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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29 Jun 2020
Tufts Health Plan Expands Substance Abuse Care Coverage
The partnership will expand coverage for substance abuse care at a time when mental and behavioral healthcare programs are in high demand. Continue Reading
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29 Jun 2020
Anthem Skill Uses AI, Alexa For Medication Adherence, Engagement
The artificial intelligence virtual assistant helps improve medication adherence and member engagement through 24/7, personalized service. Continue Reading
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25 Jun 2020
4 Health Benefits That Are Valuable to Small Businesses
Small businesses indicated four types of health benefits that they value, including nontraditional benefits. Continue Reading
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25 Jun 2020
Medicare Advantage, Part D ERSD Rules Could Boost Costs
With the 2021 Medicare Advantage and Part D rule finalized, payers may need to prepare for higher Medicare Advantage spending due to new ESRD enrollees. Continue Reading
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24 Jun 2020
CVS Health Gives Employers Access to COVID-19 Testing Solutions
The COVID-19 testing solutions embrace both on-site and off-site testing and leverage data analytics and integrated technology. Continue Reading
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24 Jun 2020
Telehealth May Help Payers Control Uncertain Healthcare Spending
Many factors driving healthcare spending, including mental healthcare utilization and specialty drug spending, are wild cards, but there are some factors that payers can control. Continue Reading
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23 Jun 2020
AMA: Payers Did Not Fix Prior Authorization, Cut Provider Burden
The American Medical Association called for federal action in response to the payer failure to fix prior authorization. Continue Reading
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23 Jun 2020
How Payers Can Improve Member Engagement by Partnering with Members
Strong partnership with members is key to member engagement and member satisfaction, a recent JD survey found. Continue Reading
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22 Jun 2020
Cigna, Priority Health Form Strategic Alliance For Employer Plans
The strategic alliance will focus on offering broader access to care and streamlining previous areas of partnership. Continue Reading
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22 Jun 2020
How Payers Scale Social Determinants of Health Goals
Humana’s Bold Goal program highlights ways that payers can scale their social determinants of health strategies across lines of business and demographics. Continue Reading
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19 Jun 2020
Blues Plans Highmark, HealthNow New York Announce New Affiliation
The non-profit Blues plans announced an “affiliation agreement” that will make Highmark Health the primary licensee of some of HealthNow’s services areas in New York. Continue Reading
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18 Jun 2020
4 Ways Payers Can Invest In Mental and Behavioral Healthcare
As payers try to meet the demand for mental and behavioral healthcare services, some put their support behind existing provider and public trainings, call centers, and hotlines. Continue Reading
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18 Jun 2020
Private Payers Face More Medicaid Competition on ACA Marketplaces
Contrary to expectations, Medicaid competition is surging on the marketplaces as differences between private payer and Medicaid payer plans diminish. Continue Reading
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17 Jun 2020
How To Scale A Telehealth Strategy: Pilots, Providers, and Payment
Blue Shield of California’s Health Reimagined initiative models a new way for payers to scale a telehealth strategy. Continue Reading
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17 Jun 2020
COVID-19 Spotlights 3 Payer Telehealth Expansion Challenges
Payer telehealth strategies face the challenges of determining coverage for new and different sites of care and technologies as well as state and federal regulatory boundaries. Continue Reading
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16 Jun 2020
High Deductible Health Plans Create Cost-Related Barriers to Care
Among other things, providers said that high deductible health plans cost patients and providers hours of rearranging schedules and delayed care. Continue Reading
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16 Jun 2020
Payers Support Dental Partners With Stipends, Boost Teledental Care
As dental partners struggle to make ends meet due to coronavirus, payers are offering direct support through stipends and exploring teledental coverage. Continue Reading
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12 Jun 2020
BCBS Deal Collaborates to Gather Population Health Data
BCBSRI and its behavioral healthcare provider partner are working together to collect and leverage population health data in Rhode Island. Continue Reading
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11 Jun 2020
4 Payer Data Points That Demonstrate Behavioral, Mental Care Parity
Experts are calling on health plans to be more transparent about behavioral and mental care parity by self-reporting these four data points. Continue Reading
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10 Jun 2020
Payer COVID-19 Healthcare Spending for 2020, 2021 May Hit $546.6B
Although the payer COVID-19 healthcare spending estimates are still uncertain, experts projected that delayed care might decrease costs. Continue Reading
