Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
722 signals
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Industry Voices—AI should help cancer patients survive the healthcare system
Cancer care navigators are an invaluable resource, but there are nowhere near enough navigators to meet the scale of the need. This is where AI can make a meaningful difference, write the Digital Medicine Society's Jennifer Goldsack and former CMS Chief Medical Officer Lee Fleisher, M.D.
Policy / Regulatory Changes · 67 signals · last 30 days -
Providence Health Plan to shut down after Medicare Advantage deal falls through
Providence Health Plan will completely shut down after it was unable to reach a deal with a national insurer to operate its Medicare Advantage business. “We are in discussion with regulators about this development and the broader wind-down of Providence’s health plan operations,” a spokesperson for the system told Becker’s. “We will share more details […] The post Providence Health Plan to shut down after Medicare Advantage deal falls through appeared first on Becker's Payer Issues | Payer Ne...
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Hippocratic AI rolls out platform to coordinate teams of conversational voice AI agents
For health plans, the AI teams support functions such as member onboarding, chronic care management and Star Ratings improvement. Provider-focused offerings target patient onboarding, care gap closure and inpatient and ambulatory workflows.
Policy / Regulatory Changes · 67 signals · last 30 days -
Insurers denied between 12% to 18% of prior authorization requests in 2025: KFF
Researchers analyzed data from insurers in Medicare Advantage, Medicaid managed care and ACA Marketplace market segments—representing approximately 71 million enrollees.
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‘Private option’ Medicaid expansion under threat from CMS
Arkansas Medicaid coverage for hundreds of thousands is uncertain next year after the Trump administration denied a key waiver renewal.
Policy / Regulatory Changes · 67 signals · last 30 days -
Luigi Mangione pleads guilty in federal case over murder of UnitedHealthcare CEO Brian Thompson
The man accused of murdering UnitedHealthcare CEO Brian Thompson has pleaded guilty in the federal trial against him, per media reports.
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO
In pleading guilty, Mangione admitted to following UnitedHealth executive Brian Thompson and then shooting him.
UnitedHealthcareUnitedHealthUnitedHealthcare · 34 signals · last 30 days -
Investors renew fight against UnitedHealth, claiming $237M in insider stock sales
UnitedHealth Group shareholders are renewing pressure on the company in an amended complaint, filed Aug. 7 in the U.S. District Court for the District of Minnesota. An initial complaint from July 2024 focused on concerns over the “firewall” between UnitedHealthcare and Optum. UnitedHealth established the policy in 2022 amid a Justice Department challenge of the […] The post Investors renew fight against UnitedHealth, claiming $237M in insider stock sales appeared first on Becker's Payer Issue...
UnitedHealthcare · 34 signals · last 30 days -
Luigi Mangione admits he shot UnitedHealthcare CEO
Luigi Mangione has pleaded guilty to federal stalking charges in connection with the December 2024 killing of UnitedHealthcare CEO Brian Thompson outside a Midtown Manhattan hotel, the New York Times reported. “I shot Mr. Thompson in Manhattan,” Mr. Mangione told the judge Aug. 14. “I understood that my actions would place him in fear of […] The post Luigi Mangione admits he shot UnitedHealthcare CEO appeared first on Becker's Payer Issues | Payer News .
UnitedHealthcare New YorkUnitedHealthcare · 34 signals · last 30 days -
Providence to wind down health plan after Medicare deal fails
Providence's insurance division had looked to partner with a national carrier to continue its Medicare Advantage operations.
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Prior authorization denials vary widely among insurers, first-of-its-kind data shows
Denials ranged from 2% to 25% among insurers last year, according to a KFF analysis of new prior authorization data that the CMS forced insurers to release.
Policy / Regulatory Changes · 67 signals · last 30 days -
How will legal challenges fare against CMS rule on gender-affirming care?
A CMS rule finalized this week may prove more difficult to challenge than previous Trump administration actions to end transgender care for young people.
Policy / Regulatory Changes · 67 signals · last 30 days -
Kaiser Foundation Health Plan, Inc. v. National Union Fire Insurance Company of Pittsburgh, PA
Case 3:26-cv-01490-EMC Document 127 Filed 08/14/26 Page 1 of 17 1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 Original document
Kaiser CaliforniaKaiser Permanente · 5 signals · last 30 days -
A look at where Aetna is seeing value-based care success in Medicare Advantage
Aetna is seeing its value-based care efforts pay off in both preventive care metrics and cost savings, according to a new analysis from the company.
