Fierce Healthcare

NOVEMBER 26, 2024

The Centers for Medicare & Medicaid Services (CMS) is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov.

Medicaid 312

Medicaid Medicare 312

Fierce Healthcare

AUGUST 13, 2024

Fifty-four percent of Medicare beneficiaries are enrolled in a private Medicare Advantage plan, and in seven states that figure tops 60%, according to a new report from KFF.

Medicare 321

Medicare 321

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 357

Medicare Medicaid 357

Fierce Healthcare

SEPTEMBER 4, 2024

Humana reaffirmed its full-year guidance but is leaving 13 Medicare Advantage (MA) markets next year, Chief Financial Officer Susan Diamond said during the Wells Fargo Healthcare Conference on Wedn | Humana is pulling back from Medicare Advantage markets and cutting benefits next year.

Medicare 306

Medicare Healthcare 306

Fierce Healthcare

APRIL 30, 2024

CVS has quietly acquired Hella Health, a startup Medicare Advantage broker based in New York City, according to a post on LinkedIn. | CVS has quietly acquired Hella Health, a startup Medicare Advantage broker based in New York City, according to a post on LinkedIn.

Medicare 328

Medicare 328

Health Care Dive

NOVEMBER 4, 2024

Physicians will see their Medicare reimbursement fall 2.9% next year if Congress doesn’t stop the cuts. Meanwhile, reimbursement for hospital outpatient departments is rising 2.9%.

Medicare 318

Medicare Hospitals 318

Fierce Healthcare

JUNE 13, 2024

The Centers for Medicare & Medicaid Services (CMS) appears poised to rework Medicare Advantage (MA) quality ratings for this year, The Wall Street Journal

Medicare 315

Medicare Medicaid 315

Fierce Healthcare

JUNE 17, 2024

Amazon Pharmacy is expanding its prescription drug subscription program, called RxPass, to Prime members on Medicare insurance. | The RxPass program, launched in January 2023, provides unlimited access to 60 eligible generic medications and will ship the medications to customers' homes for a flat monthly fee of $5.

Medicare 334

Medicare 334

Health Care Dive

JUNE 18, 2024

RxPass is now available to more than 50 million Medicare members after Amazon brought it into compliance with the insurance program’s regulatory standards.

Medicare 318

Medicare 318

Fierce Healthcare

JULY 31, 2024

Humana affirmed its guidance for the year as it continues to face headwinds in the Medicare Advantage (MA) space. Humana affirmed its guidance for the year as it continues to face headwinds in the Medicare Advantage space.

Medicare 339

Medicare 339

Fierce Healthcare

SEPTEMBER 20, 2024

Cigna is reshaping its Medicare Advantage (MA) plan lineup across eight states, affecting members in 36 health plans. Cigna is the latest company to rethink its Medicare Advantage offerings, choosing to cut plans in eight states including Florida.

Medicare 300

Medicare 300

Fierce Healthcare

AUGUST 27, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)

Medicare 325

Medicare 325

Health Care Dive

SEPTEMBER 25, 2024

Regulators say Medicare needs more data and oversight to avoid fraud and misuse. Digital health advocates argue the service is still crucial for managing chronic conditions.

Medicare 322

Medicare Regulations 322

Health Care Dive

JULY 18, 2024

The company uses AI to recommend Medicare Advantage, Medicare supplement and prescription drug plans based on enrollees’ healthcare preferences and needs.

Medicare 303

Medicare Healthcare 303

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 306

Medicare Medicaid 306

Fierce Healthcare

AUGUST 14, 2024

Getting seniors enrolled into the right Medicare plan is typically an inefficient process that many older patients find confusing and frustrating, spending hours on the phone with human call center | Startup Fair Square Medicare is using advancements with generative AI to build AI-based voice agents to screen seniors for Medicare coverage and improve (..)

Medicare 339

Medicare 339

Fierce Healthcare

JUNE 26, 2024

Medicare enrollees will pay less for 64 prescription drugs from July though the end of September because drug companies raised prices faster than the rate of inflation, the Centers for Medicare &am | Medicare enrollees will see lower prices this quarter for certain drugs treating cancer and genetic disorders under action unveiled by CMS.

Medicare 306

Medicare 306

Fierce Healthcare

DECEMBER 17, 2024

The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025. | The Value-Based Insurance Design model for Medicare Advantage plans will be terminated at the end of next year.

Medicare 306

Medicare Medicaid 306

Fierce Healthcare

OCTOBER 29, 2024

Accountable care organizations saved Medicare $2.1 billion, the largest yearly savings in program history, in 2023, the Centers for Medicare & Medicaid Services revealed on Tuesday. Accountable care organizations (ACOs) saved Medicare $2.1

Medicare 321

Medicare Accountable Care Accountability Medicaid 321

Fierce Healthcare

MAY 6, 2024

The Hospital Insurance Trust Fund will be fully solvent for longer than previously projected, according to an annual Medicare Trustee report. | The Medicare Hospital Insurance Trust Fund won't run out of money as quickly as expected. Here's how federal officials are reacting.

