tldrdailynews.com logo
Tag

Medicare Advantage

All articles tagged with #medicare advantage

Medicare Advantage Retreats: 5 Million Seniors Face Plan Cancellations and Higher Costs
health1 day ago

Medicare Advantage Retreats: 5 Million Seniors Face Plan Cancellations and Higher Costs

As 2027 open enrollment begins, approximately 5 million Americans are forced to switch Medicare Advantage plans due to widespread insurer withdrawals. Major carriers like UnitedHealth and Centene are exiting unprofitable markets, particularly in rural areas, leaving some counties with no coverage options. While average premiums may drop, out-of-pocket costs and prescription prices are rising, prompting experts to warn of increased financial hardship for older adults.

via The New York Times|
#cms#health#health-insurance
2027 Medicare Advantage: Lower premiums mask rising out-of-pocket costs and benefit cuts
healthcare9 days ago

2027 Medicare Advantage: Lower premiums mask rising out-of-pocket costs and benefit cuts

Despite a 16% drop in average monthly premiums for 2027, Medicare Advantage insurers are raising out-of-pocket costs and cutting supplemental benefits like dental care to boost margins. Major carriers including UnitedHealth Group and Humana are reducing plan availability and increasing cost-sharing, a shift driven by investor pressure for higher profits. While insurers publicly emphasize affordability and core coverage, federal data and independent analyses reveal significant reductions in benefits for millions of seniors. Open enrollment for 2027 plans begins October 15, requiring beneficiaries to carefully compare plans to avoid unexpected cost increases or loss of provider access.

via STAT|
#cms#health-insurance#healthcare
Medicare Advantage premiums drop 16% for 2027 as insurers cut plans to boost margins
healthcare11 days ago

Medicare Advantage premiums drop 16% for 2027 as insurers cut plans to boost margins

The Centers for Medicare & Medicaid Services (CMS) projects that average monthly premiums for Medicare Advantage (MA) plans will fall by 16% to $12 in 2027, down from $14.37 in 2026. While headline costs drop, insurers are significantly reducing the number of available plans and increasing cost-sharing to improve margins. Stand-alone Part D prescription drug premiums are expected to rise slightly to $36. Open enrollment runs from October 15 to December 7, 2026.

via Fierce Healthcare|
#cms#healthcare#medicare-advantage
CMS Projects 2027 Medicare Advantage Premiums to Drop 16% Despite Enrollment Disputes
healthcare12 days ago

CMS Projects 2027 Medicare Advantage Premiums to Drop 16% Despite Enrollment Disputes

The Centers for Medicare & Medicaid Services (CMS) announced that average monthly premiums for Medicare Advantage plans will decrease by 16% to $12 in 2027, while stand-alone Part D prescription drug premiums will rise slightly to $36. Although insurers predict enrollment declines, CMS expects higher participation. Open enrollment runs from October 15 to December 7.

via USA Today|
#cms#health-insurance#healthcare
Cancer-care shakeup: Dana-Farber exits MGB’s Medicare Advantage network
business1 month ago

Cancer-care shakeup: Dana-Farber exits MGB’s Medicare Advantage network

Mass General Brigham Health Plan will drop Dana-Farber Cancer Institute from its Medicare Advantage network starting Oct. 1, a move tied to financial pressures amid a broader split between Dana-Farber and MGB. About 20,500 plan members are affected, though only a fraction currently receive Dana-Farber care; roughly 250 members are actively treated there and up to 1,000 had appointments this year. Dana-Farber says it’s the first time a health insurer has removed it from a network and notes patients can stay in-network for up to 90 days or through the end of ongoing treatment, while offering financial counseling and alternative plan options. Dana-Farber is pursuing a new cancer-hospital partnership with Beth Israel Lahey Health, and MGB is investing in its own cancer institute, highlighting the broader “cancer wars” and the use of narrow networks to control costs.

via The Boston Globe|
#business#cancer-care#dana-farber
When a hospital becomes your insurer: early clues from the payvider wave
health-care-policy1 month ago

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
Costco Expands into Medicare with SCAN Partnership
business1 month ago

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
Costco to Launch Costco-Branded Medicare Plans with SCAN Group
health-care1 month ago

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
Hospitals as insurers: the payvider shift reshapes Medicare Advantage
health-policy1 month ago

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
Humana Exits 600,000 Medicare Advantage Members Ahead of 2027
personal-finance1 month ago

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
Humana trims Medicare Advantage footprint again to chase margins in 2027
payer2 months ago

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