Examining Aetna's new inpatient payment policy for Medicare Advantage plans, its conflicts with Medicare's Two-Midnight Rule, and implications for hospital reimbursement and compliance.
Medicare Part B premiums increase to generate $14 billion in revenue amid rising outpatient and managed care costs, impacting seniors and Medicare Advantage plans.
Banner Health's insurance plan integrates health system data and AI technology to improve care coordination, compliance, and member experience in Medicare and Medicaid markets.
Medicare Advantage plans are advancing outcomes by integrating clinical excellence, AI-driven engagement, health literacy, and community partnerships to support holistic member care.
Special Needs Plans (SNPs) are driving significant growth in Medicare Advantage enrollment in 2025, with chronic condition and dual-eligible SNPs leading gains. Institutional SNPs decline amid evolving care models.
FirstMedicare Direct will close operations by end of 2025, affecting 6,000 Medicare Advantage members. This exit highlights challenges in the Medicare Advantage insurance market.
Medicare Advantage market pivots from growth-at-any-cost to profitability-first amid CMS regulatory tightening and rising medical costs. Key strategic shifts include operational efficiency, agility in member services, and investment in clinical programs to improve outcomes and reduce total care costs.
CVS Health closes 16 Oak Street Health locations citing elevated medical costs and CMS risk model changes, reflecting broader strategic shifts in retail healthcare amid financial pressures.
Ballad Health sues UnitedHealth Group over alleged Medicare Advantage care denials, coding practices, and reimbursement disputes impacting rural healthcare and insurance contracts.
A federal judge upheld CMS Medicare Advantage star ratings, resulting in a downgrade for Humana that risks billions in government bonus payments. The ruling affects nearly half of Humana's Medicare Advantage members and has broad implications for the insurer and Medicare market.
