 Million to Bring Cutting-Edge Technology, Drones Prescription Deliveries, Surgical Robotics and More to Alaska
Trump Administration Announces $160 Million to Bring Cutting-Edge Technology, Drones Prescription Deliveries, Surgical Robotics and More to Alaska This federal investment will help expand access, strengthen the health workforce, improve infrastructure, and advance technology for communities across Alaska
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High medical costs continue to hang over insurers’ margin recovery: Moody’s
Most large health insurers posted stronger-than-expected earnings in the second quarter, but much of the improvement might not be durable, according to a Moody’s Ratings analysis published Aug. 24. Average EBITDA margins across the seven largest publicly traded insurers rose to 4.7% in Q2, up from 3.9% in the same period a year earlier. UnitedHealth […] The post High medical costs continue to hang over insurers’ margin recovery: Moody’s appeared first on Becker's Payer Issues | Payer News .
UnitedHealthUnitedHealthcare · 34 signals · last 30 days -
Medicare Advantage provider agrees to $2.4M false claims settlement
Tennessee-based in-home care provider Monogram Health has agreed to pay $2.4 million to settle allegations that it caused the submission of false diagnosis codes to boost Medicare Advantage payments. From Jan. 1, 2021, through Dec. 31, 2023, Monogram allegedly knowingly submitted diagnosis codes that were not clinically accurate, not supported by patients’ medical records, or […] The post Medicare Advantage provider agrees to $2.4M false claims settlement appeared first on Becker's Payer Issu...
Policy / Regulatory Changes · 67 signals · last 30 days -
Elevance’s behavioral health division nabs new president
Dr. Patrick Fox, a forensic psychiatrist and health plan leader, will take the reins at Carelon Behavioral Services effective immediately. His experience will be “invaluable” for the unit, a top Elevance executive said.
ElevanceElevance Health · 11 signals · last 30 days -
Wellpoint New Jersey, Carelon Behavioral Health get new presidents in Elevance leadership swap
Elevance Health announced two leadership changes Aug. 24, swapping the president of its New Jersey health plan into the top role at its behavioral health division and installing a longtime government affairs executive in his place. Patrick Fox, MD, has been named president of Carelon Behavioral Health, effective immediately, after previously serving as president of […] The post Wellpoint New Jersey, Carelon Behavioral Health get new presidents in Elevance leadership swap appeared first on Bec...
Elevance New JerseyElevance Health · 11 signals · last 30 days -
Highmark taps Aetna exec to lead insurance business
Highmark has named Gustavo (Gus) Giraldo as president of its health insurance division, effective immediately. Mr. Giraldo most recently served as senior vice president of individual and family plans at Aetna, and he’s previously held executive leadership roles at Magellan Health and Cigna Healthcare. He succeeds Tom Doran, who is departing the organization to pursue […] The post Highmark taps Aetna exec to lead insurance business appeared first on Becker's Payer Issues | Payer News .
AetnaCignaCVS Health / Aetna + Cigna · 19 signals · last 30 days -
Highmark Health’s insurance unit powers first-half turnaround
The subsidiary reworked its Medicare Advantage benefit offerings and directed members toward lower-cost care sites.
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BCBS Kansas City exec named CFO at NAIC
The National Association of Insurance Commissioners has named Jeff Ahlers as CFO. Mr. Ahlers was previously vice president of finance and corporate controller at Blue Cross and Blue Shield of Kansas City. The National Association of Insurance Commissioners develops model laws and guidelines that states can adopt to govern insurance markets and is made up […] The post BCBS Kansas City exec named CFO at NAIC appeared first on Becker's Payer Issues | Payer News .
Blue Cross Blue Shield plans · 20 signals · last 30 days -
Oregon to launch state-based ACA exchange
Oregon has received approval from CMS to launch a state-run ACA marketplace starting Nov. 1. The new platform, Explore Health, will let Oregon residents shop for ACA plans, check subsidy eligibility and enroll in coverage directly through the state rather than the federal exchange. The Oregon legislature authorized the transition in 2023 through Senate Bill […] The post Oregon to launch state-based ACA exchange appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
Oz says MMR vaccine 'is not a lethal vaccine'
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS), noted Sunday the measles, mumps and rubella (MMR) vaccine is not lethal, contradicting President Trump. “The MMR vaccine is not a lethal vaccine, and it is offered in other countries,” Oz told host Margaret Brennan on CBS News’s “Face the Nation.”...
Policy / Regulatory Changes · 67 signals · last 30 days -
A look inside the expanded partnership between SCAN and Costco
SCAN Group and retailer Costco are expanding their partnership with the launch of new cobranded Medicare products.