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05 Jun 2020
Beyond COVID-19: Telehealth, Partnerships, Member Engagement
Payers have been on the frontline of COVID-19 response efforts, but now plan leaders are grappling with how to handle telehealth, partnership, and member engagement in a post-pandemic world. Continue Reading
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05 Jun 2020
Inaccurate Provider Directories May Spark Surprise Medical Bills
Patients seeking mental healthcare support may find themselves hit with surprise bills due to inaccurate directory information. Continue Reading
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04 Jun 2020
MA Risk Adjustment Should Include Audio-Only Telehealth Diagnoses
As COVID-19 motivates more audio-only telehelath utilization, audio-only telehelath diagnoses should count toward Medicare Advantage risk adjustment. Continue Reading
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03 Jun 2020
Out-of-Pocket Insulin Costs Stagnant for Commercial Members
Out-of-pocket insulin costs remained steady for commercial members while the overall price soared and other plan types experienced higher costs. Continue Reading
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03 Jun 2020
BCBS Companies Hold Almost 50% of Market Share on ACA Marketplaces
The main competitor for Blue Cross Blue Shield companies is typically not national or regional payers, but rather Medicaid managed care health plans. Continue Reading
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02 Jun 2020
COVID-19 Healthcare Spending Hinges On Hospitalization Rates
While mortality has virtually no impact on COVID-19 healthcare spending, halving hospitalizations could nearly halve the overall healthcare cost of the pandemic. Continue Reading
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02 Jun 2020
Subsidizing COBRA Could Boost Enrollment, Cut Uninsurance
Without subsidizing COBRA, the health insurance option is not in high demand due to costs and enrollment procedures, although enrollees enjoy broader provider networks. Continue Reading
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01 Jun 2020
Cigna Care Card Lets Employers Support Members During COVID-19
The Cigna Care Card gives tax-free funds to members for qualifying purposes related to the coronavirus pandemic. Continue Reading
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28 May 2020
15 Payers File on WA Individual Health Insurance Marketplace
The fifteen payers filed over 180 plans on the individual health insurance marketplace as unemployment drives more consumers to the ACA exchange. Continue Reading
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27 May 2020
Claims May Rise in 2 to 3 Months As Patients Seek Deferred Care
The awaited rise in non-urgent and elective deferred care may occur in the next couple of months as patients emerge from quarantine. Continue Reading
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26 May 2020
Payers Assist States in Contact Tracing, Despite Consumer Distrust
As states accept payer support in managing the contact tracing workload, consumers express distrust in payers’ ability to preserve their anonymity in app-based contact tracing. Continue Reading
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22 May 2020
Mental Health Visits Take Majority of 1M Payer Telehealth Claims
Blue Cross Blue Shield of Massachusetts shared some of its telehealth claims data from the past nine weeks and found a strong demand for remote mental healthcare. Continue Reading
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21 May 2020
Centene Emphasizes MA Wellness Care, Waives Healthcare Costs
Payer efforts to support Medicare Advantage members getting back on their feet emphasize primary care, behavioral healthcare, telehealth, and social determinants of health. Continue Reading
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19 May 2020
How Payers Make Wellness Programming Available Despite COVID-19
Blue Cross and Blue Shield of Rhode Island and other payers are relying more heavily on digital solutions for wellness programming during COVID-19. Continue Reading
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19 May 2020
UnitedHealth Group Offers Remote, Low Cost Access to Eyewear
The announcement comes as eyewear purchases and other vision care benefits take a hit due to social distancing restrictions. Continue Reading
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14 May 2020
Healthcare Spending Boost to Come for Private Insurance Members
While many privately insured members expect to increase their healthcare spending due to coronavirus, almost an equal amount say they will skip their annual exam. Continue Reading
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14 May 2020
Payers Offer Premium Credits for Cash-Strapped Members, Employers
Priority Health offers premium credits to members and employers as many struggle financially during the coronavirus pandemic. Continue Reading
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12 May 2020
How Payer SDOH Investments Balance COVID-19 Relief Versus Recovery
Humana’s $50 million COVID-19 relief and recovery funding provides insight on the challenges of supporting community partners during the uncertainties of pandemic. Continue Reading
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11 May 2020
How Medicaid Managed Care Plans Address SDOH, Expand Care Access
Medicaid managed care plans are creating innovative solutions in telehealth, social determinants of health, and access to care, says AHIP. Continue Reading
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11 May 2020
BCBSM, Humana Waive Medicare Advantage Costs as States Reopen
