The legislation would require MA plans to report enrollee-level data on supplemental benefits to the CMS
WASHINGTON—U.S. Sens. Mark R.
Medicare Advantage
As MA private plans increase in enrolled numbers, so have concerns about the insurer's sales tactics and misleading coverage claims
This story is republished from KFF Health News—a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This proposal comes after years of concern surrounding potential barriers to care access resulting from Medicare Advantage plans’ use of prior authorization
WASHINGTON—On Monday, Nov. 6, the Biden-Harris Administration proposed steps to fix Medicare Advantage's (MA) use of prior authorization as well as curb predatory marketing within MA plans.
Valle is charged with one count of conspiracy to commit health care fraud and wire fraud, two counts of wire fraud and three counts of major fraud
WASHINGTON—The Justice Department announced charges against a former executive at HealthSun Health Plans Inc. (HealthSun)—a Medicare Advantage organization that operates Medicare Advantage plans in South Florida—for her role in a multimillion-dollar Medicare fraud scheme.
AAHomecare and the ALS Association met with CMS Part C leadership to share concerns about authorization challenges for medically necessary NIV devices
In a newsletter, AAHomecare (AAHC) announced it and the ALS Association met with the Centers for Medicare & Medicaid Services (CMS) Part C leadership to share concerns about ongoing authorization challenges for medically necessary non-invasive ventilator (NIV) devices by Medicare Advantage (MA) payers. Access to these ventilator systems is especially important for individuals with significant neuromuscular diseases such as ALS.
30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan
KFF reported that data released from the Centers for Medicare & Medicaid Services (CMS), shows Medicare Advantage (MA) now provides Medicare coverage for more than half of its eligible beneficiaries.
Nonmedical benefits have value for health & independence
BIRMINGHAM, Alabama—Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about 6% of the 35 million requests submitted on behalf of enrollees that year, a new analysis from the Kaiser Family Foundation found.
WASHINGTON, D.C. (October 4, 2022)—On Sept. 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released the list of Medicare Advantage (MA) plans that will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model during Calendar Year (CY) 2023, including those that will participate in the MA VBID Hospice Benefit Component (an offshoot of the larger VBID model which began operation in January 2021).
WASHINGTON, D.C. (August 30, 2022)—The Centers for Medicare & Medicaid Services (CMS) is seeking public comments on various aspects of the Medicare Advantage (MA) program. The American Association for Homecare (AAHomecare) is submitting comments for the request for information, due on Wednesday, Aug. 31. The association is asking industry stakeholders to add their comments to ensure better oversight of these plans and maintain strong access for home medical equipment (HME) suppliers.
CHARLOTTE, N.C. (June 7, 2022)—Elior North America has launched LiveWell with Traditions, an offering that expands the company’s expertise in serving senior nutrition meals, to provide customized, home-delivered meals for health plans, Medicare Advantage Organization (MAO) and Managed Care Organization (MCO) members.
Patients can receive care where they are most comfortable
WASHINGTON, D.C (April 19, 2022)—The Centers for Medicare & Medicaid Services (CMS) has issued a final rule with comment period that finalizes two remaining proposals from the original proposed rule that laid out policy and technical changes to the Medicare Advantage program, Medicare Part D, Medicaid and more. That proposed rule was originally issued in February 2020.
Widowed and usually living alone, Gloria Bailey walks with a cane after two knee replacement surgeries and needs help with housekeeping.
SCOTTSDALE, Arizona (February 8, 2022)—Medicare Advantage programs are likely to continue to grow at a rapid pace, replacing traditional Medicare coverage for America’s seniors in increasing numbers, former Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said Tuesday.
Make sure your clients know their options
ATLANTA (January 7, 2022)—Sharecare, a digital health company that helps people manage all their health in one place, announced that more than 400 Medicare Advantage plans—including several of the nation’s largest payers—are exclusively leveraging its home health platform and network of caregivers, CareLinx by Sharecare, to scale in-home care supplemental benefit programs in 2022.
WASHINGTON, D.C. (November 23, 2021)—Bipartisan legislation introduced in the United States Senate would ease, standardize and speed the process of prior authorization in Medicare Advantage plans.
Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.