Radar on Medicare Advantage

While MAOs Embrace ‘Flex Benefits,’ SSBCI Uptake Is Slow

After a relatively modest first year, the number of condition-specific supplemental benefits offered by Medicare Advantage plans more than doubled from approximately 820 in 2019 to 1,850 this year, according to a ne...
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© 2024 MMIT

News Briefs

✦ UnitedHealth Group on April 15 reported first-quarter 2020 adjusted earnings per share of $3.72, in line with the same period last year, and maintained its full year EPS outlook in the range of $16.25 to $16.55...
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© 2024 MMIT

CMS Eases Up on MA Data Collection, But Unknowns Remain

As efforts to contain the outbreak of COVID-19 continue to evolve, the Trump administration on March 30 issued a series of new flexibilities aimed at increasing hospital and provider capacity. At the same time, CMS ...
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© 2024 MMIT

MAOs Hope for More Clarity on Quota Share Reinsurance

Under Medicare law, Medicare Advantage organizations must assume full financial risk on a prospective basis for the provision of basic benefits provided to enrollees. But certain exceptions exist that allow MAOs to ...
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Success of PPOs, OTC Coverage May Drive 2021 MA Offerings

An earlier version of this story incorrectly stated that during the 2020 Medicare Annual Election Period, Bright Health increased its membership by 36% to more than 5 million members and Devoted Health nearly triple...
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GAO to CMS: Get More Data on Default Enrollment of Duals

As states consider new standards for Dual Eligible Special Needs Plans (D-SNPs) that will satisfy statutory requirements beginning in calendar year 2021, the enrollment of dual- eligible beneficiaries in Medicare an...
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© 2024 MMIT

News Briefs

✦ A new lawsuit filed by the U.S. Attorney for the Southern District of New York accuses Anthem, Inc. of bilking the federal government out of millions of dollars through a one-sided chart review program. The ci...
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MA, Medicaid Plans Keep Members Up to Speed on Coronavirus

In the week or so leading up to the U.S. declaring a national emergency, Medicare Advantage and other insurers’ early response to the new coronavirus outbreak included waiving cost sharing related to testing, allo...
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CMS Unveils New Part D Model to Lower OOP Insulin Costs

Under the backdrop of a public health emergency and the White House pressuring Congress to pass drug pricing legislation, CMS on March 11 unveiled a new Innovation Center model that it expects will lower out-of-pock...
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2019 Part D Misclassifications, Formulary Issues Fueled CMPs

Of the 13 Medicare Advantage and Part D organizations that were subject to 2019 program audits, nearly half received a civil monetary penalty (CMP), with noncompliance in the audit area of Part D formulary and benef...
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© 2024 MMIT