Payer: Page 12
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Most Medicare Advantage markets controlled by few insurers: KFF
UnitedHealthcare or Humana had the largest market share in two-thirds of U.S. counties, making up nearly 60% of total MA enrollment last year.
By Emily Olsen • July 15, 2025 -
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CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,’ MACRA
The sweeping regulation proposes notable changes to how Medicare pays physicians, but overall results in a modest bump to reimbursement in 2026.
By Rebecca Pifer Parduhn • July 15, 2025 -
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Alignment Healthcare wins partial victory in Medicare Advantage star ratings case
A judge agreed that the CMS should recalculate the scores for one Alignment plan in Arizona. Now, all of the insurer’s MA members are in plans rated four stars or higher.
By Rebecca Pifer Parduhn • July 10, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth names new chief of government programs, Medicaid unit
Longtime insurance executive Mike Cotton will helm the company’s Medicaid division, while Bobby Hunter is stepping up as CEO of government programs.
By Rebecca Pifer Parduhn • July 10, 2025 -
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Insurer ownership of U.S. primary care practices is small but growing: study
The first-of-its-kind research suggests vertical consolidation is being driven by plans wanting to direct more Medicare Advantage members to in-house clinics.
By Rebecca Pifer Parduhn • July 9, 2025 -
Mario Tama via Getty Images
CVS Omnicare ordered to pay $949 million in government fraud case
CVS plans to appeal the judgment, which comes after a jury ruled that its long-term care pharmacy benefits manager illegally charged Medicare, Medicaid and Tricare for prescription drugs for almost a decade.
By Rebecca Pifer Parduhn • July 9, 2025 -
Justin Sullivan / Staff via Getty Images
Judge temporarily blocks megabill’s Planned Parenthood Medicaid funding ban
The restraining order prevents the Trump administration from enacting a provision of the massive tax and policy law that would cut Medicaid funding for Planned Parenthood.
By Emily Olsen • July 8, 2025 -
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Humana agrees to purchase bankrupt Florida provider The Villages Health for $50M
The insurer’s bid is preliminary and kicks off an auction for the debt-laden provider, which decided to pursue bankruptcy after discovering it owed Medicare hundreds of millions of dollars.
By Rebecca Pifer Parduhn • July 8, 2025 -
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Molina cuts earnings guidance as costs rise in government programs
UnitedHealth and Centene both pulled their outlooks this year over elevated medical spending in Medicare Advantage and the Affordable Care Act respectively. Now, cost pressures are hitting their smaller peer.
By Rebecca Pifer Parduhn • July 7, 2025 -
Tasos Katopodis via Getty Images
Historic Medicaid cuts to come as Trump signs domestic policy bill
President Donald Trump passed the GOP's tax megabill into law, setting into motion $1 trillion in Medicaid cuts despite objections from hospitals, doctors, insurers and other stakeholders in the healthcare industry.
By Emily Olsen • July 4, 2025 -
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Optum Rx slashes reauthorization requirements for more drugs
The UnitedHealth-owned pharmacy benefit manager has removed reauthorization requirements for more than 140 drugs so far this year amid what it says is a push to improve patient access to critical medications.
By Susanna Vogel • July 2, 2025 -
Tasos Katopodis via Getty Images
Senate passes Trump’s spending bill with massive Medicaid cuts
After a marathon “vote-a-rama,” the Senate narrowly passed the legislation 51-50, with Vice President JD Vance casting the tiebreaking vote.
By Emily Olsen , Susanna Vogel • Updated July 2, 2025 -
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CMMI to add prior authorization for some Medicare services
Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.
By Susanna Vogel • July 1, 2025 -
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6 ways employers can lower healthcare costs in 2025
“Employers have absorbed the majority of cost increases over the past four years, and they likely cannot continue to do so,” one expert said.
By Michael Brady • July 1, 2025 -
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UnitedHealth changes leadership at care delivery unit
Patrick Conway, who recently became chief executive of the larger Optum health services division, will replace Dr. Amar Desai as CEO of Optum Health.
By Emily Olsen • June 30, 2025 -
Chip Somodevilla via Getty Images
Supreme Court upholds ACA preventive services mandate
The high court preserved a key portion of the Affordable Care Act that requires private insurers to cover a range of preventive healthcare services without cost sharing.
By Emily Olsen • June 27, 2025 -
Win McNamee via Getty Images
Congress should reconsider breaking up pharmacy benefit managers, experts say
Many popular proposals to reform the PBM industry are missing the forest for the trees, drug market experts said in Washington, D.C. Instead, Congress should go after the root issue: the oligopoly enjoyed by the Big Three PBMs.
By Rebecca Pifer Parduhn • June 27, 2025 -
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CVS Caremark to pay $95M in Medicare fraud case
A federal judge ruled in favor of a whistleblower, finding CVS’ pharmacy benefit manager Caremark overbilled Medicare for generic drugs.
By Sydney Halleman • June 26, 2025 -
Mario Tama / Staff via Getty Images
Medicaid, SNAP cuts could lead to nearly 500,000 lost healthcare jobs: report
A large portion of the 1.2 million jobs that could be lost nationwide in 2029 would come from the healthcare sector, like roles at hospitals, physician offices, pharmacies and long-term care providers.
By Emily Olsen • June 25, 2025 -
Win McNamee via Getty Images
Oz hints at impending CMS rule to force drug price transparency
The Trump administration hopes to issue a rule by the end of this year empowering regulators to “very forcefully” go after companies that don’t share information on drug costs, the CMS administrator said Tuesday.
By Rebecca Pifer Parduhn • June 24, 2025 -
Rebecca Pifer/Healthcare Dive
Health insurers, nudged by Trump administration, pledge reform to prior authorization
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.
By Rebecca Pifer Parduhn • June 23, 2025 -
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CMS slashes ACA sign-up periods, tightens eligibility in final rule
On Friday, the Trump administration finalized a rule that’s expected to cause between 725,000 and 1.8 million people to lose ACA coverage.
By Rebecca Pifer Parduhn • June 23, 2025 -
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Medicare go-broke date pushed up three years in latest trustees report
The clock is ticking to stabilize Medicare, as a key trust fund underpinning the insurance program’s hospital benefit is now set to be depleted in 2033 instead of 2036.
By Rebecca Pifer Parduhn • June 20, 2025 -
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ICHRA adoption grows as Congress mulls codifying the coverage into law
Though the vast majority of individual coverage health reimbursement arrangements remain among small employers, large employers are adopting the plans at a faster clip, the HRA Council found.
By Rebecca Pifer Parduhn • June 18, 2025 -
Joe Raedle/Getty Images via Getty Images
Federal policies could reverse states’ historic coverage gains: report
The uninsurance rate for working adults fell from over 20% in 2013 to 11% in 2023. But federal policies like Medicaid cuts threaten that improvement, according to the Commonwealth Fund.
By Emily Olsen • June 18, 2025
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