Medicare, Medicaid and CHIP
Government programs ensure access to healthcare for vulnerable populations. Medicare covers people 65 and older and younger individuals with specific disabilities. Medicaid and the Children's Health Insurance Program (CHIP) are joint federal-state initiatives offering health coverage to low-income families, children, pregnant women, the elderly and people with disabilities.
Top Stories
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23 Dec 2024
How to overcome weaknesses in Medicaid postpartum coverage
Medicaid postpartum coverage extensions have been critical, but states face challenges addressing access to care, quality of care and MCO accountability. Continue Reading
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06 Dec 2024
Lawmakers promote access to direct primary care in Medicaid
While Medicaid programs can use waivers to implement direct primary care, a law that is under consideration in the Senate would make it easier for states to take this approach. Continue Reading
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11 Jan 2023
Deductibles, Copayments, OOP Max Trends Indicate Cost-Sharing Growth
Between 2013 and 2020, employees experienced higher cost-sharing for many medical services, although some shifts depended on plan type and union employment. Continue Reading
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10 Jan 2023
Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM
BCBSM’s full-risk value-based care contracts aim to improve members’ healthcare experience by boosting care quality and reducing costs. Continue Reading
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04 Jan 2023
Women with Employer Sponsored Health Insurance Face Affordability Issues
Nearly 4 percent of women with employer-sponsored health insurance reported unaffordability for medical care compared to 2.7 percent of men. Continue Reading
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30 Dec 2022
CA, AZ Payers Boost Care Access for Active-Duty Service Members
Active-duty service members will have access to Blue Shield of California’s and Blue Cross Blue Shield of Arizona’s provider networks during their service and after transitioning to Veterans Affairs eligibility. Continue Reading
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28 Dec 2022
Court Says BCBSIL Cannot Exclude Coverage of Gender-Affirming Care
BCBSIL is a third-party administrator for an employer-sponsored health plan that denied coverage of gender-affirming care for an employee’s transgender son. Continue Reading
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28 Dec 2022
How Payer, Provider Alignment Enables Simplified Medical Billing Format
After years of working toward this goal, the payer and provider partners introduced a simplified medical billing format, in part made possible due to their joint venture model. Continue Reading
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22 Dec 2022
Harvard Pilgrim, Tufts Health Plan Increase Caregiver Support for Members
Commercial members will have access to caregiver support tools starting in January 2023, including care coordinators and an online peer network. Continue Reading
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21 Dec 2022
Blue Cross MN Value-Based Contract Reduced Cancer Care Costs
The value-based contract, which focuses on utilizing care coordination to prevent unnecessary hospital visits, reduced cancer care costs by more than ten percent for patients with Blue Cross employer group coverage. Continue Reading
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20 Dec 2022
How Coverage and Costs Vary Within Different Types of Health Plans
Different types of health plans, such as health maintenance organizations and preferred provider organizations, can lead to varying out-of-pocket expenses, monthly premiums, and annual deductibles for members. Continue Reading
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19 Dec 2022
93% of Employees Satisfied with Employer Sponsored Health Insurance
Employees described their employer-sponsored health insurance as affordable, high-quality, and comprehensive. Continue Reading
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15 Dec 2022
Nonprofit Sues GA for Refusing to Cover Transgender-Related Healthcare
The lawsuit aims to prevent the Georgia State Health Benefit Plan, which provides health insurance coverage for over half a million Georgians, from excluding coverage for transgender-related healthcare. Continue Reading
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15 Dec 2022
SCAN Group, CareOregon Plan to Combine, Form HealthRight Group
The new combined company that SCAN Group and CareOregon form would continue to serve Medicare and Medicaid beneficiaries. Continue Reading
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14 Dec 2022
ACAP Health Plans Will Identify Birthing-Friendly Hospitals in Directories
Including the birthing-friendly hospital designation in provider directories will help ACAP health plan members identify facilities that deliver quality maternal healthcare. Continue Reading
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13 Dec 2022
Payer Announces Partnership to Offer In-Home Care with Flexible Hours
The partnership allows members to access in-home care after normal primary care office hours any day of the week. Continue Reading
