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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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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26 Nov 2024
CMS suggests public payer weight loss drug coverage changes
Amid suggestions around prior authorizations and AI use, CMS introduces a policy that would expand weight loss drug coverage in Medicare Advantage, Medicaid and Part D plans. Continue Reading
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19 Jul 2022
UnitedHealthcare Cuts Out-of-Pocket Healthcare Costs for Insulin
Fully insured members of UnitedHealthcare can avoid out-of-pocket healthcare costs when obtaining insulin and other prescription drugs starting as early as January 2023. Continue Reading
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13 Jul 2022
Workers in Injury-Prone Industries Lack Employer-Sponsored Health Plans
Workers in industries such as the farming, fishing, and foresting industry see high injury rates and low rates of employer-sponsored health plan coverage. Continue Reading
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12 Jul 2022
UHG Makes $25M Social Determinants of Health Donation To Housing Fund
The donation will support mixed-income housing development in accessible locations to address social determinants of health needs in Massachusetts. Continue Reading
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11 Jul 2022
Consumers Continue to Experience Surprise Billing After No Surprises Act
A fifth of American adults reported experiencing surprise billing in the first half of 2022 and familiarity with the law banning surprise billing declined. Continue Reading
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08 Jul 2022
2% of ACA Marketplace In-Network Claims Denials Are for Medical Necessity
In 2020, the reasoning offered for 72 percent of in-network claims denials was “all other reasons,” highlighting a lack of transparency around claims denials. Continue Reading
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07 Jul 2022
Aetna Takes Action to Enhance Adolescent Suicide Prevention
To further its goal of suicide prevention, the payer will expand its provider mental health education program, begin clinical outreach to high-risk adolescents, and provide additional mental health resources to youth. Continue Reading
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06 Jul 2022
UHC Adds Health System to CO Doctor Plan to Boost Patient Care Access
With more than 11,000 Denver-based caregivers and support staff, HealthONE will increase patient care access to members enrolled in UnitedHealthcare’s Colorado Doctors Plan. Continue Reading
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05 Jul 2022
Payer Recognized for Health Equity, Social Determinants of Health Efforts
Health Net was recognized along with other payers for its efforts to improve health equity during the coronavirus pandemic. Continue Reading
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01 Jul 2022
Employer Sponsored Health Plans Generate Significant ROI, Benefits
Employer-sponsored health plans can reduce spending on direct medical costs, disability claims, and recruitment and retention, leading to a positive return on investment. Continue Reading
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27 Jun 2022
Health Savings Accounts Do Not Control Enrollee Healthcare Spending
As healthcare costs skyrocket, health savings accounts are no longer producing the unique financial barriers that were intended to prevent healthcare spending. Continue Reading
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27 Jun 2022
How Nurses Enable Health Plans to Support Members Aging in Place
With a growing population aging and planning to do so at home, health plans must have the personnel necessary to deliver specialized care outside the clinic. Continue Reading
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27 Jun 2022
Leveraging a Network of RNs Boosts Member Experience, Spending
Payers who leverage a scalable network of RNs as part of their care management programs are poised to succeed in a high-cost, consumer-oriented healthcare environment. Continue Reading
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22 Jun 2022
ACAP Shares Health Equity Goals for Safety Net Health Plans
The organization for community-affiliated health plans emphasized that its strategic initiatives and goals represented a few steps in a long journey toward health equity. Continue Reading
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22 Jun 2022
CVS Health Expands Free Screening Program To Advance Health Equity
The program has been running for over 15 years and will now aim to increase access to care and health equity in Las Vegas, Nevada and Richmond, Virginia. Continue Reading
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22 Jun 2022
How Data Enables Payers to Improve Member Access, Experience
Health plans must invest in data to know more about their members and support quality improvement. Continue Reading
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21 Jun 2022
SCOTUS Sides with Group Health Plan in Dialysis Reimbursement Case
The Supreme Court ruled that the health plan did not violate the Medicare Secondary Payer statute because it offered the same dialysis reimbursement rates and coverage for all individuals. Continue Reading
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20 Jun 2022
Anthem Subsidiary Brands Aim to Boost Member Care, Unify Health Plans
Anthem’s launch of Carelon and Wellpoint as subsidiary brands will focus on improving member care and uniting the payer’s collection of health plans. Continue Reading
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20 Jun 2022
A New Mindset: How Payers Ensure a Successful Digital Transformation
Internal alignment and targeted innovation can enable payers to drive more effective and affordable utilization of healthcare. Continue Reading
