#medicare-advantage

#medicare-advantage

Medicare Advantage offers expanded coverage at an additional cost, enhancing standard Medicare benefits.

The withdrawal of Medicare Advantage plans by insurers is forcing millions of patients to navigate new coverage options this open enrollment season.

Medicare Advantage beneficiaries are facing reduced benefits for utilizing their health care services, as insurers prioritize profitability.

Many older Americans will face thinner Medicare Advantage coverage options in 2025 due to insurers withdrawing from markets.

Insurance changes may negatively impact voter sentiment as elections approach.

Start considering Medicare coverage options before the enrollment window opens to avoid last-minute decisions.

The Centers for Medicare & Medicaid Services (CMS) has informed health insurance companies that using AI algorithms to determine eligibility for government healthcare coverage is not compliant with Medicare rules.

The memo seems to address controversy surrounding the use of AI software in denying Medicare Advantage coverage, which has led to lawsuits and accusations of faulty AI systems.

Understanding Medicare star ratings is crucial for selecting the best plans during Open Enrollment.

Many people overlook the importance of star ratings in their decision-making process.

Seniors face a crucial decision when choosing between traditional Medicare and Medicare Advantage plans, where the trade-off lies between predictability and flexibility in healthcare coverage.

Insurers are expected to generate billions in profit from the dual eligible population, despite their expensive health care needs.

Insurance plans' government segment is projected to be 65% more profitable than the commercial segment by 2027.

More than half of Medicare-eligible people are enrolled in Medicare Advantage, but hospitals have been dropping these plans due to issues with prior authorizations and denials.

Hospitals and health systems in at least 11 states announced they would be out-of-network for some or all Medicare Advantage plans in 2024.

Federal officials backed off plan to curb Medicare Advantage overcharges due to industry pressure, leading to ongoing fraud allegations against insurers.

CMS initially sought to regulate Medicare Advantage overcharging but withdrew efforts due to industry pressure, leaving serious implications for Medicare integrity.

Medicare Advantage plans have successfully evaded stringent regulatory oversight, leading to billions in potential overpayments and growing political influence over time.

CMS has failed to recover taxpayer funds from overpayments to Medicare Advantage despite longstanding concerns and industry pressure.

The Biden administration is encouraging the public to report misleading or deceptive sales tactics by insurers selling private Medicare Advantage and drug plans.

Specific sales pitches to watch out for include claims that suggest benefits are available to all when only some individuals qualify, mentioning benefits that are not available in the advertised service area, and using superlatives without data to back them up.

The public is also warned to be wary of companies pretending to be from the government-run Medicare program and should report any violations to CMS at 800-MEDICARE.

Cigna and Humana's merger could create a powerful healthcare company.

The merger would allow Cigna to enter the highly lucrative Medicare Advantage industry.

The combined company would compete with UnitedHealth Group, the current industry leader in Medicare Advantage.

Cigna and Humana could merge to create a healthcare powerhouse

Cigna has a large pharmacy benefit management business while Humana has a strong presence in the Medicare Advantage industry