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12 Dec 2022
Aetna Grants $9.3M to Support Behavioral Health for Youth in Foster Care
The funding supports Aetna’s goal of helping children in foster care transition to home- or community-based settings and receive behavioral health services. Continue Reading
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12 Dec 2022
Heat-Related Illness Diagnoses Among Private Payer Members Are Increasing
Payers should be aware that heat-related illness diagnoses are increasingly prevalent among males and older privately-insured populations. Continue Reading
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09 Dec 2022
High Deductibles Create Barriers to Screening Mammograms, Follow-Up Tests
More than 20 percent of women said they would skip follow-up tests for a screening mammogram if they knew they would face a high deductible. Continue Reading
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08 Dec 2022
Elevance Health ACO Generated Cost Savings Among Fully Insured Members
Under Elevance Health’s ACO model, cost savings ranged from -$25.42 per member per month in 2016 to -$44.08 per member per month in 2020 for fully insured members. Continue Reading
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06 Dec 2022
Behavioral Health Treatment was Associated with Lower Healthcare Costs
The mean per member per month healthcare cost for individuals who received outpatient behavioral health treatment was $571 compared to $686 for those who did not receive treatment. Continue Reading
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05 Dec 2022
CareFirst Funds Community-Based Orgs to Boost Behavioral Healthcare Access
The community-based organizations are working to improve behavioral healthcare access for youth and strengthen the provider workforce in low-income and rural areas. Continue Reading
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02 Dec 2022
Payer Sees Significant Mental Healthcare Utilization, Network Size Growth
Blue Cross Blue Shield of Massachusetts shared data on mental healthcare utilization and network size shifts that reflected the payer’s mental healthcare expansions. Continue Reading
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01 Dec 2022
Health Insurance Price Growth Rises to 20%, Outpacing Other Medical Care
Experts anticipated high health insurance prices, but it remains unclear whether high prices in the rest of the nation’s goods and services will push health insurance prices even higher. Continue Reading
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30 Nov 2022
Gold Carding Has Mixed Effects on Streamlining Prior Authorization Processes
Gold carding is a relatively new approach to streamlining prior authorization processes that appealed to many health plans but may not consistently deliver on its promises. Continue Reading
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29 Nov 2022
Health Insurance Coverage Disruptions Tied to Higher Mortality Risks
The link between health insurance coverage disruptions and high mortality risks highlights the importance of including coverage disruption assessments in social risk screenings. Continue Reading
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28 Nov 2022
SCAN Health Plan Expands Dual Eligible Special Needs Plan in CA
The payer’s Fully Integrated Dual Eligible Special Needs Plan includes zero-dollar copays for prescription drugs, free access to virtual behavioral health services, and dental coverage, among other benefits. Continue Reading
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23 Nov 2022
35% More MA Plans Offering Home-Based Supplemental Benefits in 2023
The number of Medicare Advantage plans to offer primarily health-related supplemental benefits increased from 824 in 2022 to 1,111 in 2023. Continue Reading
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22 Nov 2022
Health Insurance Is Expensive, But Americans Intend to Keep Their Plans in 2023
Seven out of ten Americans plan to stay in their current health plan in 2023 even as healthcare costs escalate, but many also have a threshold for how much more they are willing to pay. Continue Reading
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22 Nov 2022
Medicare Advantage Premiums Rise, Zero-Dollar Premium Plan Uptake Declines
Data from the first half of the 2023 open enrollment season is revealing departures from the last three years’ open enrollment trends. Continue Reading
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17 Nov 2022
Top 5 States with the Highest Levels of Healthcare Spending
Healthcare spending was highest in South Dakota, Louisiana, West Virginia, Florida, and Wyoming. Continue Reading
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17 Nov 2022
CareSource Addresses LGBTQA+ Housing Social Determinants of Health Barriers
The payer will help pay for the construction of an inclusive housing setting for LGBTQA+ seniors who often face discrimination and social determinants of health barriers when seeking housing. Continue Reading
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16 Nov 2022
ERIC: Allow Employer Sponsored Health Plans to Electronically Deliver AEOB