Payers focus on covering primary care visits, mental and behavioral healthcare, and enabling Medicare Advantage members to adapt to the post-pandemic world. Continue Reading
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05 May 2020
$820M Payer Acquisition Boosts Medicaid Portfolios Amid COVID-19
Molina is using the deal to expand its Medicaid and Medicare portfolios as coronavirus drives Medicaid enrollment higher. Continue Reading
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04 May 2020
The Building Blocks of an Effective Coronavirus Response Strategy
The coronavirus pandemic has forced payers to leverage strategies for engaging members, providers, employees, and the community to fight COVID-19. Continue Reading
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30 Apr 2020
AHIP Releases COVID-19 Priorities as States Consider Re-Opening
The priorities outline health plan commitments to providers, patients, and the general public as the coronavirus pandemic continues and some states are re-opening. Continue Reading
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30 Apr 2020
BMA: CMS Should Lessen Medicare Advantage 2021 Bid Uncertainty
Better Medicare Alliance called on CMS to exclude vaccine costs, use 2019 data, and reduce normalization factors for Medicare Advantage plans. Continue Reading
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29 Apr 2020
BCBS MA Deploys Employees for Contact Tracing, Staffing Support
Blue Cross Blue Shield of Massachusetts has committed over 100 employees to coronavirus-related efforts, including contact tracing and supplementing healthcare staff. Continue Reading
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28 Apr 2020
Payers Slated to Pay $2.7B in Medical Loss Ratio Rebates in 2020
Private payers are on track to pay more than double last year’s record high of medical loss ratio rebates to beneficiaries, Kaiser Family Foundation reports. Continue Reading
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27 Apr 2020
How Population Health Tactics Fortify COVID-19 Member Engagement
Population health management is key to identifying, segmenting, and reaching members with effective member engagement during coronavirus. Continue Reading
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26 Apr 2020
Key Fixes to NY Commercial Payer Exchange to Ease New Enrollment
UHF outlines key changes for the New York off-exchange marketplace that will help consumers who have lost their jobs shop for commercial coverage directly from payers. Continue Reading
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24 Apr 2020
Medicare Advantage Enrollment, Quality Continue Upward Trend
Medicare Advantage enrollment has doubled in ten years and, in 2020, 16 percent more plans score four stars or more than did in 2015. Continue Reading
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23 Apr 2020
Humana Calls for Social Determinants of Health in Risk Adjustment
The payer argued that incorporating social determinants of health into risk adjustment models will help identify care disparities and improve cost predictions. Continue Reading
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21 Apr 2020
UnitedHealth Gives $5M to Support Healthcare Workers During COVID-19
The donation is part of UnitedHealth’s commitment to combat COVID-19 and support impacted populations. Continue Reading
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21 Apr 2020
Health Plan Costs Keeping Unemployed from Coverage in COVID-19
Many individuals recently unemployed are struggling to find a new health plan due to health plan costs and limited availability. Continue Reading
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20 Apr 2020
Individual Market COVID-19 Treatments May Cost Less Than Expected
Actual COVID-19 treatment costs for the health insurance market could be as much as $3.37 billion less than anticipated. Continue Reading
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20 Apr 2020
$5.1M Grant Addresses Social Determinants of Health in Seniors
SCAN Health Plan will target social determinants of health funding to senior members struggling during the coronavirus. Continue Reading
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17 Apr 2020
Role of Market Share In Payer-Provider Reimbursement Negotiations
Providers’ market share may in part explain why private payers pay almost 200 percent the Medicare reimbursement rate for all hospital services. Continue Reading
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16 Apr 2020
3 Economic Uncertainties That Payers Face Amid Coronavirus Crisis
As payers and providers scramble to address extensive healthcare needs, payers are also turning to the economic impacts that coronavirus could present. Continue Reading
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16 Apr 2020
ACHP Suggests Regulatory Steps To Extend Coronavirus Coverage
ACHP’s recommendations seek to provide stronger coverage for uninsured, employee, employer, Medicare, and Medicaid populations. Continue Reading
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15 Apr 2020
COVID-19 Healthcare Spending Forces Difficult Choices for Payers
Coronavirus will affect payers’ healthcare spending in a variety of ways, which leaves Medicaid, Medicare, and private payers with different decisions to make. Continue Reading
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15 Apr 2020
Payers Expect Claims Spike After COVID-19, No 2021 Premium Hike
Most payers do not currently plan to hike 2021 premiums, despite an expected increase in claims after the coronavirus pandemic. Continue Reading
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14 Apr 2020
Medicare Advantage Plans Target Social Isolation In New Programs
Medicare Advantage plans leverage volunteers and community partnerships to reduce loneliness among seniors. Continue Reading
