SCAN, Costco Launch Medicare Partnership
SCAN Health Plan and Costco are partnering to provide a suite of insurance products for seniors.
Stop the Revolving Door: Why Five-Year Contracts are the Key to Saving Medicare Advantage
To truly deliver on the promise of proactive, preventive care for seniors with complex, chronic conditions, we should move away from the current one-year open enrollment cycle and toward a five-year contract period.
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The Healthcare Payments Industry Faces a Perception Challenge
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
Medicare to Spend $13B on MA Quality Bonus Program in 2026
KFF estimates Medicare will spend $13.4 billion on the Medicare Advantage Quality Bonus Program in 2026 amid continued scrutiny of the program.
Medicare Advantage’s Big Decision: Reset or Retreat?
Today’s adjustment offers insight into what the next phase of the program is focusing on and will subsequently reward, and why this moment matters, especially for newer and regional plans.
OIG: 3 Largest MA Insurers Deny Prior Auth Requests at High Rates for Long-Term Acute Care, Inpatient Rehab
An OIG report found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at higher rates than other MA plans in 2024.
Startup Enabling Aging at Home Raises $6M, Gains New MA and Medicaid Partnerships
Rosarium Health's seed round was led by Kalos Ventures, with support from ResilienceVC, Rock Health Capital, Symphonic Capital, American Family Insurance Institute for Corporate and Social Impact, Black Tech Nations Ventures and The Council.
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Closing the Quality-Affordability Gap in Workplace Mental Health
In an interview, Kyan Health Co-Founder and Chief Commercial Officer Konstantin Struck discussed how Kyan gives mid-market and enterprise employers access to premium workforce mental healthcare, at a price point that is affordable.
Bipartisan Bill Seeks to Strengthen Oversight of Medicare Advantage
Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to tighten prior authorization rules, boost transparency and curb practices that delay care.
CEO of For-Profit MA Plan Tells CMS “Pay Us Less”
Ed Park is sincere and passionate about his calling as the CEO of Devoted Health, which provides Medicare Advantage plans to seniors in 29 states. But it remains to be seen if he can do more or the same with less.
Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage
A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny.
Report: Growth in MA Is Associated With Lower Total Medicare Spending
New research from the Elevance Health Public Policy Institute finds that higher enrollment in Medicare Advantage may be linked to lower overall Medicare spending.
Where Will AI Deployment Benefit Payers the Most?
We are taking a look at how health insurers are using AI, defining success, and managing cybersecurity risks. Give us your opinions by completing our brief, anonymous survey.
Jefferson Health Sues Aetna As Providers’ Frustration with MA Grows
Jefferson Health in Philadelphia is suing Aetna over a new Medicare Advantage payment policy that hospitals say unfairly reduces reimbursements for legitimate inpatient stays. The case highlights a broader clash between providers and Medicare Advantage plans over “downcoding” short hospital stays and controlling costs.
Do Healthcare CEOs Agree on Whether VBC and MA Actually Save Money?
Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more transparent way to control spending.
The Kaiser Settlement Should End the Guesswork in Medicare Advantage Oversight
The settlement demonstrates that enforcement risk is real and substantial, but it also highlights an opportunity. Medicare Advantage oversight does not require years of new rulemaking or experimental pilots because the technical capability to validate documentation at scale already exists and can be deployed today.
2026 Star Ratings Shift: 4 Strategies for MA Plans
Further change in the Star Ratings program is inevitable, but one thing won’t change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher overall rating.
Why Providers Can’t Ignore CMS Audits
At the end of the day, it doesn’t matter what your patient mix looks like; your notes can and will be pulled into audits. Waiting until CMS is at your doorstep isn’t a strategy — it’s a risk. Now is the moment to get ahead of it.