AetnaCVS Health / Aetna · 10 signals · last 30 days -
Where prior authorization stands — and where data still falls short
Prior authorization data is now public — but it is not giving much to work with. CMS’ Interoperability and Prior Authorization Final Rule from 2024 focused on easing prior authorization across government-affiliated healthcare programs. Involved payers now have to report certain aggregated metrics, such as approval and denial rates. Data covering 2025 went live March […] The post Where prior authorization stands — and where data still falls short appeared first on Becker's Payer Issues | Payer...
Policy / Regulatory Changes · 67 signals · last 30 days -
Payers ranked by prior authorization denial rates
Health insurers denied between 12% and 18% of standard prior authorization requests across Medicare Advantage, Medicaid managed care and ACA marketplace plans in 2025, with wide variation among the largest payers, according to a KFF analysis published Aug. 13. CMS previously finalized a rule requiring certain insurers to publicly report prior auth metrics, including denial […] The post Payers ranked by prior authorization denial rates appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
Luigi Mangione expected to plead guilty in UnitedHealthcare CEO killing
The plea would come at a Friday hearing that U.S. District Judge Margaret Garnett set after federal prosecutors and defense lawyers jointly requested one.
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
Glenmark’s US subsidiary reaches $15.3M settlement with Humana
The U.S. subsidiary of Glenmark Pharmaceuticals will pay Humana nearly $15.3 million in the wake of antitrust and consumer protection lawsuits. Glenmark disclosed the settlement in an Aug. 11 filing with the National Stock Exchange of India. The document said the company faced allegations of price-fixing, market allocation and anticompetitive behavior in more than 35 […] The post Glenmark’s US subsidiary reaches $15.3M settlement with Humana appeared first on Becker's Payer Issues | Payer News .
HumanaHumana · 13 signals · last 30 days -
Almost All Custodial Parents, Caretaker Relatives Should Not be Impacted by Medicaid Work Reporting Requirements in 28 States
As states rush to implement complex new work reporting requirement provisions before January 2027, the new Interim Final Rule (IFR) released by the Centers for Medicare and Medicaid Services (CMS) has caused massive confusion. However, the IFR made important clarifications about which adults are not subject to work reporting requirements (WRRs), are excluded from WRRs, […]
Policy / Regulatory Changes · 67 signals · last 30 days -
Oscar taps CVS exec as chief health officer
Lia Gass Rodriguez, MD, is joining Oscar Health as chief health officer. The company shared the update on LinkedIn Aug. 13. Dr. Rodriguez had worked at CVS Health as a leader for CVS Healthspire Payor Solutions and Aetna. Previously, she was a medical director for Houston-based Texas Children’s Hospital’s health plan, according to her LinkedIn […] The post Oscar taps CVS exec as chief health officer appeared first on Becker's Payer Issues | Payer News .
CVS Health / Aetna · 10 signals · last 30 days -
St. Luke’s, UnitedHealthcare automate 88% of claim statuses via Epic
Bethlehem, Pa.-based St. Luke’s University Health Network and UnitedHealthcare say they’ve automated claim status updates for 88% of the claims exchanged between the two organizations, using Epic’s Payer Platform, according to Epic’s newly released 2026-2027 Almanac. The two organizations turned on Epic’s Claim Status feature to give St. Luke’s staff real-time visibility into where claims […] The post St. Luke’s, UnitedHealthcare automate 88% of claim statuses via Epic appeared first on Becke...
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
Investor lawsuit alleges UnitedHealth ignored Medicare, cyber risks
The complaint alleges that UnitedHealth shut down an internal audit program that showed problems in its Medicare billing.
UnitedHealthUnitedHealthcare · 34 signals · last 30 days -
Humana, Cityblock partnership reaches 20,000 Medicare Advantage members in North Carolina
Cityblock Health, a tech-driven provider group, has partnered with Humana to serve nearly 20,000 Medicare Advantage and dual-eligible beneficiaries in North Carolina. According to an Aug. 13 news release, Cityblock has been supporting eligible Humana members with complex chronic conditions since July 1. Cityblock is working with members’ current primary care providers and the insurer’s […] The post Humana, Cityblock partnership reaches 20,000 Medicare Advantage members in North Carolina appea...
Humana North CarolinaHumana · 13 signals · last 30 days -
Medicaid Managed Care: The Big Five in Q2 2026
The “Big Five” have announced their results for the calendar quarter ending June 30. They are, of course, the five publicly-traded companies with the largest presence in the Medicaid managed care market, together accounting for about half of all Medicaid enrollees: Centene Corporation, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group. The Medicaid market […]
UnitedHealthCVS HealthUnitedHealthcare + CVS Health / Aetna · 42 signals · last 30 days -
Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain
This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.