The CMS has temporarily stopped accepting new proposals from health insurance companies seeking to enroll their commercial or Medicaid patients automatically into their Medicare Advantage plans.
The percentage of Humana Medicare Advantage members in plans with four stars or higher fell by half, from 78% a year ago to 37%. Cigna has only 20% of its members in plans rated four stars or higher. Meanwhile, 91% of Aetna's members are enrolled in four-star plans.
Doctors say they're losing patients when commercial health plans automatically move consumers over to a Medicare Advantage plan when they turn 65. The MA plans mean more revenue for insurers, but it often means patients' usual doctors will be considered out of network.
Senate Majority Leader Mitch McConnell last week unveiled a bill that would prevent a government shutdown and provide more than $1 billion to battle the Zika virus.
Healthcare organizations that run afoul of federal regulations will be paying heftier penalties, due to updates made by HHS last Friday that factor in multiple years of inflation.
Cigna has spent the past eight months attempting to resolve the major problems found in its Medicare Advantage plans, but the health insurer does not expect those issues will be rectified by the time Medicare beneficiaries participate in annual enrollment this autumn.
Aetna and Humana fought back against the U.S. Justice Department's challenge to their proposed $37 billion merger, saying the feds' arguments ignore the fluid nature of Medicare Advantage markets.
Not-for-profit co-ops and other small health plans have been the leading critics of risk adjustment. Now, Aetna is right behind them.
The five-star system as launched underdelivers for consumers and imperils hospitals' journey to improve value for patients.
The federal government will expand a new Medicare Advantage program to three states in 2018 and allow interested insurers to offer expanded benefits to two new types of chronically ill members.
A new requirement for hospitals to notify Medicare patients when they are receiving observation care but have not been admitted will cost the industry $23 million annually, according to the CMS.
Even if the feds bury Anthem's acquisition of Cigna and Aetna's Humana deal, the big five health insurers are likely to forge new transactions to scale up and improve their position at the bargaining table with consolidating hospitals and systems.