News
Stop the Revolving Door: Why Five-Year Contracts are the Key to Saving Medicare Advantage
4+ hour ago (724+ words) Medicare Advantage has become the dominant way older Americans receive healthcare, but the program still lacks one key ingredient: a long-term commitment. In two decades, Medicare Advantage has more than quadrupled enrollment to surpass traditional Medicare. Today one of every…...
ACA Marketplace Insurers Propose 14% Median Premium Increase in 2027
2+ day, 19+ hour ago (393+ words) KFF found that ACA Marketplace insurers are proposing a median 14% premium increase for 2027, driven by rising healthcare costs and the expiration of enhanced premium tax credits. Affordable Care Act Marketplace insurers are proposing a median premium increase of 14% in 2027, according…...
Pearl Health Lands $110M to Support Value-Based Care for Medicare Patients
3+ day, 18+ hour ago (237+ words) Pearl's $110 million raise includes a $50 million equity investment led by Andreessen Horowitz with participation from Viking Global Investors, AlleyCorp and Ulysses Capital, as well as a $60 million debt facility led by Trinity Capital. Pearl Health, a healthcare technology company helping…...
Elevance Sues CMS Over Star Ratings, Seeks Same Recalculation Applied to Clover
4+ day, 18+ hour ago (277+ words) The star ratings battle continues, this time with Elevance Health. Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance’s 2026 Medicare…...
CMS Recalculates Star Ratings — Again
1+ week, 6+ day ago (580+ words) CMS is recalculating some 2026 Medicare Advantage Star Ratings after a court ruled it improperly calculated Clover Health's rating, a decision that could boost payments for a small number of insurers. The flux around CMS Star Ratings continues. Conflict between CMS…...
New Bill Led by Democrats Aims to Cap Medicare Out-of-Pocket Costs
2+ week, 1+ day ago (329+ words) The Medicare Cost Cap Act seeks to create a $5,000 cap on out-of-pocket costs for traditional Medicare beneficiaries. A group of Democratic senators introduced a new bill on Thursday that would create a $5,000 cap on out-of-pocket costs for traditional Medicare beneficiaries....
OIG: 3 Largest MA Insurers Deny Prior Auth Requests at High Rates for Long-Term Acute Care, Inpatient Rehab
4+ week, 1+ day ago (402+ words) An OIG report found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at higher rates than other MA plans in 2024. A new report from the Office of Inspector General revealed…...
CMS Finalizes Rule to Simplify Payer-Provider Disputes Under No Surprises Act
1+ mon, 2+ week ago (571+ words) CMS finalized a new rule aimed at streamlining the No Surprises Act’s overwhelmed arbitration system. Provider groups largely welcomed the reforms — though some industry leaders said additional changes are still needed to address alleged misuse and improve transparency. The Centers…...
Debunked Episode 25: Sutter Health’s Allina Health Acquisition Strategy, a Deep Dive on Doctronic
3+ mon, 1+ week ago (216+ words) In the latest episode of the Debunked podcast, MedCity News Editor-in-Chief Arundhati Parmar and Samir Batra, Managing Partner of Health Innovation Pitch, discussed recent M&A deals and how bots can be manipulated. Several March M&A deals caught the…...
Hospitals Take CVS to Court Over Alleged $250M 340B Scheme
1+ mon, 2+ week ago (348+ words) Three health systems — Mount Sinai, Michigan Medicine and the University of Kansas Health System — are suing CVS Health, alleging its pharmacy benefit manager diverted roughly $250 million in savings from the 340B program through “spread pricing” between 2020 and 2025. Three health systems are…...