Post 2Q, Medicaid MCOs Proceed With Caution
Earnings posted by publicly traded insurers for the second quarter of 2020 reflect the continued impact of the COVID-19 pandemic that began in March, with low medical loss ratios (MLRs) driven by depressed utilizati...
News Briefs
✦ The Dept. of Justice (DOJ) on Aug. 4 filed a complaint-in-intervention in the U.S. District Court for the Southern District of New York, alleging that Cigna Corp. and its affiliates submitted false and fraudule...
Uncertainties Abound as MAOs Prep for 2020 Program Audits
After providing a break to Medicare Advantage and Part D plans dealing with the COVID-19 pandemic by suspending audit and quality reporting activities, CMS appears to be hitting the restart button on 2020 program au...
Election, Pandemic Will Flip the Script on AEP Sales Tactics
Given the likelihood of continued social distancing as a result of the COVID-19 pandemic, health plans and brokers selling Medicare Advantage plans this fall will rely heavily on call center and online enrollment, t...
With Record Unemployment, Recession Alters Medicare ‘Age-In’ Landscape
As shutdowns tied to the COVID-19 pandemic have led to the highest unemployment rate seen in the U.S. since the Great Depression, the current recession appears to be reversing the trend of Medicare “age-ins” put...
Is Molina the Next Aggregator of Smaller Medicaid Plans?
With an increasing share of seniors enrolling each year, a healthy rate environment and a meaningful return on scale, Medicare Advantage is largely seen as a safe space for insurers and one that is likely to drive m...
News Briefs
✦ The Pennsylvania Dept. of Human Services (DHS) on July 8 named the successful respondents to its latest request for applications to serve some 2.6 million HealthChoices enrollees, but the agency said it is unab...
ESRD Enrollment Creates Cost, Network Unknowns for MAOs
As Medicare Advantage plans prepare to enroll patients with end-stage renal disease (ESRD) this fall, a recent change to network adequacy measurement will give them some flexibility in how they include dialysis care...
Star Ratings Take Aim at Member Experience in ‘Huge’ Shift
CMS, building on its multi-year theme of emphasizing member experience within Medicare Advantage (MA), is increasing the weight of member experience measures beginning with the 2021 star ratings. By the 2023 star ra...
Post-COVID, Centene Foresees Expansion in MA and Medicaid
Providing updated guidance three months into the COVID-19 pandemic, managed Medicaid leader Centene Corp. last month raised its full year adjusted earnings per share outlook by 20 cents at the midpoint to an EPS ran...