The DOJ sues Inland Empire Health Plan for allegedly misusing $320 million in federal Medicaid surplus funds, highlighting compliance challenges in managed care programs.

Congress must decide soon on extending enhanced ACA premium credits, balancing coverage stability against rising federal costs and healthcare expenses.

Several Medicare Advantage providers are expected to exit the New Hampshire market in 2025, prompting significant changes for beneficiaries during the Medicare open enrollment period.

Special Needs Plans (SNPs) enrollment now constitutes 21% of Medicare Advantage, driven by regulatory changes and payer concentration, amid overall MA market growth challenges.

Explore effective strategies for Medicare Annual Enrollment Period 2024 to enhance client trust, streamline processes, and ensure regulatory compliance.

UnitedHealth Group, America's largest health insurer, navigates DOJ investigation and CEO changes while planning AI-driven cost reductions and premium hikes. Stock shows undervaluation amid demographic tailwinds.

UnitedHealth Group's stock has plummeted amid concerns over opaque financial reporting and Medicare Advantage upcoding investigations. Analysts demand greater transparency to assess future performance and regulatory impacts in the U.S. health insurance market.

Medicare Advantage plans saw a slower growth in administrative expenses in 2024, with detailed insights from the Sherlock Benchmarks revealing trends in cost drivers and plan management effectiveness.

The potential expiration of the ACA enhanced premium tax credit by the end of 2025 could lead to significant health insurance premium increases and coverage losses, with lawmakers negotiating extensions amid broader economic pressures.

Ambetter from Centene is refunding over $1 billion to Missouri health insurance policyholders for underspending on care under ACA Medical Loss Ratio rules, reshaping the state's individual insurance market.