If employer sponsored health plans could deliver advanced explanation of benefits materials electronically, it could improve costs and members’ healthcare literacy. Continue Reading
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15 Nov 2022
50% of Coronavirus Hospitalizations Covered by ESI Cost Over $25K
Coronavirus hospitalizations could cost between $10,000 and more than $38,000 in employer-sponsored health plans, depending largely on whether the hospitalization included an ICU stay. Continue Reading
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10 Nov 2022
How Massachusetts’ Benchmark Impacted Healthcare Cost Growth
Accountability mechanisms that accompanied the state’s benchmark legislation, including Cost Trends Hearings and Performance Improvement Plans, did little to constrain healthcare cost growth, stakeholders noted. Continue Reading
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09 Nov 2022
Community Health Plans Lowered Consumer Healthcare Spending in 2022
Community health plans improved healthcare spending in a variety of ways, but largely through their drug pricing advocacy and premium adjustments. Continue Reading
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09 Nov 2022
Elevance Health Will Acquire Specialty Pharmacy To Treat Chronic Diseases
The payer has already shared plans to improve the specialty pharmacy’s speed and expand its services to encompass a wider scope of chronic diseases. Continue Reading
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07 Nov 2022
Banner|Aetna Health Plan Streamlines Bill Format to Improve Medical Billing
Given how confusing medical billing can be for members, Banner|Aetna reformatted the medical bill that patients receive and implemented automated billing along with other solutions. Continue Reading
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07 Nov 2022
37% of People Switched Health Insurance Plans During Perinatal Period
Individuals covered by Medicaid or Medicaid managed care were more likely to switch health insurance plans during the perinatal period than those with private insurance. Continue Reading
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04 Nov 2022
Report Urges CMS to Increase Oversight of Medicare Advantage Marketing
The Senate Finance Committee report urged CMS to conduct regular oversight of Medicare Advantage marketing materials and prohibit plans from contracting with deceptive agents and brokers. Continue Reading
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04 Nov 2022
AMA: 79% of Medicare Advantage Markets Have Little Competition
AMA found that around a third of Medicare Advantage markets in 2021 had one insurer with a market share of 50 percent or more, indicating low competition levels. Continue Reading
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03 Nov 2022
Better Access to Health Insurance Coverage Boosted Healthcare Use
Gen Z and Millennials were more likely to say that premium subsidies and Medicaid provisions, which improved access to health insurance during the pandemic, led to increased healthcare use compared to older generations. Continue Reading
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03 Nov 2022
Employers Juggle High Healthcare Spending, Hiring Challenges in 2022
Employers are turning to whole person care, high-cost claims management, hospital quality and price transparency as they seek to control healthcare spending. Continue Reading
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02 Nov 2022
Medicare Advantage Offers Better Access to Behavioral Healthcare Than FFS
Behavioral healthcare services are crucial for seniors, but fee-for-service Medicare may not provide enough coverage. Continue Reading
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01 Nov 2022
2022 Employee Contributions Trends in Employer Sponsored Health Plans
Employee contributions to healthcare costs in employer sponsored health plans will vary based on the size of the company and the type of coverage. Continue Reading
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31 Oct 2022
Dialysis Triples Healthcare Spending for Members with Chronic Diseases
Private health plan members with chronic diseases that require dialysis demonstrate a dramatic spike in healthcare spending when they start dialysis. Continue Reading
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31 Oct 2022
Cigna Expands Value-Based, In-Home Primary Care Services in Medicare Advantage
The payer sought to expand access to in-home primary care services in order to improve healthcare spending and quality of care in its Medicare Advantage plans. Continue Reading
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24 Oct 2022
Blue Cross NC Scholarship Program Aims to Diversify Health Insurance Industry
The program aims to lower cost-related barriers for minorities and women seeking to enter the health insurance industry. Continue Reading
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21 Oct 2022
Humana Expands 2023 Medicare Advantage Dental Benefits in Florida
Humana Medicare Advantage members in Florida will have access to new dental benefits in 2023, including higher annual allowances of up to $6,000 that can be used for out-of-pocket dental, vision, or hearing expenses. Continue Reading
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19 Oct 2022
UHC Supports Health Equity for Disabled Members Through Program Investments
