Healthcare experts widely expected the Affordable Care Act to hobble Medicare Advantage. But Since 2010, enrollment in Medicare Advantage has doubled to more than 20 million enrollees, growing from a quarter of Medicare beneficiaries to more than a third.
UnitedHealth Group leads the pack into earnings season with its third-quarter results. In the second quarter, the company reported both higher revenue and profit.
Ahead of Medicare open enrollment, the CMS said seniors enrolled in traditional Medicare will pay slightly higher premiums and deductibles in 2019.
The average star-ratings performance of stand-alone Part D plans, which are managed by pharmacy benefit management companies and health insurers, has bobbled up and down for years. Part D plans fared worse in 2019 than they have in the last five years.
This model—known as "full-risk" or "global risk"—is increasingly used by Medicare plans such as Humana and UnitedHealthcare to shift their financial exposure from costly patients to physician-management companies.
DaVita Medical Holdings paid the U.S. Justice Department $270 million to settle allegations that it used improper Medicare Advantage billing practices that led to inflated payments.
Average monthly premiums for Medicare Advantage will hit a three-year low next year at $28 a month, according to the CMS. Plan enrollment is expected to rise to 22.6 million, encompassing more than 36% of Medicare beneficiaries.
Medicare Advantage plans could be denying claims to maximize profits, according to a new HHS Office of Inspector General report. Insurance companies overturned 75% of their own denials after an appeal was filed between 2014 and 2016.
A federal judge's recent decision to vacate the 2014 Medicare Advantage overpayment rule paves the way for insurers to continue upcoding to reap higher CMS payments that could cost billions of dollars, experts said.
The CMS' proposed Medicare value pay experiment isn't playing well for some physicians who feel the administrative burden is too high. Their concerns come after years of lobbying to have MA plans count as an alternative pay model under MACRA.
A federal judge in Washington, D.C., ruled that a 2014 CMS rule violated federal law requiring payments to Medicare Advantage insurers be actuarially equivalent to traditional fee-for-service providers.
A lawsuit against Anthem exposes a potential flaw in Medicare Advantage that likely is driving costs higher.