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10 Apr 2020
Centene Program Helps Providers with Grant Writing, Business Loans
The program will assist providers who are seeking grants or business loans from the Small Business Administration through the CARES Act. Continue Reading
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07 Apr 2020
3 Ways COVID-19 Is Changing Payer Utilization of Technology
Coronavirus is forcing payers to improve on their existing technologies, develop new technological solutions, and reinforce their telehealth teams. Continue Reading
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06 Apr 2020
Payers, Providers Under Fiscal Strain Rally To Combat COVID-19
As payers and providers alike face economic losses and enormous pressure to meet escalating demands of coronavirus, they find ways to support each other. Continue Reading
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06 Apr 2020
Top 10 Payers’ Strategies for Broadening Access to COVID-19 Care
Some of the largest payers are covering both coronavirus testing and treatment to deliver broader access to care for those affected by the coronavirus. Continue Reading
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03 Apr 2020
How Payers Use Special Enrollment Periods To Boost Coverage
State and private payers are using special enrollment periods to increase healthcare coverage as unemployment soars. Continue Reading
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02 Apr 2020
COVID-19 to Impact Employer-Sponsored Health Plans for 3.5M
The coronavirus pandemic is costing works their jobs and their employer-sponsored health plans. Continue Reading
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01 Apr 2020
Member Engagement Requires Advanced Analytics, Specialized Team
In order to properly utilize advanced analytics data, personalize responses, and track members’ behaviors, payers need a specialized member engagement team. Continue Reading
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01 Apr 2020
COVID-19 Projected to Drive Increased Costs for Consumers, Employers
COVID-19 costs could lead to significant increases in premiums and out-of-pocket expenses for consumers. Continue Reading
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31 Mar 2020
Cigna, Humana Eliminate Coronavirus Treatment Out-Of-Pocket Costs
Along with other cost-cutting measures, the payers are working to reduce out-of-pocket costs for members related to coronavirus treatment. Continue Reading
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31 Mar 2020
UnitedHealth Group Unveils Self-Administered COVID-19 Test
Payers looking for ways to decrease the burden on providers and extend hospital resources may turn to self-administered COVID-19 tests as a solution. Continue Reading
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30 Mar 2020
DOJ Launches Lawsuit Against Anthem for Risk Adjustment Fraud
The DOJ says that Anthem used diagnosis codes assigned to a delayed chart review to receive higher Medicare Advantage risk adjustment payments. Continue Reading
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30 Mar 2020
Payers Eliminate Coronavirus Treatment Cost-Sharing Before Feds
A handful of payers, including CVS Health, have eliminated cost-sharing for coronavirus treatments, a move that experts have called for on a federal level. Continue Reading
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26 Mar 2020
Payers Seek National Recognition as Essential Businesses
Payers play a pivotal role in fighting the coronavirus and maintaining healthcare industry functions, payer associations argue. Continue Reading
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25 Mar 2020
Payers Relax Hospital Transfer Policies, Match Medicare Waivers
AHIP announced its commitment to relax policies and match Medicare’s waivers regarding enhancing hospitals capacities with the influx of coronavirus patients. Continue Reading
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23 Mar 2020
Coronavirus Out-of-Pocket Healthcare Spending May Exceed $1,300
For payers, employers, and patients, overall healthcare spending could be $20,000 or higher for serious cases. Continue Reading
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19 Mar 2020
52% of Members Surveyed Saw No Member Engagement on Coronavirus
Survey respondents cited concerns about out-of-pocket healthcare spending and coronavirus coverage, with limited member engagement. Continue Reading
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18 Mar 2020
Telehealth Key to Payer COVID-19 Prevention, Diagnosis, Testing
Payers are partnering are exploring ways to use telehealth in preventing, diagnosing, and testing for COVID-19. Continue Reading
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12 Mar 2020
Will MA Beneficiaries See Lower Healthcare Spending for COVID-19?
Beneficiaries see lower healthcare spending and lower cost burden in Medicare Advantage than in Medicare; but will those results stand the test of COVID-19? Continue Reading
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11 Mar 2020
Using Member Engagement to Create Personalized Payer Experience
Payers are using a wide variety of technologies to increase personalization in their product offerings across distinct populations of consumers. Continue Reading
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10 Mar 2020
Volatility Drives Payer Technological Innovation, Partnerships
The Best’s Special Report found that payer medical and ideological innovation is fueled by the ever-changing healthcare environment. Continue Reading
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09 Mar 2020
How Are Payers Covering COVID-19 Testing for High-Risk Patients?
