Healthcare Dive

JULY 31, 2024

The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.

Medicare 340

Medicare Medicare 340

Healthcare Dive

OCTOBER 3, 2024

Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed Wednesday. The downgrade could wipe out Humana’s profits in 2026.

Medicare 306

Medicare Medicare 306

Healthcare Dive

JUNE 6, 2024

Hundreds of thousands of seniors could switch plans during next year’s open enrollment, depending on how drastically the MA market giants slash benefits in an attempt to improve profits.

Medicare 338

Medicare Medicare 338

Healthcare Dive

JULY 11, 2024

Regulators said Medicare’s budget neutrality requirement is to blame for the reduction, which was quickly decried by provider groups. However, it’s likely Congress will step in to mitigate the drop.

Medicare 316

Medicare Medicare 316

Healthcare Dive

OCTOBER 23, 2024

Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.

Medicare 279

Medicare Medicare 279

MRO Compliance

NOVEMBER 21, 2024

The Centers for Medicare & Medicaid Services (CMS) 2025 Physician Fee Schedule (PFS) Final Rule brings notable updates to the Quality Payment Program (QPP), which will impact eligible clinicians, groups, virtual groups, subgroups, and APM entities. The QPP Landscape in 2025: What’s Changing? Let’s break down the updates.

Compliance 147

Compliance Medicare Medicare Medicaid 147

Healthcare Dive

NOVEMBER 4, 2024

The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.

Medicare 262

Medicare Medicare 262

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Fierce Healthcare

JANUARY 31, 2024

Medicare Advantage (MA) payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment. Medicare Advantage payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment.

Medicare 124

Medicare Medicare 124

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. | The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups.

Medicare 132

Medicare Medicare Doctors Medicaid 132

Fierce Healthcare

OCTOBER 11, 2024

Analyses of 2025 Medicare Advantage star ratings continue to pour in and not all of it bodes well for the conventional juggernauts. UnitedHealth and Humana saw star ratings decrease, whereas insurtechs celebrated their scores. We break down how all major insurers—and their investors—are reacting.

Medicare 126

Medicare Medicare 126

Healthcare Dive

MAY 17, 2022

The payer plans to open about 100 new value-based primary care clinics for Medicare patients between 2023 and 2025 through the latest deal.

Medicare 264

Medicare Medicare 264

Fierce Healthcare

MARCH 11, 2024

trillion budget for fiscal year 2025 on Monday, which continued upon and expanded key health items from previous years. Drug price negotiations and Medicare solvency were just two areas HHS officials hit upon while unveiling President Biden's 2025 fiscal year proposed budget. President Biden unveiled a proposed $7.3

Medicare 135

Medicare Medicare 135

HIT Consultant

DECEMBER 3, 2024

Here’s what to watch for on these frontiers and more in 2025: Continued adoption of clinical note-taking tools. The Centers for Medicare & Medicaid Services (CMS) added codes for Digital Mental Health Treatment in its 2025 Medicare Physician Fee Schedules. Technology is often met with distrust among practitioners.

FDA 111

FDA Medicare Medicare Medicaid 111

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

DECEMBER 16, 2024

Medicare Advantage has steadily grown over the past decade, and now encompasses more than half of all seniors eligible for Medicare. Medicare Advantage has steadily grown over the past decade, and now encompasses more than half of all seniors eligible for Medicare.

Medicare 94

Medicare Medicare 94

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

Mobi Health News

JULY 12, 2024

The proposed 2025 physician fee schedule from the Centers for Medicare & Medicaid Services includes payment and coding for digital health tools for behavioral health.

Medicaid 126

Medicaid Medicaid Medicare Medicare 126

Fierce Healthcare

NOVEMBER 3, 2021

Part D, Medicare Advantage drug plans must install cost-sharing cap by 2025 in new drug price bill. Wed, 11/03/2021 - 17:25.

Medicare 116

Medicare Medicare 116

Fierce Healthcare

JUNE 3, 2024

Blue Cross and Blue Shield of Kansas City is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. Blue Cross and Blue Shield of Kansas City is opting out of the Medicare Advantage market.

Medicare 124

Medicare Medicare 124

Fierce Healthcare

OCTOBER 30, 2024

Physicians and other healthcare practitioners may get a pay boost in 2025 through a bipartisan bill introduced in Congress on Tuesday. | The bill would increase the 2025 Physician Fee Schedule conversion factor by 4.73%, which would wipe out the expected 2.8% inflationary payment increase for 2025.

