Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
722 signals
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Medicare Program; Regulatory Alignment for Predictable and Immediate Device (RAPID) Coverage Pathway
This notice with comment period provides information to the public on the process CMS will use to provide accelerated Medicare coverage through the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway for new innovative technologies. The RAPID coverage pathway leverages existing processes to provide expedited national Medicare coverage for eligible technologies. This notice with comment period solicits public comment on the proposed RAPID coverage pathway.
Policy / Regulatory Changes · 67 signals · last 30 days -
Federal judge dismisses legal challenges to South Dakota drug discount law
A judge has ruled in favor of a South Dakota law that helps rural healthcare providers buy discounted drugs and mark up their sale price to fill budget holes created by low Medicare and Medicaid reimbursement rates. AbbVie, maker of the arthritis drug Humira, among other medications, sued the state in April 2025. The Chicago-based […]
Competitive / Operational Strategy · 38 signals · last 30 days -
Humana taps Johns Hopkins Health Plans CEO as Medicaid president
Humana has named James “J.P.” Holland as senior vice president and president of Medicaid, effective Aug. 17. In his new role, Mr. Holland will lead the company’s Medicaid business, which currently serves more than 1.6 million members across 11 states. He will report to Humana’s insurance president, Aaron Martin. Mr. Holland has served as president […] The post Humana taps Johns Hopkins Health Plans CEO as Medicaid president appeared first on Becker's Payer Issues | Payer News .
HumanaHumana · 13 signals · last 30 days -
Arkansas requests 2-year extension of Medicaid expansion waiver
Arkansas is seeking CMS’ approval of a two-year extension for the Section 1115 waiver enabling the state’s Medicaid expansion program, Arkansas Health and Opportunity for Me. Arkansas Department of Human Services Secretary Janet Mann sent CMS a letter Aug. 5 detailing the request. The letter follows CMS’ denial of the waiver’s renewal past 2026, affecting […] The post Arkansas requests 2-year extension of Medicaid expansion waiver appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in the State of Washington
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in the State of Washington The Centers for Medicare & Medicaid Services (CMS) announced today additional resources and flexibility available in response to a Public Health Emergency (PHE) in Washington state due to emergency conditions resulting from major wildfires, including the Fairview, Autumn Lane, and Old Trails fires near Spokane County beginning Aug.1, 2026, and continuing. CMS is working closely with Washin...
Policy / Regulatory Changes · 67 signals · last 30 days -
Blue Shield of California names health AI exec to board
Kedar Mate, MD, is joining Blue Shield of California’s board of directors, according to an Aug. 10 news release. Dr. Mate is currently chief medical officer of Qualified Health AI, an enterprise AI platform he founded for health systems. Previously, he was president and CEO of the Institute for Healthcare Improvement, a healthcare quality and […] The post Blue Shield of California names health AI exec to board appeared first on Becker's Payer Issues | Payer News .
Blue Shield CaliforniaBlue Cross Blue Shield plans · 20 signals · last 30 days -
CMS lifts enrollment suspension on Maryland Medicare Advantage plan
CMS has lifted the enrollment suspension it imposed on Provider Partners Health Plans’ Maryland I-SNP after the insurer corrected network deficiencies. The agency suspended enrollment into the plan in late May after Provider Partners’ lost all contracted long-term care facilities in its network and then disenrolled 29 members from the program without their consent. In […] The post CMS lifts enrollment suspension on Maryland Medicare Advantage plan appeared first on Becker's Payer Issues | Pay...
Policy / Regulatory Changes · 67 signals · last 30 days -
Missouri health system to stop offering ACA plans, partners with Oscar
Cox HealthPlans, the insurance arm of Springfield, Mo.-based CoxHealth, will stop selling ACA marketplace plans directly starting in 2027, instead partnering with insurer Oscar Health to offer marketplace coverage. The new Oscar plans will be built around CoxHealth’s network of hospitals and clinics in eight southwest Missouri counties. The health system said Aug. 7 it […] The post Missouri health system to stop offering ACA plans, partners with Oscar appeared first on Becker's Payer Issues |...
