Analysis & Research

Long-Term Services and Supports in Supplemental Benefits in Medicare Advantage Plans

August 11, 2025

JAMA

To what extent have Medicare Advantage (MA) plans provided long-term services and supports (LTSS) supplemental benefits over time? In this cohort study of 4,521 MA plans in 2019 and 6,614…

Read this article

Medicare Advantage in 2025: Enrollment Update and Key Trends

July 28, 2025

More than half (54%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2025. While a growing share of Medicare beneficiaries are enrolled in a Medicare Advantage plan, the…

Read this article

Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

July 28, 2025

In 2025, more than three quarters (76%) of enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is…

Read this article

Most Medicare Advantage Markets are Dominated by One or Two Insurers

July 14, 2025

Enrollment in Medicare Advantage, the private plan alternative to traditional Medicare, has increased steadily since 2010. The average beneficiary has access to 34 Medicare Advantage plans with prescription drug coverage…

Read this article

Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates

July 3, 2025

JAMA

Is enrollment in Medicare Advantage plans with greater degrees of integration associated with lower plan disenrollment rates? In this cross-sectional study of 2.7 million dually eligible Medicare beneficiaries, dually eligible…

Read this article

Medicare and the Health Care Delivery System

June 12, 2025

MedPAC

MedPAC also highlighted institutional special needs plans (I-SNPs) for nursing home residents, highlighting their potential for improved care coordination despite limitations in data and access. The report also touches on…

Read this article

Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent

June 1, 2025

Health Affairs

This article quantifies the prevalence of claim denials in Medicare Advantage (MA), along with their direct impact on provider revenue. Employing medical claims data from multiple MA plans, covering 30…

Read this article

When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too

April 28, 2025

…After several anxious weeks, Neary learned Humana and Baylor were parting ways as of this year, and he was forced to choose between the two. Because the breakup happened during…

Read this article

Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types

April 18, 2025

JAMA

How do the characteristics of dual-eligible beneficiaries with full Medicaid vary across Medicare Advantage (MA) plans that attain different levels of coordination and integration with Medicaid? This cross-sectional study including…

Read this article

Insurer-Level Estimates of Revenue From Differential Coding in Medicare Advantage

April 8, 2025

Annals of Internal Medicine

GAINING CLARITY: This must-read for skilled nursing facilities dissects key trends shaping the 2024 Medicare Advantage landscape, directly impacting resident referral patterns and facility bottom lines.

Read this article

Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023

January 28, 2025

Read this article

Do Medicare Beneficiaries Under Accountable Care or Medicare Advantage Use Lower Quality Nursing Homes?

December 31, 2024

Journal of the American Geriatrics Society

Read this article

Medicare Spending was 27% More for People who Disenrolled from Medicare Advantage than for Similar People in Traditional Medicare

December 6, 2024

Read this article

Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending

November 2, 2024

Health Affairs

Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial…

Read this article

journal-of-post-acute-and-long-term-care-medicine

Trends in Post-Acute Care use in Medicare Advantage Versus Traditional Medicare: A Retrospective Cohort Analysis

October 1, 2024

JAMDA

Study ObjectivesWe sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional…

Read this article

Medicare Advantage: Questionable Use of Health Risk Assessments Continues To Drive Up Payments to Plans by Billions

October 1, 2024

Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS) for enrollees who are sicker, which helps to ensure that plans receive sufficient…

Read this article

Dual-Eligible Nursing Home Residents: Enrollment Growth In Managed Care Plans That Coordinate Care, 2013–20

September 30, 2024

Health Affairs

“Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system…

Read this article

Medicare Advantage Quality Bonus Payments Will Total at Least $11.8 Billion in 2024

September 11, 2024

Read this article

Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

August 8, 2024

Read this article

Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

August 8, 2024

In 2024, three quarters (75%) of enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is a big…

Read this article

Use of Prior Authorization in Medicare Advantage Exceeded 46 Million Requests in 2022

August 8, 2024

GAINING CLARITI: This analysis from KFF highlights the substantial increase in prior authorization requests for Medicare Advantage beneficiaries, exceeding 46 million in 2022. This trend affects skilled nursing facilities as…

Read this article

Structural Inequities in Medicare Advantage — A Growing Cause for Concern

July 23, 2024

JAMA

From its inception, Medicare Advantage (MA), a program in which private health insurers contract with the Medicare program to provide coverage on a capitated basis, has faced significant criticism that…

Read this article

Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage Members

July 9, 2024

American Journal of Managed Care

Key Takeaways Following acute hospitalization, Medicare Advantage members with orders to receive home health may not ultimately receive these services for member- and health care system–related reasons. Common reasons for…

Read this article

Denials and Appeals in Medicaid Managed Care

March 30, 2024

MACPAC

Chapter 2 looks at the monitoring and oversight of denials and appeals in Medicaid managed care and the beneficiary experience with the appeals process. Beneficiaries appeal few denials, and program…

