Tag: Medicare Advantage plans

unitedhealthcare-loses-medicare-advantage-overpayment-suit.

UnitedHealthcare loses Medicare Advantage overpayment suit

Dive Brief: A federal appeals court has ruled against UnitedHealthcare, the biggest private payer in the U.S., and reversed a 2018 decision overturning Medicare’s overpayment rule requiring insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support. UnitedHealthcare argued in court in November the overpayment rule was […]
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CMS axes hospital price transparency mandate from 2022 inpatient payment rule

Dive Brief: In a win for providers, CMS dropped a requirement that would have forced hospitals to disclose their contract terms with Medicare Advantage plans from its final inpatient pay rule for 2022 released Monday. The rule bumps payment for inpatient services by 2.5%, which will result in hospitals getting $2.3 billion more than this […]
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payer-moves-to-increase-member-access-to-acute-home-healthcare

Payer Moves to Increase Member Access to Acute Home Healthcare

Regence BlueShield’s new partnership will offer members access to quality acute home healthcare services. Regence BlueShield (Regence) has partnered with a home healthcare provider to increase member access to acute home healthcare services. Regence members in Pierce County, Washington will have access to the new program. The payer plans to expand the acute home healthcare […]
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Alignment Expands Medicare Advantage for Seniors in 3 States

The payer will debut its Medicare Advantage plans in select Arizona counties and expand coverage to additional counties in North Carolina and Nevada. Alignment Healthcare (Alignment) is extending its Medicare Advantage (MA) footprint in Arizona, North Carolina, and Nevada to provide coverage for more senior beneficiaries. Starting in 2022, Alignment will introduce its MA health […]
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pros-cons-of-non-emergency-medical-transportation-benefits

Pros, Cons of Non-Emergency Medical Transportation Benefits

MACPAC’s June 2021 report to Congress included findings about non-emergency medical transportation benefits in Medicaid programs that could prove useful for benefits design. A small fraction of the Medicaid population utilizes non-emergency medical transportation (NEMT) benefits, but for that community of beneficiaries NEMT programs can be indispensable, a MACPAC report recently found. It has been […]
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Medicare-Advantage-Plans-Benefits

Medicare Advantage Plans and Benefits Exploding in Popularity

Many plans charge a daily copayment, starting the first day, compared to deductibles charged by traditional Medicare plans. Last fall, I reported on the rise of Medicare Advantage (MA) plans, most of which have added coverage for issues associated with the social determinants of health (SDoH). Of 62 million Medicare beneficiaries, over 24 million enrolled […]
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ACHP Urges Policymakers to Solidify Affordable Care Act Changes

ACHP provides several steps that will leverage the advancements of the Affordable Care Act and increase access to high-quality coverage and care. The Alliance of Community Health Plans (ACHP) released recommended steps to build on the success of the Affordable Care Act (ACA) and enhance and expand coverage in the individual health insurance market. First, […]
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Medicare Advantage Plans

Medicare Advantage Plans Could See Payments Drop in 2021 Due To Covid-19, Analysis Finds

  The COVID-19 outbreak appears to have impacted claims patterns for Medicare Advantage enrollees, according to a new analysis by Avalere Health. Even though seniors are historically the most vulnerable population health-wise, their claims were down dramatically during the month of April. The survey suggests it could impact risk score factors for MA plans in 2021, driving […]
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Medicare For All

Trump Seeks To Boost Medicare Advantage To Fend Off Medicare For All

President Donald J. Trump pushed back against his democratic rivals October 3 by signing an executive order aimed at taking the wind out of the sails of their Medicare for all propositions. The executive order says that the proposals calling for “Medicare for All” in the Senate would destroy the current Medicare program, and that […]
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