UnitedHealthcare put $5 million toward an organization that addresses employment opportunities and healthcare support for Texans with disabilities. Continue Reading
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18 Oct 2022
Subsidies Drive Individual Health Insurance Marketplace Enrollment
Individual health insurance marketplace enrollment has grown in recent years, largely driven by subsidized coverage on the Affordable Care Act marketplace. Continue Reading
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17 Oct 2022
SCAN Health Plan Starts a Medicare Advantage Health Plan for LGBTQ+ Seniors
The Medicare Advantage health plan is available for enrollment during the 2023 open enrollment season which started on October 15, 2022. Continue Reading
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14 Oct 2022
BCBS Health Plan Expands Medicare Advantage Drug, Mental Health Benefits
The health plan unveiled new benefits that expanded Medicare Advantage members’ access to brand-name drugs, mental healthcare services, and fitness services. Continue Reading
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07 Oct 2022
Blue Cross Blue Shield Expands Benefits for Federal Employees
Blue Cross Blue Shield made changes to its federal employee healthcare coverage with the goal of reducing costs for members. Continue Reading
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06 Oct 2022
Blue Cross NC Partnership Aims to Improve Fall Prevention for Members
The payer partnered with a healthy housing organization to assess members’ fall risk and offer them fall prevention resources. Continue Reading
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06 Oct 2022
Alignment Health Expands Medicare Advantage Offerings for 2023
The payer is expanding its Medicare Advantage offerings to reach members in 14 additional counties and two new states: Florida and Texas. Continue Reading
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05 Oct 2022
Employer Sponsored Health Plan Enrollment Dropped 5% During Pandemic
Employer-sponsored health plan enrollment fell from 14 million members in January 2020 to 13.3 million members in June 2021. Continue Reading
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05 Oct 2022
Health Plan Shares Insurance Definitions to Boost Member Health Literacy
Bolstering member health literacy is critical in the weeks leading up to open enrollment season for Medicare and the federal marketplace. Continue Reading
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03 Oct 2022
Payer Donates to Expand Mental Health Treatment Training for Providers
The Aetna health plan sought to open up another mental health treatment option for members suffering with adverse childhood events and trauma. Continue Reading
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03 Oct 2022
4 Payers Share 2023 Medicare Open Enrollment Benefits, Inflation Drives Updates
Payers framed their new benefits for 2023 Medicare open enrollment in the context of rising inflation and efforts to lower healthcare costs. Continue Reading
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29 Sep 2022
Independence Expands Value-Based Care Relationship, Seeks to Boost Primary Care
The payer will sell a minority stake in one of its subsidiaries to Penn Medicine, continuing the payer’s value-based care relationship with the health system. Continue Reading
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29 Sep 2022
Modernizing Patient Payments to Address Healthcare Consumerism
Healthcare consumerism and increased patient financial responsibility are challenging providers to think differently about patient payments. Continue Reading
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28 Sep 2022
UHC Awards $200K in Social Determinants of Health Grants in NM
To address social determinants of health needs in New Mexico—particularly housing-related needs—UnitedHealthcare offered the grants to four community organizations. Continue Reading
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26 Sep 2022
Businesses Struggle to Meet Employer Sponsored Health Plan Expectations
Nearly three in four employees said their employer prioritized business needs over worker needs when selecting employer-sponsored health plan options. Continue Reading
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26 Sep 2022
How Data, Analytics, and Collaboration Drive Healthcare Innovation
For the healthcare industry to achieve the goals of truly patient-centered care, stakeholders must work collaboratively and break down silos of information and knowledge. Continue Reading
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23 Sep 2022
Payers Leverage Technology to Boost Maternal Health Outcomes
With the worsening maternal mortality crisis, AHIP noticed more payers are working to improve maternal health outcomes by integrating telehealth and other technologies into care programs. Continue Reading
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23 Sep 2022
Uninsurance, High Deductible Plans Linked to Greater Medical Debt
Around 15 percent of uninsured adults and 12 percent of those with private high-deductible health plans reported medical debt, compared to 9.4 percent of Medicare beneficiaries. Continue Reading
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22 Sep 2022
