Insurers like UnitedHealth may have to scale back benefits or raise prices, analysts say.

Federal officials have a plan that could curb billions of dollars in overpayments to Medicare Advantage plans. But will they ...

Why the debate matters.

Medicare Advantage is facing unprecedented challenges from a decrease in reimbursement rates and the federal government’s ...

Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Almost 8% of those requests were partially or fully ...

Rising costs coupled by flat rates set by the Trump administration for Medicare Advantage could trigger withdrawals of health insurers from markets across the U.S.

CMS proposes a 0.09% Medicare Advantage payment increase for 2027 and plans to eliminate chart review payments, impacting insurers’ revenue.

The agency quietly released a memo updating MA plans on how it’s approaching risk adjustment data validation audits after a ...

Policymakers are exploring reforms to address shortcomings of risk adjustment that inflate Medicare Advantage payments and ...

Objective: To address concerns about payment adequacy in Medicare Advantage (MA) plans, a 2017 federal policy change increased risk scores and associated capitated payments for community-dwelling ...

Insurers have been canceling Medicare Advantage programs for years. Fresno Unified isn't alone in the fight between payers and providers.

A new Oklahoma executive order on Medicare Advantage may go further than any other state initiative to rein in practices largely seen as unfavorable to both beneficiaries and providers.