Tag

Medicare Advantage

All articles tagged with #medicare advantage

health-care-policy6 days ago•59 min saved

When a hospital becomes your insurer: early clues from the payvider wave

Hospitals that also own insurance plans (the payvider model) are becoming more common, potentially improving care coordination but raising concerns about incentives to game risk-adjustment payments and inflate costs. Early data suggest affiliated Medicare Advantage plans can have higher premiums and prices than unaffiliated ones, though explanations vary and many questions remain about overall costs, care quality, and competition. More research is needed to understand the trade-offs.

via Yahoo|

#health-care-policy #healthcare-competition #hospital-owned-insurance

business7 days ago•2 min saved

Costco Expands into Medicare with SCAN Partnership

Costco is partnering with SCAN Group to offer private Medicare plans in a limited number of states, including jointly branded Medicare Advantage plans in two states and a Medicare Supplement plan in a third, subject to regulatory approval. The plans may include pharmacy, vision, hearing and OTC benefits and would be marketed at Costco locations via SCAN’s sales team and brokers. SCAN operates in AZ, CA, NV, NM, TX and WA with about 460,000 enrollees. The move aims to simplify benefits and leverage Costco’s senior-friendly reputation, but Medicare Advantage plans can face scrutiny over prior authorization. Open enrollment runs Oct. 15–Dec. 7.”,

via USA Today|

#business #costco #health-insurance

health-care7 days ago•18 min saved

Costco to Launch Costco-Branded Medicare Plans with SCAN Group

Costco Wholesale and SCAN Health Plan are partnering to offer Costco-branded Medicare plans, marking Costco’s first foray into Medicare. The rollout will begin with Medicare Advantage products in two states and a Medicare supplement plan in a third, subject to CMS approval. Plans will be sold in Costco stores and through traditional channels, with federal rules prohibiting bundling the plans with a Costco membership. SCAN’s footprint covers 33 counties across CA, AZ, NV, TX, NM, and WA, serving about 460,000 members (roughly 500,000 when affiliated programs are included).

via Yahoo Finance|

#costco #health-care #healthcare

business8 days ago

Costco Targets Medicare Advantage, Expanding Beyond Retail

Costco reportedly plans to offer a Medicare Advantage product, signaling a move into health insurance; the excerpt provides no timeline or strategic details.

via CNBC|

#business #costco #healthcare

health-policy8 days ago•6 min saved

Hospitals as insurers: the payvider shift reshapes Medicare Advantage

Hospitals that own Medicare Advantage plans—the so-called payviders—now cover about one in six MA enrollees, a shift that can improve care coordination but also risks gaming risk‑adjustment payments and harming competition. Early data show affiliated plans often charge higher premiums and price marks vs. non‑affiliated plans, though some observed benefits include fewer prior authorizations and better care coordination; much remains unknown about the net effects on costs, taxpayer expenditures, and patient access.

via The Conversation|

#competition #health-policy #hospital-owned-plans

business8 days ago•3 min saved

Costco Sets Sights on Multiyear Medicare Plan With SCAN Health Plan Pending Approval

Costco plans a multiyear Medicare plan and other senior‑focused insurance products through a partnership with SCAN Health Plan, pending regulatory approval, with a potential rollout of Medicare Advantage in two states and a Medicare supplement in a third.

via PYMNTS.com|

#business #costco #healthcare-partnerships

personal-finance11 days ago•19 min saved

Humana Exits 600,000 Medicare Advantage Members Ahead of 2027

Humana says it will terminate plans covering about 600,000 Medicare Advantage members in 2027 (roughly 8% of its MA base), with disenrollment letters going out in September 2026. The exit triggers a 63-day guaranteed-issue Medigap window (Plan G commonly) to buy coverage without health underwriting, plus ongoing enrollment options during AEP and a special enrollment period. Members should confirm their disenrollment date, secure Medigap quotes within the window, and compare Original Medicare plus a Medigap plan vs staying with another MA plan, as costs can vary widely.

via 24/7 Wall St.|

#health-insurance #humana #medicare

payer28 days ago•22 min saved

Humana trims Medicare Advantage footprint again to chase margins in 2027

Humana plans to exit more Medicare Advantage plans in 2027 to hit its sustainable margin target of at least 3%, cutting its MA footprint by about 600,000 members (roughly 8% of its 7.2 million MA enrollment) and aiming to reassign about 240,000 to other Humana plans. The exits come as MA star ratings and CMS payments pressure profits, even as Humana beat quarterly expectations but lowered its non-adjusted earnings guidance; executives remain confident in improving star ratings toward 2028 and in growth initiatives like CenterWell.