Read this article

Coverage Denials in Medicare Advantage—Balancing Access and Efficiency

March 1, 2024

JAMA

“Given the lack of available data to describe MA claim denials, increasing transparency is a critical first step. Although the rule requires public disclosure of MA plans’ utilization review criteria,…

Read this article

CMS’ Medicare Benefit Policy Manual

October 5, 2023

The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…

Read this article

‘Not Accountable to Anyone’: As Insurers Issue Denials, Some Patients Run Out of Options

August 21, 2025

…Health insurers issue millions of denials every year. And like the Tennants, many patients find themselves stuck in a convoluted appeals process marked by long wait times, frustrating customer service…

Read this article

Elevance loses lawsuit over Medicare Advantage quality ratings

August 19, 2025

STAT

A federal judge in Texas struck down Elevance Health’s lawsuit that argued the government unfairly lowered its Medicare Advantage quality ratings — a decision that could cost Elevance $375 million…

Read this article

Humana must face class action suit over use of AI in denying post-acute care

August 18, 2025

McKnights

Humana must face a class action lawsuit alleging that its use of artificial intelligence to deny post-acute care to Medicaid Advantage beneficiaries became fraud when those automated decisions replaced the…

Read this article

Long-Term Services and Supports in Supplemental Benefits in Medicare Advantage Plans

August 11, 2025

JAMA

To what extent have Medicare Advantage (MA) plans provided long-term services and supports (LTSS) supplemental benefits over time? In this cohort study of 4,521 MA plans in 2019 and 6,614…

Read this article

Expanding PACE could further reduce taxpayer burden, improve care, report finds

August 7, 2025

McKnights

The Program of All-Inclusive Care for the Elderly saves taxpayers more than $2.8 billion annually, according to a new issue brief from the Center for Medical Economics and Innovation at…

Read this article

The great Medicare Advantage contraction appears set to continue

August 6, 2025

Healthcare Dive

Shakespeare famously wrote in The Tempest, “What’s past is prologue,” to express how events of the past set the stage for developments in the present. That sentiment was clear for…

Read this article

Medicare Advantage in 2025: Enrollment Update and Key Trends

July 28, 2025

More than half (54%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2025. While a growing share of Medicare beneficiaries are enrolled in a Medicare Advantage plan, the…

Read this article

Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

July 28, 2025

In 2025, more than three quarters (76%) of enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is…

Read this article

Most Medicare Advantage Markets are Dominated by One or Two Insurers

July 14, 2025

Read this article

Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates

July 3, 2025

JAMA

Read this article

Medicare Advantage Linked to Delays in Nursing Home Care, Longer Hospital Stays

June 25, 2025

Skilled Nursing News

Amid increasing evidence that prior authorization and denials in Medicare Advantage (MA) may delay access to nursing homes, a new study shows that MA patients often experience longer hospital stays…

Read this article

CarDon CEO Zach Cattell: Managed Medicaid is ‘Biggest Wrench’ Pushing System Overhaul

June 24, 2025

Skilled Nursing News

As Zach Cattell, the newly appointed president and CEO of CarDon & Associates, celebrates wins, he is mindful of several challenges stemming from both federal and state policies, with the…

Read this article

Health insurers promise to reduce barriers to care under pressure from Trump administration

June 23, 2025

STAT

Last week’s pledge from more than 40 health insurers to cut down on prior authorizations came after some behind-the-scenes convincing from the Trump administration. The administration pushed insurers to sign…

Read this article

Medicare and the Health Care Delivery System

June 12, 2025

MedPAC

Read this article

Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent

June 1, 2025

Health Affairs

Read this article

Congress Focuses on Reforming Medicare Advantage Prior Authorization

May 23, 2025

US Senate

Federal lawmakers urge CMS to increase oversight of MA plans, particularly those “inventing new strategies” like concurrent reviews, pre-payment audits, and payment integrity administrative reviews to delay or deny care…

Read this article

CMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage Audits

May 21, 2025

The CMS Audit initiative involves deploying advanced technology and expanding the workforce of medical coders to clear a backlog of audits from 2018-2024 and audit all eligible MA contracts going…

Read this article

Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers

May 21, 2025

Wall Street Journal

A Guardian investigation finds insurer quietly paid facilities that helped it gain Medicare enrollees and reduce hospitalizations. Whistleblowers allege harm to residents UnitedHealth Group, the nation’s largest healthcare conglomerate, has…

Read this article

How Will Trump and Oz Handle Post Acute Medicare Advantage?

May 13, 2025

With the new administration, industry players are looking for signs of a trend in the management of Medicare Advantage (MA) plans, reflecting ongoing efforts to control costs, improve quality, and…

Read this article

UnitedHealth stock tumbles as CEO resigns, 2025 outlook pulled

May 13, 2025

STAT

UnitedHealth Group CEO Andrew Witty abruptly stepped down from the health insurance and care conglomerate on Tuesday, citing personal reasons, capping the end of a tumultuous four-year tenure that included…

Read this article

Find More Medicare Advantage Resources