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.
A federal report finds many Medicare Advantage and Medicaid managed care plans list inaccurate mental health providers, affecting access and compliance. Recommendations include using billing data and creating a national provider directory.
Explore the latest 2025 Medicare Advantage policy updates, including CMS rule changes on prior authorization, risk adjustment models, Star Ratings, supplemental benefits, provider directories, and marketing oversight.
Court upholds CMS decision on Humana Medicare Advantage star ratings amid rising class-action insurance lawsuits involving provider network inaccuracies and insurer duties.
Commonwealth Fund's Medicare State Scorecard highlights significant disparities in access, affordability, and quality of Medicare care across U.S. states, with Connecticut ranked 12th but 31st in quality metrics.
Wellcare expands Medicare Advantage plans to 51 million beneficiaries in 32 states and transitions dual-eligible members to integrated D-SNPs in 2026, reflecting industry shifts in Medicare-Medicaid integration and care coordination.
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.
Samaritan Health Plans exits Medicare Advantage in Lincoln County, Oregon, leaving Devoted Health as sole 2026 provider. Insights on market sustainability, special enrollment, and resources for seniors.