Oscar Health MissouriOscar Health · 2 signals · last 30 days -
Temporary Medicare program that lowered prescription drug premiums is ending early. Here’s what that means for seniors.
By Ashley Fredde Key Takeways: The Trump administration is ending a temporary federal program — created to soften the effects of Medicare’s biggest prescription drug overhaul in nearly two decades — a year earlier than planned. The move, experts say, could mean higher monthly premiums for some North Carolinians and create new hurdles for beneficiaries […] The post Temporary Medicare program that lowered prescription drug premiums is ending early. Here’s what that means for seniors. appeared f...
Financial / Operating Pressure · 13 signals · last 30 days -
Regulatory Alignment for Predictable and Immediate Device Coverage Pathway (CMS-3487-NC) Procedural Notice Inviting Comment
Regulatory Alignment for Predictable and Immediate Device Coverage Pathway (CMS-3487-NC) Procedural Notice Inviting Comment
Policy / Regulatory Changes · 67 signals · last 30 days -
CVS Caremark taps chief growth officer
CVS Health’s pharmacy benefit manager, CVS Caremark, is bringing on Keith Reynolds as chief growth officer. Chief Sales Officer Jim Fowler will transition into retirement, according to an Aug. 7 LinkedIn post from Mr. Reynolds. Mr. Reynolds had spent 25 years at CVS Health and Aetna previously, the post said. He most recently was COO […] The post CVS Caremark taps chief growth officer appeared first on Becker's Payer Issues | Payer News .
CVS HealthAetnaCVS Health / Aetna · 10 signals · last 30 days -
Dr. Oz urges senators to reject Budd hemp amendment
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS), is urging senators to not support an amendment that would allow a federal ban on most hemp-derived products to take effect in November. In a Friday letter, Oz noted he had “grave concerns” about the amendment from Sen. Ted Budd (R-N.C.),...
Policy / Regulatory Changes · 67 signals · last 30 days -
Anthem BCBS Indiana’s ortho network is saving employers $15,000 per case
It has been about eight months since Anthem Blue Cross and Blue Shield in Indiana kicked off its HealthSync Designated Orthopedic Network, directing Anthem HealthSync plan members to surgeons and facilities that satisfy certain cost and quality benchmarks. Now, savings are rolling in. In an upcoming episode of the “Becker’s Payer Issues Podcast,” Jessica Lopez-Liggett, […] The post Anthem BCBS Indiana’s ortho network is saving employers $15,000 per case appeared first on Becker's Payer Issues...
Elevance Health + Blue Cross Blue Shield plans · 29 signals · last 30 days -
Elevance names president for Georgia Medicaid subsidiary
Elevance Health’s Amerigroup Community Care of Georgia, a Medicaid organization, named Tich Changamire, MD, PhD, as its president, effective Aug. 12. According to an Aug. 7 news release shared with Becker’s, Dr. Changamire will work on care coordination, quality and access across Medicaid and Medicare. While Amerigroup Community Care of Georgia is a Medicaid plan, […] The post Elevance names president for Georgia Medicaid subsidiary appeared first on Becker's Payer Issues | Payer News .
Elevance GeorgiaElevance Health · 11 signals · last 30 days -
Clover posts $28M Q2 profit, rebounds from earlier loss
Clover Health posted a $28 million profit for the second quarter of 2026, according to a recent earnings filing. During the same period last year, Clover logged a $10.6 million loss. The company had its first profitable quarter in 2024. Total revenue for the second quarter of 2026 was $743.2 million, up nearly 56% year […] The post Clover posts $28M Q2 profit, rebounds from earlier loss appeared first on Becker's Payer Issues | Payer News .
