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Medicare Advantage plans must comply with new network adequacy and health equity standards in 2025. Here are five policy changes taking effect in 2025: CMS will require Medicare Advantage plans to ...

Payers have faced state penalties in 2024 for slow reimbursements, improper claims denials, or the sale of unapproved products. 12 recent examples of payers fined or agreeing to settlements with ...

HHS' Office of Inspector General has issued a special fraud alert about the risks of fraud and abuse in certain marketing and compensation arrangements related to Medicare Advantage. The December ...

CMS revised the star ratings for some Medicare Advantage plans and introduced major proposed reforms to the program in recent weeks. Humana misrepresented the providers its Medicare Advantage plans ...

Sanford Health Plan is expanding its Medicare Advantage offerings to more rural communities. In December, Sanford Health Plan, part of Sioux Falls, S.D.-based Sanford Health, partnered with Lincoln, ...

Enrollment in ACA plans hit a record high of 21.4 million in 2024, driven by premium subsidies. The enhanced ACA subsidies, which offer premium assistance to individuals earning up to 400% of the ...

Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with restructuring strategies. Below are workforce reduction efforts or job eliminations that ...

Sacramento, Calif.-based Sutter Health has named Aparna Abburi as senior vice president of population health and health plan services and CEO of Sutter Health Plan. Ms. Abburi previously held ...

The prices for some GLP-1s have dropped significantly in recent years for individuals covered by Medicare and commercial insurance, according to a new report from HHS. In 2024, the U.S. list prices ...

Priority Health has closed on its purchase Physicians Health Plan of Northern Indiana, a Fort Wayne-based payer with more than 50,000 members in Indiana and Ohio. The acquisition was first announced ...

Georgia will award Medicaid contracts to four Medicaid managed care organizations. According to a notice published Dec. 2, the agency plans to grant Medicaid contracts to Humana, CareSource, Molina ...