SCANSCAN Health Plan · 11 signals · last 30 days -
Cigna named in addiction treatment providers’ lawsuit claiming $12.8M underpayment
Ten California addiction providers filed a lawsuit against Cigna on Aug. 19, claiming the insurer shortchanged them by $12.8 million. The lawsuit spans March 1, 2022, through March 15, 2026. Before 2015, Cigna would pay billed charges in full or at a “reasonable and customary” rate but eventually changed that policy, according to the complaint, […] The post Cigna named in addiction treatment providers’ lawsuit claiming $12.8M underpayment appeared first on Becker's Payer Issues | Payer News .
Cigna CaliforniaCigna · 10 signals · last 30 days -
Blue Cross and Blue Shield of Illinois marks two years of progress through expanded special beginnings program
Blue Cross and Blue Shield of Illinois announced the second anniversary of its expanded Special Beginnings® Maternal and Infant Health Initiative, highlighting investments and partnerships supporting healthier outcomes for moms […]
Blue Cross Blue Shield plans · 20 signals · last 30 days -
The MolinaCares Accord Grants $100,000 to Illinois Public Health Association to Support Illinois’ Medicaid Population
The MolinaCares Accord (“MolinaCares”), in collaboration with Molina Healthcare of Illinois (“Molina”), announced a $100,000 grant to support the Illinois Public Health Association’s (“IPHA”) new community health worker (“CHW”) pilot program that aims to reduce procedural Medicaid disenrollment during redetermination – the annual Medicaid renewal process.
Molina IllinoisMolina Healthcare · 1 signal · last 30 days -
Aetna to cut Medicare Advantage broker commissions again
Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning Sept. 15, the company confirmed to Becker’s. “Aetna routinely reviews and updates our distribution strategy, including the commissionable status of our plan offerings,” an Aetna spokesperson said. “As a result, we have made a business decision to change certain plans to non-commissionable starting […] The post Aetna to cut Medicare Advantage broker commissions again appeared first on Becker's Payer Issues...
AetnaCVS Health / Aetna · 10 signals · last 30 days -
Cityblock Health acquires rural Medicare provider Homeward Health
Cityblock Health has signed a definitive agreement to acquire Homeward Health, a rural-focused Medicare Advantage provider, in an all-stock transaction. The combination pairs Cityblock’s urban Medicaid and dual-eligible care model with Homeward’s rural-first approach, Cityblock CEO and co-founder Toyin Ajayi, MD, said in an Aug. 21 note published on the company’s website. Homeward serves nearly […] The post Cityblock Health acquires rural Medicare provider Homeward Health appeared first on Be...
Demographic Shifts · 1 signal · last 30 days -
Mental health workers say algorithmic triage is hurting patients
When Kaiser Permanente triage clinician Harimandir Khalsa began working in the psychiatry department at Kaiser’s Walnut Creek Medical Center in Northern California, she was on a team of nine people. Today, just over three years later, she is one of only three triage clinicians left. Some of the work once handled by employees has shifted […]
Kaiser CaliforniaKaiser Permanente · 5 signals · last 30 days -
Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Int...
Policy / Regulatory Changes · 67 signals · last 30 days -
UnitedHealthcare expands behavioral coaching program for youths
UnitedHealthcare is expanding access to its child and family behavioral coaching program, making it available to 13 million commercial members.
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
‘We’re in wartime’: As major insurers continue pulling back on Medicare Advantage, SCAN places another contrarian bet
As insurers nationwide prepare to take their latest Medicare products to market this fall, SCAN Group is doubling down on an unconventional growth strategy meant to grab the attention of seniors and healthcare leaders alike. “You can’t solve a problem until you actually acknowledge you have a problem,” SCAN President and CEO Sachin Jain, MD, […] The post ‘We’re in wartime’: As major insurers continue pulling back on Medicare Advantage, SCAN places another contrarian bet appeared first on Beck...
SCANSCAN Health Plan · 11 signals · last 30 days -
Senate Democrats call on feds to halt Medicaid data sharing with ICE
Senate Democrats on Aug. 17 called on federal officials to end Medicaid enrollee data sharing with the Department of Homeland Security and Immigration and Customs Enforcement. Sens. Ron Wyden, D-Ore., Jeff Merkley, D-Ore., Edward Markey, D-Mass., Cory Booker, D-N.J., and Chris Van Hollen, D-Md., sent two letters, one to CMS and HHS and another to […] The post Senate Democrats call on feds to halt Medicaid data sharing with ICE appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
Trump Administration Delivers Critical Funding to Launch the Coordinating and Connecting Care Initiative in North Dakota
Trump Administration Delivers Critical Funding to Launch the Coordinating and Connecting Care Initiative in North Dakota This federal investment will help bring high-quality care closer to home by improving coordination for rural North Dakotans