Medicare 306

Medicare Hospitals 306

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 291

Medicare Medicaid 291

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. | cut to physician payments in 2025 despite protest from major industry groups.

Medicare 325

Medicare Doctors Medicaid 325

Fierce Healthcare

MAY 13, 2024

The gap between insurance plans and Medicare's payments to hospitals for inpatient and outpatient services widened over the course of just a couple of years, a new study from RAND Corporation | A new report from RAND Corporation highlighted just how much more employers and private insurers are paying hospitals for inpatient and outpatient services. (..)

Medicare 332

Medicare Hospitals 332

Health Care Dive

MARCH 20, 2025

The deal, which removes Cigna from the volatile Medicare Advantage market, closed a little over a year after being announced.

Medicare 306

Medicare 306

Fierce Healthcare

JULY 11, 2024

A recent lawsuit has pushed back against an industry-opposed Centers for Medicare & Medicaid Services (CMS) final rule on broker compensation in Medicare Advantage (MA) plans. | A district court in Texas is halting a federal rule that changes broker compensation and overhauls marketing to seniors.

Medicare 300

Medicare Medicaid 300

Health Care Dive

JANUARY 30, 2025

nominee for HHS secretary, seemed unfamiliar with the massive insurance program during Thursday’s hearing, mistakenly saying Medicare Part A mainly paid for primary care or physicians. Kennedy Jr.,

Medicare 307

Medicare Primary Care 307

Fierce Healthcare

NOVEMBER 3, 2024

Under a final rule issued by the Centers for Medicare and Medicaid Services, outpatient hospital facilities and ambulatory surgical centers will get a 2.9% Medicare pay increase next year, up from | Under a final rule issued by CMS, outpatient hospital facilities and ambulatory surgical centers will get a 2.9%

Medicare 306

Medicare Medicaid Hospitals 306

Fierce Healthcare

SEPTEMBER 6, 2024

In its comments to the Centers for Medicare and Medicaid Services (CMS) on the draft CY2025 Medicare physician fee schedule (PFS), the American Medical Association badgered CMS on its pro | The American Medical Association submitted its comment letter to CMS on its draft CY2025 Medicare physician fee schedule.

Medicare 325

Medicare Doctors Medicaid 325

Health Care Dive

AUGUST 27, 2024

If all newly eligible patients received semaglutide, Medicare Part D spending could increase by $34 billion to $145 billion each year, according to new research.

Medicare 313

Medicare 313

Fierce Healthcare

NOVEMBER 4, 2024

R-Louisiana, and Maggie Hassan, D-New Hampshire, published a policy paper advocating to impose site-neutral Medicare payments on hospitals. | The lawmakers argue that site-neutral Medicare payment reform would lead to lower healthcare costs for patients and save taxpayer dollars. Senators Bill Cassidy, M.D.,

Medicare 294

Medicare Hospitals Healthcare 294

Fierce Healthcare

OCTOBER 15, 2024

CareNu is starting to sign members up for health insurance through its Medicare Advantage plan for the first time. CareNu's subsidiary is launching an Institutional Special Needs Medicare Advantage plan in Florida for patients with chronic illness.

Medicare 299

Medicare 299

Health Care Dive

MARCH 22, 2024

Two weeks after the FDA updated Wegovy’s label, Medicare changed its stance to allow people with a history of heart disease to receive treatment, a shift that could further boost access to the fast-selling medicine.

Medicare 329

Medicare 329

Fierce Healthcare

NOVEMBER 15, 2023

UnitedHealthcare is facing a potential class action lawsuit following allegations that it used an algorithm to deny claims for post-acute care services in Medicare Advantage.

Medicare 355

Medicare 355

Fierce Healthcare

SEPTEMBER 27, 2024

Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries of | A new report from HHS OIG looked at access to medication for opioid use disorder services and found many high need counties do not have specialized providers. (..)

Medicaid 316

Medicaid Medicare 316

Fierce Healthcare

OCTOBER 16, 2024

Medicare's annual enrollment period is officially underway, and, to assist beneficiaries in selecting plans, U.S. Medicare's annual enrollment period is officially underway, and to assist beneficiaries in selecting plans, U.S. News & World Report has released its list of the best Medicare Advantage and Part D insurers.

Medicare 275

Medicare 275

Fierce Healthcare

AUGUST 20, 2024

The upward trajectory of Medicare Advantage (MA) enrollment is likely to become an issue for hospitals and other healthcare providers forced to contend with plans’ prior authorization requirements | Prior authorization burdens and "a challenging contract negotiation season" on the horizon are likely headwinds for providers, and hospitals (..)

Medicare 321

Medicare Hospitals Healthcare Providers Healthcare 321

Fierce Healthcare

OCTOBER 31, 2024

Medicare Advantage’s popularity is associated with lower total Medicare spending, a new report from Elevance Health finds. Elevance Health researchers might have an explanation for lower-than-expected Medicare spending: the proliferation of Medicare Advantage plans.

Medicare 269

Medicare 269