Aetna Reduces Member Suicide Rate, Adolescents Behavioral Health Lagging
The payer achieved a 15.7 percent reduction in its suicide rate between 2019 and early 2022, but adolescent behavioral health continues to suffer increases in the suicide rate. Continue Reading
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19 Sep 2022
Employer Sponsored Health Plan Costs Expected to Increase in 2023
Employer-sponsored health plan costs will likely increase as one in four employers plan to shift rising expenses to employees through higher premiums. Continue Reading
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19 Sep 2022
NCQA Shares Health Plan Performance Ratings Ahead of Open Enrollment
The NCQA ratings reflect various measures of health plan performance in 2021, including clinical quality and patient experience. Continue Reading
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12 Sep 2022
Large Employers Aim to Redirect Healthcare Spending, Boost Quality
Large employers will focus on improving healthcare affordability, member outcomes, and health equity by redirecting healthcare spending and purchasing to support high-quality, whole-person care. Continue Reading
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09 Sep 2022
Anthem Grants $150K to Support Substance Use Disorder Services
The $150,000 grant will go towards helping people with substance use disorders transition from treatment, incarceration, or other high-risk settings to stable housing environments. Continue Reading
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08 Sep 2022
CVS Health: How Educators, Parents Factor Into Adolescent Mental Health
Parents and educators can play important roles in adolescents’ mental health journeys, especially as the adolescent mental health crisis escalates. Continue Reading
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07 Sep 2022
HCSC Employs Virtual Care To Expand Access to Primary Care Services
The payer’s virtual care solution was already available in some regions but will now enter two new states: Illinois and Texas. Continue Reading
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07 Sep 2022
Most of Premium Dollar Used for Prescription Drugs, Medical Services
Inpatient and outpatient hospital costs combined accounted for 38.9 cents of the healthcare premium dollar, while 22.2 cents went toward prescription drugs. Continue Reading
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06 Sep 2022
Trends in 2021 Employer Sponsored Health Plan Costs, Coverage
Almost half of private-sector businesses offered access to an employer-sponsored health plan and 85 percent of employees were eligible for coverage in 2021. Continue Reading
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31 Aug 2022
Medicare Advantage Plan Quality Varies by Premium Cost
Medicare Advantage plan quality was generally higher in plans with steeper premiums, but some lower-premium plans were also high-quality. Continue Reading
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26 Aug 2022
Senator Looks Into Deceptive Marketing by Medicare Advantage Plans
Senator Ron Wyden requested data from 15 states on beneficiary complaints and deceptive marketing practices by Medicare Advantage plans. Continue Reading
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25 Aug 2022
Employer Sponsored Health Plans Will Prioritize Mental Health in 2023
Despite concerns about rising healthcare costs, employer-sponsored health plans are focused on improving access to mental health services and reducing burnout among employees. Continue Reading
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24 Aug 2022
How Coverage, Costs Vary Within Different Types of Health Plans
Different types of health plans, such as health maintenance organizations and preferred provider organizations, can lead to varying out-of-pocket expenses, monthly premiums, and annual deductibles for members. Continue Reading
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23 Aug 2022
How Medicare Advantage Enrollment Has Grown, Diversified in 10 Years
Medicare Advantage enrollment growth stems both from brand new enrollees and enrollees who are switching to Medicare Advantage from traditional Medicare. Continue Reading
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22 Aug 2022
Medicare Advantage Member Satisfaction Soars, Mental Health Coverage Lags
Medicare Advantage member satisfaction rose 3 points in 2022, but fewer members reported having enough coverage for mental health services. Continue Reading
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22 Aug 2022
How Payers Are Increasing Access to Behavioral, Mental Healthcare Services
Payers are working toward achieving broader access to mental healthcare and behavioral healthcare services by reimbursing at higher rates and supporting primary care. Continue Reading
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17 Aug 2022
Judge Finalizes Blue Cross Blue Shield Antitrust Settlement
The companies will pay out $2.67 billion in the antitrust settlement and agreed to change some of their practices. Continue Reading
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16 Aug 2022
Cigna + Oscar Extends Small Business Health Plan to Philadelphia