Populations most vulnerable to high out-of-pocket costs for COVID-19 testing include low-income, uninsured, underinsured, and immigrants. Continue Reading
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05 Mar 2020
Cigna and Houston Methodist Announce Contract After UHC’s Ended
The news of Cigna new agreement comes after a messy end to UnitedHealthcare’s contract with Houston Methodist. Continue Reading
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02 Mar 2020
Reinventing Formularies, Drug Pricing to Up Medication Adherence
Oscar Health’s recent $3 Drug List begs the question: how can payers rethink their formularies to support medication adherence and lower drug pricing? Continue Reading
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27 Feb 2020
Health Payer Segments to Stay Profitable, Face Tighter Margins
Regulatory changes motivated major shifts in the health payer industry in 2019 and most segments are expected to remain profitable for 2020, despite tighter margins. Continue Reading
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26 Feb 2020
Aetna Offers Atlanta Employers Fully-Insured, Self-Insured Plans
The Aetna Whole Health plan aims to provide employers fully-insured and self-insured plan options with ACOs and upside risk contracts. Continue Reading
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25 Feb 2020
Managed Care Organizations Lead to 27% Lower Prescription Costs
AHIP data shows that managed care organizations can control Medicaid prescription drug spending more effectively than Medicaid fee-for-service programs. Continue Reading
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24 Feb 2020
Outpatient Costs Push Spending in Employer-Sponsored Health Plans
Prices for outpatient services took up a large share of employer-sponsored health plan spending from 2014 through 2018. Continue Reading
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24 Feb 2020
Out-of-Pocket Costs, Surprise Billing Loom as UHC, MEDNAX Split
The termination would end contracts with eleven obstetrics, anesthesiology, and other specialist organizations in four states and could result in surprise billing. Continue Reading
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21 Feb 2020
How Peer Recovery Increases Medication Adherence, Lowers Spending
Through a partnership with Anchor Peer Recovery, BCBSRI is seeing greater treatment and medication adherence in substance abuse care. Continue Reading
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12 Feb 2020
How to Implement AI Platform to Fight Commercial Insurance Fraud
Payers that want to fight commercial insurance fraud with artificial intelligence must ask themselves a new question. Continue Reading
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11 Feb 2020
Humana Primary Care Clinics Boost Senior Patient Care Access
The payer-agnostic primary care centers will expand access to care by opening primary care centers for seniors on Medicare Advantage. Continue Reading
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11 Feb 2020
How Provider Relationships Shape VBC Pediatric Quality Measures
By building a robust payer-provider relationship, payers can better ascertain the right quality measures to mobilize pediatric quality measures in value-based care. Continue Reading
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10 Feb 2020
Cigna Starts 3 Strategic Partnerships While Closing 2019 M&A Deals
Major payers like Cigna are overlapping finalizing of previous mergers and acquisitions deals with new partnership announcements that aim to strengthen payer identity. Continue Reading
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28 Jan 2020
Centene-WellCare Merger Alters GA Medicaid Managed Care Landscape
The health insurance merger places Centene-WellCare in charge of two-thirds of Georgia’s Medicaid HMO business and significantly impacts the Medicaid managed care landscape. Continue Reading
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28 Jan 2020
BCBS Tackles Outpatient Generic Medication Spending, Access
BCBS Association and Blue Cross Blue Shield companies are focusing on increasing access to care through lowering outpatient generic medication spending. Continue Reading
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27 Jan 2020
Virtual Behavioral Health Visits Improve Care Access
Cigna’s partnership with MDLIVE gives members the ability to schedule and attend virtual behavioral health appointments, improving adherence and access to care. Continue Reading
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22 Jan 2020
Louisiana’s Medicaid Managed Care Contracts in Disarray
Louisiana’s Medicaid care contracts have been scrapped due to the claims that the health department mishandled the bid process for deals to provide health services to 1.5 million people. Continue Reading
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22 Jan 2020
Blue Shield of CA Pledges $20M to Support Behavioral Health Services
The contribution will support behavioral health services and initiatives to tackle the homelessness crisis in order to ensure that commitment to health and wellness is at the forefront. Continue Reading
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21 Jan 2020
Medicare Advantage Costs 40% Less than Fee-For-Service Medicare
Medicare Advantage tends to cost less in both premiums and out-of-pocket costs than fee-for-service Medicare, the report found. Continue Reading
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17 Jan 2020
AL Providers, Payer Form Value-Based Medicare Advantage Plan
In a new trend, Huntsville Hospital and UAB are joining together to offer their own health plan, a value-based Medicare Advantage plan through Viva Health. Continue Reading