via Healthcare Dive|

#humana #margins #medicare-advantage

business1 month ago•4 min saved

UnitedHealth Bets on AI as Q2 Beats Lift 2026 Profit Outlook

UnitedHealth beat Q2 estimates and raised 2026 adjusted EPS guidance to $19.50–$20 on about $112.0B revenue, aided by AI-driven efficiency while continuing to curb costs and stabilize margins. The company plans $1.5B in AI to speed up prior authorizations and improve payment accuracy as it shrinks membership and exits unprofitable contracts; UnitedHealthcare membership fell to 48.5M, with projected 2026 losses of roughly 500k ACA exchange and 1.1M Medicare Advantage members. A DOJ Medicare billing probe remains ongoing.

via CNBC|

#artificial-intelligence #business #earnings

health2 months ago•7 min saved

Mastering Medicare 2026: Your Guide to Enrollment and Avoiding Penalties

Medicare enrollment hinges on understanding Parts A–D, the seven-month Initial Enrollment Period, and the risk of lifelong penalties for late Part B signup. The piece warns that 2026 brings tougher drug-price rules, urges beneficiaries to use official portals for cost comparisons, and cautions against auto-pilot Medicare Advantage plans with hidden costs. It also highlights Special Enrollment Periods for those still with employer coverage and recommends consulting a SHIP counselor before signing any plans, noting the needs of expats abroad relying on US coverage.

via streamlinefeed.co.ke|

#enrollment #health #medicare

health2 months ago•4 min saved

HHS IG flags high, uneven denials by top Medicare Advantage plans

An HHS inspector general report finds unusually high and highly variable denial rates for rehabilitation and other long-term care services in major Medicare Advantage plans, with some plans denying requests over 70% of the time; 95% of denials are overturned on appeal, prompting CMS to collect more data and examine insurer-wide variation as regulators consider reforms to prior authorization.

via NBC News|

#denial-rates #health #inspector-general

market-news4 months ago•17 min saved

Morgan Stanley Upgrades UNH Ahead of Earnings on Margin and AI Upside

Morgan Stanley upgrades UnitedHealth (UNH) to Top Pick ahead of its Q1 results, citing clearer Medicare Advantage rate guidance, ongoing MA margin improvement, an Optum Health turnaround, and potential AI-driven efficiencies. A Q1 miss or beat is expected to be largely in line with expectations, with analysts eyeing tangible margin gains in 2027–2028 and a stronger stock trajectory if results align. The firm’s price target is $375 amid a broader Street consensus of Strong Buy with roughly 13% 12‑month upside.

via TipRanks|

#earnings #market-news #medicare-advantage

health4 months ago•258 min saved

Medicare Advantage gets a $13B boost for 2027, easing costs for seniors

CMS approved a 2.48% funding uplift for 2027, adding over $13 billion to Medicare Advantage plans and giving insurers more room to hold premiums and maintain extra benefits like dental and vision; while overall health-care costs won't drop dramatically, the change could ease out-of-pocket costs for many seniors, making coverage more stable—so review plans during open enrollment.

via AOL.com|

#health #healthcare-costs #medicare-advantage

healthcare5 months ago•4 min saved

Aetna Pays $117.7 Million to Resolve Medicare Advantage Coding Allegations

Aetna will pay $117.7 million to settle False Claims Act allegations that it submitted or failed to withdraw inaccurate diagnosis codes to inflate Medicare Advantage payments, including morbid obesity codes for 2018–2023, and related issues from a 2015 chart-review program; a whistleblower, a former Aetna risk-adjustment coder, will receive about $2.01 million. The case was pursued by the DOJ Civil Division, Fraud Section, and HHS-OIG with the U.S. Attorney’s Office for the Eastern District of Pennsylvania.

via Department of Justice (.gov)|

#aetna #false-claims-act #healthcare

politics7 months ago•9 min saved

Trump’s 2027 Medicare Advantage bump signals austerity for private plans

The Trump administration proposes a 2027 pay increase for Medicare Advantage of less than 1% (about $700 million), a smaller boost than insurers hoped and aimed at stabilizing payments while curbing upcoding. Insurers warn the modest increase could force benefit cuts or higher seniors’ premiums, while CMS argues the measure is a right-sizing effort to reduce waste; a final rate decision in spring will trigger renewed lobbying from industry and policymakers.

via Politico|

#cms #medicare-advantage #medicare-payments