Medicare Advantage (MA) star ratings have become a hot topic for Humana Inc. (NYSE: HUM). On Oct. 18, the company filed a lawsuit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) over its drop in star ratings. The number of Humana MA plans rated […]
Category: Medicare Advantage
Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS) for sicker enrollees. This helps ensure that plans receive sufficient payments to cover increased care costs and that enrollees have access to plans. However, a new report states that taxpayers are footing the bill for billions of dollars […]
UnitedHealth Group (NYSE: UNH) and Amedisys (Nasdaq: AMED) leaders are reportedly expected to meet with officials from the Department of Justice over the next week to discuss their pending deal. The companies will likely make a final case for why the deal should go through, while the DOJ considers whether to officially file a lawsuit […]
The Federation of American Hospitals (FAH) released a statement Thursday regarding recent investigations into Medicare Advantage (MA) plans. Those investigations included concerns around claim denials, as well as discrepancies between MA plan practices when compared to traditional Medicare. It is yet another example of health care providers and advocates pushing back. It also shows that […]
As home-based care demand continues to increase, several leaders are thinking about the unique growth trajectories at their companies. At Impact Healthcare, growth has been achieved by not overextending. In recent years, the company has seen 35% year-over-year growth, except for in 2020. “When I think about our growth trajectory, it’s making sure that we […]
Humana Inc. (NYSE: HUM) and Cigna Group (NYSE: CI) have reportedly resumed conversations around a merger. The two companies discussed the possibility of a merger in 2023, but ultimately paused those conversations a few weeks later. Bloomberg first reported resumed merger discussions between the two companies on Friday. The news comes at a time when […]
The Senate Homeland Security Permanent Subcommittee on Investigations (PSI) released a report on Thursday revealing that the nation’s three largest Medicare Advantage (MA) insurers have significantly increased the rate at which they denied seniors’ post-acute care from 2020 to 2023. This includes denying access to nursing homes, inpatient rehabilitation facilities and long-term acute care hospitals. […]
The Medicare Payment Advisory Commission (MedPAC) paints a rosy portrait of home health margins. But an analysis of cost reporting data – that considers both traditional Medicare and Medicare Advantage (MA) payments – shows that providers are generally not sitting atop a hill of money. Instead, they are struggling to stay above water. Kalon Mitchell […]
The Centers for Medicare & Medicaid Services (CMS) dealt a blow to UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) – the two largest Medicare Advantage (MA) administrators – by lowering their star ratings for 2025. Broadly, MA plans are rated on a scale from one to five, and CMS has lowered those ratings […]
Despite multiple large insurers pulling back on Medicare Advantage (MA), about 51% of Medicare beneficiaries are expected to be enrolled in an MA plan come 2025. The Centers for Medicare & Medicaid Services (CMS) has created a less rosy payment environment for MA plans over recent years, and that has forced some plans to exit […]