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17 Jun 2022
Payers Expected to Issue $1B in Medical Loss Ratio Rebates in 2022
The estimated $1 billion in medical loss ratio rebates for 2022 is lower than what payers issued in both 2021 and 2020. Continue Reading
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14 Jun 2022
BMA: MA Member Satisfaction Is High, Prior Authorization Denials Low
Medicare Advantage member satisfaction is widespread and 77 percent of beneficiaries had not experienced prior authorization denials. Continue Reading
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10 Jun 2022
Private Insurance Covers Most Nonelderly Adults with Mental Health Needs
Most nonelderly adults with mental health needs and substance use disorders have private coverage, but the Medicaid program has the highest prevalence of members with these conditions. Continue Reading
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09 Jun 2022
AHIP to Offer Members Access to Analytics Platform, Data Reports
Payers can use the analytics platform to access evidence-based data reports that can help influence their operational decisions. Continue Reading
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09 Jun 2022
Californians Report Good Quality of Care, Easy Access to Care
Nearly nine out of ten respondents shared that they had experienced good quality of care in 2022. Continue Reading
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08 Jun 2022
Anthem Announces Partnership to Support Maternal Mental Healthcare
The payer is using a digital solution to enable greater access to maternal mental healthcare and community. Continue Reading
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07 Jun 2022
Consumers Say Insurers Are Responsible for Access to Mental Healthcare
Many Americans hold health insurers responsible for providing access to mental healthcare, the survey also found. Continue Reading
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06 Jun 2022
How Data Impacts Medication Access, Adherence, and Utilization
Improved data sharing between providers, payers, and pharmacies will ensure consumers can benefit from a growing body of effective therapies. Continue Reading
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03 Jun 2022
SCAN Group Acquires Home Healthcare Organization, Forms New Practice
The organization’s new home healthcare services will be available to SCAN Health Plan members in addition to other payers’ memberships. Continue Reading
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02 Jun 2022
Humana Continues Integrating Home Healthcare Program into Senior Services
The payer is in the second of three phases as it integrates Kindred at Home, a senior home healthcare program, into its CenterWell Home Health brand. Continue Reading
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01 Jun 2022
Payer Launches At-Home Chronic Disease Management, Education Solution
Blue Cross Blue Shield of Massachusetts implemented a Nudge unit to improve members’ options for at-home chronic disease management. Continue Reading
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01 Jun 2022
CVS Health Offers Virtual Primary Care Solution to Aetna Members
The payer’s virtual primary care solution will be available to members of self-insured, fully-insured health plans through a single digital platform. Continue Reading
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26 May 2022
Pre-Deductible Coverage Expansion in HSAs Might Slightly Boost Premiums
Pre-deductible coverage might increase premiums by 0.03 percent to 1.5 percent, depending on a variety of circumstances. Continue Reading
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25 May 2022
CareFirst Partnership Aims to Identify, Address Social Risk Factors
The payer will leverage an analytics platform to determine which populations face social risk factors and would benefit from community-based investments. Continue Reading
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20 May 2022
Payer Invests in Public Health Program To Advance Health Equity
Blue Shield of California started a fellowship to support students from underrepresented communities as they enter the healthcare workforce and to improve health equity. Continue Reading
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17 May 2022
Employer-Sponsored Health Plans Facilitated Mental Health Access
Members utilized telehealth and primary care physician visits in 2020 to receive mental healthcare services through their employer-sponsored health plans. Continue Reading
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12 May 2022
Consumers Share on Employer-Sponsored Mental, Behavioral Coverage
Employer-sponsored mental and behavioral healthcare coverage offered access to care during the coronavirus pandemic, employees attest. Continue Reading
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10 May 2022
KLAS: 6 Vendors That Aim to Resolve Payer-Provider Friction
Payer-provider friction can result from a number of challenges, but payers are leaning on certain vendors to help bridge the gap. Continue Reading
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10 May 2022
Role of Health Insurance Coverage, Benefits in Great Resignation
The Great Resignation forced employers to focus on how they can improve healthcare benefits to retain talent, but employers and employees have differing opinions on healthcare coverage. Continue Reading
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06 May 2022
Anthem Announces Finalization of Integra Managed Care Acquisition
The payer shared that it aims to enhance its government business with its acquisition of Integra as it pursues whole-person care. Continue Reading
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05 May 2022
Centene Announces Sale of Pharmacy Benefit Manager, Pharmacy
Centene indicates that the deal is part of Centene’s decision to exit the pharmacy benefit management space. Continue Reading