Medicare 105

Medicare Medicare 105

Healthcare IT News - Telehealth

APRIL 22, 2024

Medicare was the first to cover RPM. If the AMA approves the changes under consideration, and Medicare follows suit, which it usually does, then providers who make modifications and expand their RPM programs to fit the new codes will gain the most benefits for their patients and their clinics. However, the federal agency often does so.

Medicare 180

Medicare Medicare Medicaid Medicaid 180

Fierce Healthcare

NOVEMBER 4, 2024

Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)

Medicare 127

Medicare Medicare Medicaid Medicaid 127

Fierce Healthcare

AUGUST 7, 2024

Centene is exiting six states through its WellCare Medicare Advantage subsidiary next year, investment bank Stephens has revealed. WellCare is leaving six states next year, impacting more than 37,000 Centene members across the country.

Medicare 122

Medicare Medicare 122

Fierce Healthcare

JANUARY 31, 2024

Cigna will sell off its Medicare business to Health Care Service Corporation in a deal valued at $3.7 HCSC will acquire Cigna's Medicare Advantage, Part D, supplemental benefits and CareAllies businesses, and the parties expect the deal to close in the first quarter of 2025. billion, the company announced Wednesday.

Medicare 124

Medicare Medicare 124

Fierce Healthcare

FEBRUARY 5, 2024

Humana reaffirmed its guidance in the face of likely cuts in Medicare Advantage payment rates for 2025, despite saying the proposed decrease was higher than it expected.

Medicare 97

Medicare Medicare 97

Fierce Healthcare

DECEMBER 17, 2024

The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025. | The Value-Based Insurance Design model for Medicare Advantage plans will be terminated at the end of next year.

Medicare 90

Medicare Medicare Medicaid Medicaid 90

Healthcare Dive

FEBRUARY 8, 2024

As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.

Medicare 173

Medicare Medicare 173

Healthcare Dive

SEPTEMBER 12, 2023

The partnership, which Walgreens plans to launch in ACO REACH in 2024 and Medicare Advantage in 2025, is the retail giant’s first significant move in the healthcare space since CEO Roz Brewer departed earlier this month.

Doctors 182

Doctors Medicare Medicare 182

Fierce Healthcare

NOVEMBER 25, 2024

UnitedHealthcare successfully won its lawsuit over the Centers for Medicare and Medicaid Services, a federal judge determined Nov. UnitedHealthcare will get to claim victory over CMS for its star ratings lawsuit win.

Medicaid 119

Medicaid Medicaid Medicare Medicare 119

Fierce Healthcare

SEPTEMBER 30, 2024

Food insecurity is a critical challenge facing seniors, and SCAN Health Plan is teaming up with Instacart to roll out a new grocery benefit as part of its 2025 Medicare Advantage plan lineup.

Medicare 129

Medicare Medicare 129

Fierce Healthcare

OCTOBER 2, 2024

Humana's stock took a tumble early on Wednesday after it revealed in a filing with the Securities and Exchange Commission that its Medicare Advantage star ratings had declined significantly.

Medicare 116

Medicare Medicare 116

Fierce Healthcare

OCTOBER 21, 2024

Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star | Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star ratings results.

Medicaid 116

Medicaid Medicaid Medicare Medicare 116

Fierce Healthcare

NOVEMBER 13, 2024

AUSTIN, Texas—On Day 1 of the Fierce Health Payer Summit, panelists discussed the role of technology to retain members, trends in Medicare Advantage and changes to Medicare Part D. AUSTIN, Texas—The second annual Fierce Health Payer Summit kicked off Wednesday to tackle the most pressing issues facing health plan leaders.

Medicare 119

Medicare Medicare 119

HIT Consultant

OCTOBER 22, 2024

What You Should Know: – Essence Healthcare , a provider of Medicare Advantage (MA) plans forms a new partnership with ŌURA , the maker of the Oura Ring. “For two decades, Essence has been at the forefront of innovation, dedicated to improving the lives of seniors and Medicare beneficiaries. ”

Medicare 98

Medicare Medicare 98

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. The coverage gap will be eliminated in 2025, and manufacturers’ discounts will begin in ICL. PDT on June 3, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Fierce Healthcare

MARCH 12, 2024

President Joe Biden's 2025 budget did not just touch upon cybersecurity, the drug price negotiation program and Medicare solvency, as the plan also suggested policy for mental health, health equity | Many significant policy items in Biden's proposed 2025 fiscal year budget don't grab the initial headlines, but he's looking to make (..)

Medicare 124

Medicare Medicare 124