Radar on Medicare Advantage

2021 Outlook: COVID Vax, State Budget Issues Add to Medicaid MCOs’ Urgency to Address Disparities

As the novel coronavirus erupted across the U.S. and created a widespread economic downturn, it led to increased enrollment in state Medicaid programs and created devastating budget shortfalls for states. Yet Congre...
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© 2024 MMIT

News Briefs

✦ Humana Inc. in a new lawsuit alleges that Kentucky violated its five Medicaid contracts by allowing Molina Healthcare, Inc. to acquire the Medicaid membership of Passport Health Plan, reports Louisville Busines...
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© 2024 MMIT

COVID Vax Rollout May Hinge On MCO Messaging, Tracking

With a recent emergency use authorization (EUA) granted to the first COVID-19 vaccine and another one expected at press time, states and the federal government this week began rolling out the vaccine to health care ...
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© 2024 MMIT

Marketers Report Slow Start to AEP, Rise in Digital Channels

Preliminary observations from several Medicare Advantage marketing experts indicate that during the 2021 Medicare Annual Election Period (AEP), consumers were slow to make enrollment decisions early on, and switchin...
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Advocates, MCOs Urge Longer Postpartum Medicaid Coverage

As states face intense budget pressures during the COVID-19 pandemic and beneficiary advocates urge the federal government to provide additional financial support to state Medicaid programs, extending postpartum car...
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BMA, Avalere Research Illustrates MA Outperformance on Multiple Care Measures

A new study comparing quality outcomes for Medicare Advantage enrollees vs. traditional fee-for-service (FFS) Medicare beneficiaries found that high-need, high-cost populations enrolled in MA had better care experie...
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News Briefs

✦ Risk scores used to adjust Medicare Advantage plan payments were more than 3% higher than in Medicare fee for service, despite CMS establishing a 5.9% coding intensity adjustment to account for the impact of co...
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Without Rebate Dollars, Part D Plans Ponder 2022 Bids

As part of a late-term rulemaking blitz, the Trump administration on Nov. 20 finalized a controversial HHS rule designed to eliminate the use of drug manufacturer rebates in Medicare Part D and ensure that such reba...
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Questions Linger About Part D Rebate Rule’s Fate, Legality

As Medicare Part D plans consider their 2022 plan year bids without the negotiating tool of manufacturer rebates, it remains to be seen whether HHS’s recently finalized rebate rule (85 Fed. Reg. 76666, Nov. 30, 20...
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MA, D-SNP Sponsors Ask for Grace in Risk Score Determination

As CMS considers its final rate notice for the 2022 plan year and charts a full transition to the encounter data system (EDS) for calculating risk scores, Medicare Advantage insurers are pleading with the agency to ...
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