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05 May 2022
Payer Targets Health Equity in Colorectal Cancer Prevention
Independence Blue Cross and Colorectal Cancer Alliance seek to improve health equity in colorectal cancer by boosting screening rates among Black Americans in Philadelphia. Continue Reading
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28 Apr 2022
How Humanizing Healthcare Enables Future Health Plan Success
Health plans seeking to support member engagement and decision-making should consider strategies for humanizing the healthcare experience. Continue Reading
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27 Apr 2022
Employer Sponsored Health Plan Trends in High Enrollment States
California, Texas, and New York have the highest employer-sponsored health plan enrollment and an AHIP resource shares some of their economic and healthcare trends. Continue Reading
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20 Apr 2022
Key Advantages of Medicare Advantage Plans Versus FFS Medicare
Medicare Advantage plans draw a more diverse beneficiary population and can result in lower healthcare spending for low-income beneficiaries. Continue Reading
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19 Apr 2022
5 Major Payers Recognized for Employer Sponsored Wellness Benefits
The major health insurers offered strong coverage to their own employees through employer-sponsored wellness benefits, delivering on health equity and mental healthcare. Continue Reading
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18 Apr 2022
How Health Plans Use Communication to Enable Member Empowerment
Approachability is a key element of healthcare access, enabling members with health needs to identify and access high-quality, affordable care. Continue Reading
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14 Apr 2022
Payer, Walgreens Partner to Improve Equity, Care Coordination
Blue Shield of California and Walgreens blend in-person and virtual care services to reduce care disparities and promote care coordination. Continue Reading
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14 Apr 2022
UHC Introduces Employer-Sponsored, Virtual Care Physical Therapy
The payer’s virtual care physical therapy program relies on artificial intelligence in an app to assess members’ progress on physical therapy exercises. Continue Reading
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13 Apr 2022
Payer Precision Medicine Program Covers At-Home Genetic Tests
The precision medicine program relies on a vendor partner to assess the results of members’ at-home DNA samples to inform members’ treatment and medication plans. Continue Reading
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13 Apr 2022
How Health Plans Build Trust to Become Member Advocates
For health plans to become advocates for their members, they must focus on building trust directly with members. Continue Reading
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11 Apr 2022
UnitedHealthcare Expands Maternal Health Equity Program in NC
The payer partnered with an organization that connects members with doulas in order to improve patient education and patient outcomes and advance maternal health equity. Continue Reading
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04 Apr 2022
Aetna Prioritized Member Mental Healthcare, Virtual Care in 2021
Aetna introduced a virtual-first health plan and other virtual offerings, helping to increase member access to affordable medical and mental healthcare. Continue Reading
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01 Apr 2022
How Coverage Mandates May Impact DBT Breast Cancer Screenings
Coverage mandates for a certain kind of breast cancer screening known as DBT may drive utilization upward and cost downward, but the value of this screening remains uncertain. Continue Reading
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31 Mar 2022
Job Satisfaction, Equity Characterize 2022 Wellness Program Design
Overall spending on wellness program design in 2022 is expected to fall, except among large employers who are responding to the shift to hybrid work environments. Continue Reading
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25 Mar 2022
How to Introduce Medicare Advantage Caregiver Benefits in SNPs
Medicare Advantage caregiver benefits should seek to educate members’ caregivers and listen to caregivers’ needs through multimodality. Continue Reading
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23 Mar 2022
High Deductible Health Plans Impact Employee Mental Healthcare
High deductible health plans decreased overall mental healthcare spending, but they also led to a decline in utilization and increased employee mental healthcare spending. Continue Reading
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22 Mar 2022
MedPAC Releases Medicare Advantage Recommendations, BMA Reacts
The commission’s assessment of Medicare Advantage drilled down on how coding intensity might boost Medicare Advantage payments. Continue Reading
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22 Mar 2022
Centene Receives Health Equity Innovation Award from NCQA
Centene’s model pursued health equity by diminishing the care disparity gap in HbA1c testing between the American Indian and Alaska Native populations and White populations. Continue Reading
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21 Mar 2022
How Patient Management Promotes Medication Adherence, Lowers Costs
Comprehensive patient management plans, specifically risk-based care plans, establish relationships between patients and specialty pharmacy nurses to promote adherence. Continue Reading
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17 Mar 2022
UnitedHealthcare Funds Pediatric SCD Behavioral Care, Education
UnitedHealthcare announced it will be funding sickle cell disease behavioral healthcare resources and patient education efforts in Mississippi. Continue Reading
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11 Mar 2022
