Medicare Advantage

Latest Headlines

Latest Headlines

Opportunities for Medicare Advantage plans amid rate cut proposal

The Centers for Medicare & Medicaid Services raised eyebrows when it proposed lower Medicare Advantage reimbursement rates for 2016, but the proposal isn't all bad news for Medicare Advantage plans.

DOJ investigating Humana's Medicare Advantage billing process

The Department of Justice has requested information from Humana regarding risk adjustments assigned to Medicare Advantage beneficiaries, according to an annual report the insurance company filed to the Securities and Exchange Commission.

Medicare Advantage rate cut would reduce payer funding

The Centers for Medicare & Medicaid Services claim that its proposal to cut Medicare Advantage reimbursement rates by 0.95 percent in 2016 will not impact insurers' revenue, but industry experts say the changes will hit their bottom lines.

CMS proposes slight decrease in Medicare Advantage rates for 2016

The Centers for Medicare & Medicaid Services has proposed a 0.95 percent decrease in Medicare Advantage reimbursement rates for 2016. However, risk-scoring adjustments should give payers a 1.05 percent increase in total revenue, CMS said.

Florida fraud case highlights concerns surrounding Medicare Advantage upcoding

In what is believed to be the first case of its kind in South Florida, prosecutors are pursuing criminal fraud charges against a physician that overcharged Medicare Advantage plans. The case has pulled the health plan into the spotlight as it attempts to stave off spending cuts.

Avalere identifies 4 trends affecting payers in 2015

The healthcare industry continues to evolve in the post-Affordable Care Act market. A new Avalere Health report has summarized four key trends that will impact insurers this year as they update their business models to remain profitable and competitive.

Study: Most Medicare Advantage members come from Medicare

Medicare Advantage is an increasingly popular choice among eligible consumers--including those who are already enrolled in traditional Medicare. In fact, at least half of new Medicare Advantage enrollees switched from Medicare each year.

Insurers ready to push back against another round of MA cuts

Insurers are readying efforts to fight back against another round of Medicare Advantage cuts that are expected to come next month. But the campaign to keep Medicare Advantage payments stable may be harder than last year due to the post-midterm election political environment.

Medicare Advantage plans could lose members to feds

If Medicare Advantage plans drop significant amount of providers from their networks, their affected members can leave those plans and enroll instead in traditional Medicare.

What caused the Medicare spending slowdown?

Back in 2009, the Congressional Budget Office predicted that Medicare spending would be $706 billion in 2014. But spending will end up amounting to $580 billion.    A number of factors contributed to this  $126 billion gap, according to a new analysis from the Kaiser Family Foundation.