…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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…