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.
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 incurs a $5.7 billion underwriting loss in 2024 due to increased utilization, medical inflation, and regulatory changes, impacting insurer profitability and market dynamics.
Medicare Advantage plans cost taxpayers 22% more per enrollee than traditional Medicare. Understanding payment system flaws and reform options is critical for policymaker and insurer strategy.
CMS is intensifying Medicare Advantage audits to recover $43 billion in overpayments, impacting provider contracts and regulatory compliance across the MA ecosystem.
UnitedHealth Group cuts profit forecasts due to higher Medicare Advantage care costs and lower coding revenue, highlighting challenges in Medicare Advantage management and insurance financials.
The Johns Hopkins ACG System is a leading population health analytics tool used globally to improve care for over 250 million people weekly, integrating clinical and social data to advance health equity and risk adjustment.
UnitedHealth Group reports significant OptumHealth underperformance driven by higher Medicare Advantage utilization and risk adjustment challenges, raising profitability concerns and prompting strategic prioritization of patient engagement.
Reveleer acquires Novillus to enhance its AI-driven value-based care platform, improving payer-provider collaboration, care gap closure, and clinical intelligence for health plans.
Medicare Advantage increases federal spending but offers lower out-of-pocket costs for seniors. SCAN CEO Sachin Jain highlights program flaws, risk adjustment abuses, and broker roles.