Clover Health -
CMS releases notice on pathway for expediting access to certain medical devices for Medicare beneficiaries
The Centers for Medicare & Medicaid Services Aug. 7 released a procedural notice on its new pathway to expedite access to certain Food and Drug Administration-designated Class II and Class III devices for Medicare beneficiaries. The Regulatory Alignment for Predictable and Immediate Device coverage pathway, or RAPID, is designed to reduce delays between FDA market authorization and Medicare national coverage determinations. CMS is accepting comments on the procedural notice for 60 days follow...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS releases implementation timeline guidance for updates to No Surprises Act independent dispute resolution process
Guidance on the implementation timeline for the No Surprises Act independent dispute resolution operations final rule was released Aug. 7 by the Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management. The final rule, issued May 28, was designed to streamline communication between group health plans and health insurance issuers, providers and certified IDR entities, while clarifying timelines and processes. The guidance includes details...
Policy / Regulatory Changes · 67 signals · last 30 days -
Clover faces 4 lawsuits over data breach
Four possible class-action lawsuits have emerged in the wake of Clover Health’s data breach. The Medicare Advantage insurer disclosed a cybersecurity incident July 17. An unauthorized party gained access to some health plan employees’ accounts through social engineering earlier that month. While those accounts did not have access to corporate financial or claims systems, they […] The post Clover faces 4 lawsuits over data breach appeared first on Becker's Payer Issues | Payer News .
Clover Health -
STAT+: Pharmalittle: We’re reading about Replimune’s melanoma drug, a Medicare policy change, and more
Eli Lilly and Novo Nordisk convinced a federal judge to toss an antitrust lawsuit by a compound pharmacy
Competitive / Operational Strategy · 38 signals · last 30 days -
On the heels of star rating win, Clover Health boosts outlook on strength of MA membership growth in Q2
The company posted $153 million in profit, up 54% year-over-year, according to financial results published Wednesday afternoon.
Clover Health -
Oscar Health hikes 2026 outlook after record profitability during first half of the year
CEO Mark Bertolini said during Thursday’s earnings call that the company brought in $1.1 billion in earnings and $1 billion in net income for the first half of 2026.
Oscar HealthMark BertoliniOscar Health + Mark Bertolini · 2 signals · last 30 days -
‘We aren’t just going to deploy AI to talk about AI’: Centene strikes a new tone amid insurers’ automation push
Health insurers, like most major companies in the U.S., have spent the better part of 2026 talking up the size and speed of their AI investments. Three billion dollars at UnitedHealth Group. More than $1 billion at Elevance Health. A $20 billion decade-long technology commitment at CVS. Now one insurer is taking a notably different […] The post ‘We aren’t just going to deploy AI to talk about AI’: Centene strikes a new tone amid insurers’ automation push appeared first on Becker's Payer Issue...
UnitedHealthElevanceUnitedHealthcare + Elevance Health · 45 signals · last 30 days -
Senate confirms UnitedHealth leader as CDC director
Erica Schwartz, MD, was confirmed by the Senate as the next CDC director Aug. 5 in a 51-43 vote, which split almost entirely across party lines. The move makes her the agency’s first permanent director in nearly a year. Every present Republican senator backed Dr. Schwartz, who received a single Democratic vote from Sen. Tim […] The post Senate confirms UnitedHealth leader as CDC director appeared first on Becker's Payer Issues | Payer News .
UnitedHealthUnitedHealthcare · 34 signals · last 30 days -
Oscar adds nearly 1 million members over past year
Oscar Health’s membership as of June 30 was 2,963,002, up from 2,027,148 at the same time in 2025. The company reported net income of $361.8 million for the second quarter of 2026, up from a $228.4 million loss during the same period last year. Revenue was roughly $4.9 billion, up 70.4% year over year. Earnings […] The post Oscar adds nearly 1 million members over past year appeared first on Becker's Payer Issues | Payer News .
Oscar HealthOscar Health · 2 signals · last 30 days -
CMS to begin sharing GLP-1 Bridge utilization data with payers
This fall, CMS will start sharing monthly utilization reports with Part D plans on how their enrollees are using the Medicare GLP-1 Bridge program. The agency said in an Aug. 5 memo that the reports will be organized at both the contract and plan level and will include claims-level data such as the date of […] The post CMS to begin sharing GLP-1 Bridge utilization data with payers appeared first on Becker's Payer Issues | Payer News .
Policy / Regulatory Changes · 67 signals · last 30 days