Payer
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Medicare Advantage enrollment projected to fall in 2026: CMS
Nearly 1 million fewer people could sign up for the privatized Medicare plans next year, according to the CMS, marking the first time in years MA enrollment could decline.
By Emily Olsen • Sept. 29, 2025 -
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Sponsored by Sutherland GlobalLeveraging automation and AI to transform payer operations
How AI and automation can help payers drive revolutionary new efficiencies in provider lifecycle management (PLM), medical management and member outreach and support.
Sept. 29, 2025 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
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Sponsored by Quest DiagnosticsGetting the picture: How comprehensive member-based lab data helps payers close gaps and optimize care
Learn more about how member-based data helps payers.
Sept. 29, 2025 -
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Judge vacates Medicare Advantage audit rule in win for industry
On Thursday, Texas Judge Reed O’Connor threw out a Biden-era rule that would have recouped billions of dollars in overpayments to MA plans.
By Rebecca Pifer • Sept. 26, 2025 -
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UnitedHealthcare launches direct-to-consumer marketplace for health and wellness programs
The insurance giant is unveiling UHC Store as payers work to shore up eroding consumer trust.
By Rebecca Pifer • Sept. 25, 2025 -
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Physician practice acquisitions on the rise: GAO
Consolidation with health systems can lead to higher prices, alongside a decrease or no change in care quality, according to a review from the Government Accountability Office.
By Emily Olsen • Sept. 24, 2025 -
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Aetna expands program curbing hospital readmissions for Medicare Advantage members
One hospital has piloted the program for a few months and seen some early successes that have made other operators interested, an Aetna spokesperson said.
By Rebecca Pifer • Sept. 23, 2025 -
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States should be full steam ahead on Medicaid work requirements, experts say
There’s a lot that states want the CMS to weigh in on. But given the tight rollout timeline for the controversial mandates, they shouldn’t delay implementation, experts said during a MACPAC meeting.
By Rebecca Pifer • Sept. 22, 2025 -
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Medicare Advantage plans to share provider directories under CMS final rule
The policy was originally proposed by the Biden administration in November, but comes amid a larger push for more transparency around payers’ provider networks from health officials in the Trump regime.
By Rebecca Pifer • Sept. 19, 2025 -
Courtesy of Blue Shield of California
Kansas, Hawaii Blues invest in Blue Shield of CA’s health tech sister company
Stellarus was launched as part of Blue Shield of California’s restructuring to sell services to nonprofit plans that they don’t have the resources to build themselves. That pitch has now worked on at least two Blues plans.
By Rebecca Pifer • Sept. 18, 2025 -
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How to reform Medicare’s physician fee schedule to reprioritize primary care
America’s primary care chassis is crumbling, and how Medicare pays physicians is partially to blame. Expanding value-based payment arrangements could be the answer, experts say.
By Rebecca Pifer • Sept. 17, 2025 -
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Optum Rx hikes payment floor on brand name drugs for independent pharmacies
The move builds on the major PBM’s pivot to cost-based pricing for pharmacies announced earlier this year.
By Rebecca Pifer • Sept. 17, 2025 -
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GOP bill extends telehealth flexibilities, sidesteps ACA subsidies
The continuing resolution would preserve virtual care flexibilities through Nov. 21. But it makes no mention of extending more generous financial assistance for people who buy plans on the ACA exchanges.
By Emily Olsen • Sept. 17, 2025 -
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Doctors slam specialty cuts in 2026 Medicare pay proposal
Major physician groups and specialists commented in droves that regulators missed the mark on the Medicare physician fee schedule for next year.
By Rebecca Pifer • Sept. 16, 2025 -
Dan Zukowski/Healthcare Dive
Democrat governors urge Congress to extend ACA subsidies
Eighteen blue state governors are warning of a looming affordability cliff for millions of Americans if lawmakers allow generous financial assistance to lapse at the end of this year.
By Rebecca Pifer • Sept. 16, 2025 -
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Medicare prior authorization pilot raises concerns among providers
The additional red tape could save money, but may harm patient access and quality of care. Stakeholders are urging the CMS to increase transparency and hold participants accountable.
By Michael Brady • Sept. 16, 2025 -
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AMA releases 2026 medical codes
The American Medical Association unveiled new CPT codes on Thursday amid signs that the Trump administration may reduce the lobby’s influence over the medical billing system.
By Rebecca Pifer • Sept. 12, 2025 -
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Health benefit cost increases expected to hit 15-year high, Mercer warns
2026 will mark the fourth consecutive year of substantial health benefit cost growth, signaling “mounting pressure on employers’ healthcare budgets.”
By Ginger Christ • Sept. 10, 2025 -
Courtesy of UnitedHealth Group
Early Medicare Advantage stars data bodes well for UnitedHealth
The healthcare behemoth expects to have roughly 78% of its MA enrollees in plans rated four stars or higher, a key cutoff for valuable bonuses in the privatized Medicare program.
By Rebecca Pifer • Sept. 9, 2025 -
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Medicare Advantage penetration doesn’t translate to lower hospital margins: MedPAC
The findings throw cold water on allegations from hospital groups that MA plans contribute to shrinking margins.
By Rebecca Pifer • Sept. 9, 2025 -
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House Republicans probe CVS for alleged HIPAA violation
In June, CVS sent a mass text to pharmacy customers in Louisiana urging them to contact their representatives to oppose a PBM reform bill. That may have been illegal, two Republican congressmen say.
By Rebecca Pifer • Sept. 8, 2025 -
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States unprepared to implement Medicaid work requirements: report
Implementing work requirements should be a “multi-year project,” researchers said, but states have just until next year to prepare.
By Susanna Vogel • Sept. 8, 2025 -
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Aetna, Optum settle ‘dummy codes’ case for $8.4M
The decade-long case alleged that Aetna and Optum Health conspired to pass along administrative costs to patients by disguising them as medical codes.
By Rebecca Pifer • Sept. 8, 2025 -
Permission granted by Elevance Health
Elevance cuts MA footprint, exits standalone Medicare prescription drug plans
Roughly 150,000 individual and group MA members will be affected by the plan exits, as will some 400,000 Part D enrollees.
By Rebecca Pifer • Sept. 5, 2025 -
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HHS expands access to catastrophic plans ahead of premium pain on ACA exchanges
The move will give more Americans a coverage alternative with low monthly premiums come November’s open enrollment, but could come at the expense of people who remain in standard Affordable Care Act plans.
By Rebecca Pifer • Sept. 4, 2025