Under the Cigna + Oscar small business health plan, enrollees will have access to behavioral health support, and Cigna’s network of physicians, specialists, and hospitals. Continue Reading
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16 Aug 2022
Humana Plans to Acquire Medicaid Managed Care Organization
The acquisition of Medicaid managed care organization, Inclusa, will ramp up the number of Medicaid recipients that Humana serves. Continue Reading
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15 Aug 2022
Payer Fuses Family, Maternal Care Through Virtual Care, Care Management
Blue Cross Blue Shield of Michigan and Blue Care Network took a different approach to maternal care by incorporating family-building benefits. Continue Reading
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15 Aug 2022
How Payers Overcome Nursing Shortages to Improve Patient Experience
With demand for post-acute care and home health increasing among Medicare beneficiaries, payers must adapt quickly to changing staffing and quality reporting needs to scale their offerings successfully. Continue Reading
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12 Aug 2022
UHC Rebrands Self-Funded Health Plan, Focus on Price Transparency
UnitedHealthcare’s rebranded health plan offers price transparency tools that, according to company data, have secured savings for members and employers. Continue Reading
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11 Aug 2022
UnitedHealthcare Grants Address Social Determinants of Health, Care Access
UnitedHealthcare provided $11 million in grants to reduce disparities and improve social determinants of health barriers that can reduce access to care. Continue Reading
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10 Aug 2022
Employees Lack Health Insurance Enrollment Knowledge, Support
Health insurance enrollment is a complex issue for many employees, who tend to overestimate their own knowledge on the subject and are hesitant to reach out to human resource support. Continue Reading
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08 Aug 2022
SCAN Health Plan Announces Medicare Advantage Expansion into TX
The payer’s executives stated that local providers with similar objectives invited the payer to enter the markets in Texas. Continue Reading
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08 Aug 2022
How Long COVID Could Impact Health Insurance Coverage, Eligibility
If federal disability programs classify long COVID as a disability, individuals who lose employer-sponsored health insurance coverage could newly qualify for Medicare or Medicaid. Continue Reading
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05 Aug 2022
Humana Receives Top Ranking for Health Plan Member Experience
In addition to ranking number one for member experience, Humana received the highest ranking for customer service, offering transparent prices, and providing clear communication. Continue Reading
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04 Aug 2022
UHG Data Shows Impact of Telehealth on Outpatient Behavioral Health
Outpatient behavioral health—particularly care delivered by counselors, therapists, and clinical social workers—received a significant boost due to telehealth utilization. Continue Reading
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04 Aug 2022
Aetna CVS Health Intends to Enter CA Individual Health Insurance Marketplace
Aetna CVS Health members of the new individual health insurance marketplace plan will have access to a range of services including chronic disease management. Continue Reading
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03 Aug 2022
Cigna Extends Medicare Advantage Transportation Benefit Due to Heat
The Medicare Advantage transportation benefit was already available to seniors for appointments and other needs, but now it may help them escape the heat. Continue Reading
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02 Aug 2022
UHG Initiative for Children with Special Needs Boosts Net Promoter Score
UnitedHealth Group’s initiative for families who have children with special needs resulted in a 76-point increase in the net promoter score within that population. Continue Reading
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01 Aug 2022
Aetna Medicaid Plan Recognized by NCQA for Health Equity Efforts
The NCQA recognized Aetna’s California Medicaid plan for its efforts to boost health equity and provide members with culturally and linguistically sensitive services. Continue Reading
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29 Jul 2022
Top Factors Influencing Employer Sponsored Health Plan Premiums in 2023
Employer-sponsored health plan premiums for 2023 will be subject to inflation and utilization trend changes, along with some lingering effects from the coronavirus pandemic. Continue Reading
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25 Jul 2022
Data Shows Lack of Health Equity in Employer Sponsored Health Plans
Care disparities between races and sexual orientations highlight the need for better health equity in employer-sponsored health plans. Continue Reading
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20 Jul 2022
Medicare Advantage Plans See High Enrollment, Low Spending in 2022
Health maintenance organizations still dominate members’ selection of Medicare Advantage plans. Continue Reading