Medical Debt Points To Holes in Health Insurance Industry
Nine percent of individuals who had been uninsured for zero to six months reported medical debts of $250 or more. Continue Reading
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08 Mar 2022
Payer Orgs Respond to CMS Medicare Advantage Advance Notice
AHIP and ACHP relayed concerns about parts of the Medicare Advantage advance notice like benchmarks and payment methodologies and responded to the health equity index proposal. Continue Reading
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07 Mar 2022
BCBSA Partnership Aims to Increase Access to Low-Cost Insulin
The payer is collaborating on an initiative that will offer members low-cost insulin for no more than $30 per vial and $55 for a box of five pens. Continue Reading
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02 Mar 2022
Employer Sponsored Health Plan Dialysis Costs More Than Medicare
The cost of Medicare-covered dialysis amounted to less than one-sixth the cost of employer-sponsored health plan dialysis. Continue Reading
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01 Mar 2022
Humana Transitions Home Healthcare Products to CenterWell Brand
The payer is fulfilling its promise to begin consolidating certain services for seniors under the new brand, including home healthcare services. Continue Reading
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28 Feb 2022
Commercial Health Plan Trends Reveal High Turnover, Reenrollment Rates
Although most members disenrolled at least once in 12 years, nearly half of commercial health plan members enrolled in their plan again within ten years of disenrolling. Continue Reading
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24 Feb 2022
Employers Identify Key Biosimilar Strategies, Knowledge Gaps
Biosimilars have the potential to reduce healthcare costs, but employers may need to educate themselves and reshape their health plans to accommodate these drugs. Continue Reading
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17 Feb 2022
Humana, UofL Invest in Health Equity, Social Determinants Initiative
Through UofL’s health equity innovation hub, Humana aims to influence health equity and social determinants of health through research, analytics, and community engagement. Continue Reading
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16 Feb 2022
9 Employer Best Practices for High Deductible Health Plan Design
Since high deductible health plans shift more fiscal responsibility to members, employers are learning new ways to empower employees to make the most of their benefits. Continue Reading
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15 Feb 2022
CareFirst Distributes $1.76M to Address Diabetes Epidemic, SDOH
The payer has awarded funds to 27 local health organizations that help address the social determinants of health that may exacerbate the diabetes epidemic. Continue Reading
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15 Feb 2022
7 Steps for Employer Social Determinants of Health Strategies
Employer social determinants of health strategies can range from analyzing existing benefits to assess health equity to providing financial wellbeing classes. Continue Reading
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14 Feb 2022
What Are the Pros and Cons of Consumer Driven Health Plans?
Payers may find that there are both significant advantages and challenges when it comes to consumer-driven health plans. Continue Reading
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09 Feb 2022
AHIP Shares Privacy, Cybersecurity Goals To Protect Consumer Data
Consumer data is becoming increasingly vulnerable as healthcare continues to innovate, but payers, providers, and policymakers can take steps to prevent vulnerabilities. Continue Reading
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07 Feb 2022
BCBSTX Launches SDOH Grant Cycle for Community-Based Organizations
Nonprofit community-based organizations across Texas can apply for the grants and receive funding for their social determinants of health and health equity initiatives. Continue Reading
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04 Feb 2022
3 Major Payer Q4 2021 Earnings Reports Show COVID-19 Impacts
The end of 2021 saw the coronavirus pandemic impact payers fiscally and operationally with renewed energy, according to earnings reports. Continue Reading
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02 Feb 2022
Walmart Launches Provider Recommendation Tool for Health Plan Members
The provider recommendation tool aims to facilitate the process of finding a healthcare provider for Walmart associates who are enrolled in the company’s health plan. Continue Reading
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26 Jan 2022
Change Healthcare May Sell Assets to Prepare for UHG Merger
The payment solution sale could generate more than $1 billion to help Change Healthcare get ready for the upcoming UnitedHealth Group merger. Continue Reading
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25 Jan 2022
Key Factors Behind How Much Commercial Insurers Pay Providers
Hospital market share, input prices, quality of care, and other factors can influence healthcare prices for commercial payers. Continue Reading
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25 Jan 2022
Oscar Health Cost Estimator Tool Aims to Increase Price Transparency
Oscar Health members can use the cost estimator tool to achieve greater price transparency around primary care visits, specialty visits, and other outpatient services. Continue Reading
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18 Jan 2022
How The Affordable Care Act Impacted Small Group Coverage Trends
Small group coverage did not pursue the trends that many experts anticipated after the Affordable Care Act went into effect. Continue Reading
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17 Jan 2022
How Home Health Will Evolve in the Year Ahead
