Despite initial challenges, 2025 appears promising for home health providers, as indicated by industry experts in Home Health Care News’s recent webinar, Home Health Outlook 2025. During the discussion, experts addressed several key issues, including Medicare Advantage (MA) reimbursement rates, labor shortages and improved technology integration. The panel also explored future risk-sharing opportunities and highlighted […]
Category: Medicare Advantage
The U.S. Centers for Medicare & Medicaid Services (CMS) in 2026 plans to raise payments to Medicare Advantage plans by 4.3% in 2026. CMS has issued an advance notice of policy changes for Medicare Advantage and Part D that would install technical updates, including to the ways the agency calculates payments to health plans. “CMS […]
Democratic lawmakers are expressing concern over President-elect Donald Trump’s choice of Dr. Mehmet Oz to head the U.S. Centers for Medicare and Medicaid Services (CMS). Specifically, lawmakers are focused on Oz’s advocacy for the elimination of traditional Medicare, and what they call his “deep financial ties” to private health insurers. In a recent letter — […]
A new analysis by the Kaiser Family Foundation (KFF) reveals that Medicare spending is higher for beneficiaries who switch from Medicare Advantage (MA) to traditional Medicare compared to similar beneficiaries who have continuously been enrolled in traditional Medicare. These beneficiaries cost Medicare an average of 27% more, according to the analysis, which examined health costs […]
Congress has begun discussions on important health care policies set to expire on Dec. 31. On Dec. 3, Republicans submitted a preliminary proposal to Democrats, which includes a three-year extension of Medicare’s telehealth and hospital-at-home programs. They also suggested funding for community health centers and extensions for public health programs in Medicare and Medicaid. The […]
UnitedHealthcare CEO Brian Thompson was shot and killed Wednesday morning in New York City, where UnitedHealth Group (NYSE: UNH) was hosting its annual investor conference. New York City Mayor Eric Adams called it a “targeted murder.” The city’s police commissioner, Jessica Tisch, also described it a “brazen targeted attack.” UnitedHealth Group is one of the […]
The Centers for Medicare & Medicaid Services (CMS) is proposing new limits on Medicare Advantage (MA) plans regarding prior authorization, utilization management, coverage decisions and the use of artificial intelligence (AI). These proposed changes aim to address the barriers to accessing care identified by CMS. Data reported to CMS by MA plans show that, on […]
Home health providers may walk away from specific health plans due to financial feasibility, administrative burdens, or misalignment with their patient care values and priorities. However, this decision can create short-term challenges with referral partners and health systems, as they may have patients enrolled in those plans. “If a health plan consistently under-reimburses for services […]
Medicare Advantage (MA) companies have faced an unfavorable rate and regulatory environment over the last couple of years. That has given home health providers hope that MA penetration may cool off. It also has given them a bit more leverage in negotiations. Plans will see a 0.16% decrease to core payments in 2025, a second-straight […]
Essentia Health has reached an agreement with UnitedHealthcare (UHC) to remain an in-network provider for UHC’s Medicare Advantage insurance plan in 2025. Earlier this year, Essentia announced plans to discontinue its status as an in-network provider for UHC and Humana Inc. (NYSE: HUM) Medicare Advantage insurance plans due to reported issues with denials of payment […]
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