Changes in care delivery and strategic shifts to drive affordable, whole-person care will be important trends in home healthcare in 2022. Continue Reading
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14 Jan 2022
At-Home COVID-19 Tests in Low Supply Before New CMS Requirements
An analysis of six online retailers and ten at-home COVID-19 test brands offered insight into the low supply of at-home COVID-19 tests available and reinforce payers’ concerns. Continue Reading
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13 Jan 2022
Payers Lag On Acupuncture Coverage Despite Rising Utilization
Increased acupuncture utilization has been tied to expanded acupuncture coverage, but most of acupuncture spending is still out-of-pocket. Continue Reading
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13 Jan 2022
UnitedHealthcare Offers Initiatives to Improve Vision, Eye Health
The payer will offer members discounts on laptops and screen filters that help reduce exposure to blue light and support vision and eye health. Continue Reading
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12 Jan 2022
HRSA Expands Preventive Care Coverage Under ACA for Women, Children
The updated preventive care guidelines include coverage of double electric breast pumps without cost-sharing for mothers as well as suicide risk screenings for adolescents. Continue Reading
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10 Jan 2022
Closing Gaps in Care with Advanced Interoperability Capabilities
Payers must improve their ability to access data by addressing interoperability capabilities within their health IT infrastructure. Continue Reading
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07 Jan 2022
Centene Finalizes Acquisition of Behavioral Healthcare Platform
The acquisition of the behavioral healthcare platform will help the payer offer members integrated mental and physical healthcare services. Continue Reading
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06 Jan 2022
Priority Health, Epic Partner to Improve Patient Data Exchange
Priority Health aims to use the payer platform to boost quality of care, lower costs, and to achieve real-time data. Continue Reading
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04 Jan 2022
UHC Will Not Implement Emergency Care Coverage Changes
UnitedHealthcare previously announced that it would change how it assesses emergent care for coverage, but now the payer does not plan to make changes to emergency care coverage. Continue Reading
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04 Jan 2022
Humana Expands Value-Based Care to Medicare Advantage Members in OR
Through a new partnership, Humana Medicare Advantage members will gain access to an integrated care team, physical and mental healthcare services, and regular wellness classes. Continue Reading
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03 Jan 2022
Cancer Patients in High Deductible Health Plans Face Steep Costs
Patients who had cancer faced higher out-of-pocket costs compared to patients who did not have cancer, with patients in high deductible health plans experiencing the most expenses. Continue Reading
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17 Dec 2021
Top 5 Insurers With The Highest Market Shares In The Most States
The payers with the highest national market shares are not the same as the payers with the highest market shares by state. Continue Reading
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16 Dec 2021
Payer Funds Tech, Training To Support Rural Maternity Healthcare
Rural maternity healthcare services are challenging to initiate and maintain, but payers can support growth in these services with their funding. Continue Reading
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14 Dec 2021
MA Plan Introduces Benefits to Address Chronic Disease Management
The new benefits from UVM Health Advantage prioritize chronic disease management, specifically supporting members with heart disease and diabetes. Continue Reading
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13 Dec 2021
2021 Employer-Sponsored Health Plan Spending Growth Hit 6.3%
In 2020, employer-sponsored health plan spending rose by 3.4 percent, but 2021 spending exceeded that, and 2022 is expected to perpetuate the trend. Continue Reading
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08 Dec 2021
BMA Asks CMS to Enhance, Solidify Medicare Advantage Benefits
The letter supported policies that allow health plans to introduce Medicare Advantage benefits that address beneficiaries’ social determinants of health. Continue Reading
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06 Dec 2021
How Health Plans Provide Effective Mental Health Support to Members
Demand for mental healthcare has increased during the pandemic and health plans have an opportunity to streamline access for members. Continue Reading
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03 Dec 2021
Payer Funds Local Practices to Help Address Racial Care Disparities
The $25 million in grants will help local physicians and hospitals improve health equity strategies and address racial care disparities. Continue Reading
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02 Dec 2021
CVS Health Contributes $9.2M to Address SDOH, Homelessness in DC
The payer’s contributions will go toward building a 41-unit housing development in DC that aims to reduce homelessness and increase access to affordable housing. Continue Reading
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02 Dec 2021
UnitedHealthcare Launches Health Plan to Improve Customer Support
The payer has partnered with an accountable care organization to launch the health plan in two Arizona counties, aiming to streamline customer support. Continue Reading
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01 Dec 2021
UnitedHealthcare Vision, Dental Plans Lead in Customer Satisfaction
Vision and dental plan customer satisfaction increased overall in 2021, with UnitedHealthcare receiving the highest scores. Continue Reading