CMS previews rollout of 'Simple Choice Plans' and quality ratings

The agency will be seeking feedback regarding the best means to provide the quality rating information.

By Heather Caspi • May 1, 2016

Uber-a-docs: Changing the healthcare landscape for better or worse?

While convenient, some worry house-call apps could undermine the traditional relationship between patients and their primary care doctors.

By Meg Bryant • April 30, 2016

Aetna books strong Medicaid showing in Q1, declining net income

The health insurance giant said two-thirds of states have approved its acquisition of Humana, putting it on target to close in the second half of the year.

By Meg Bryant • April 29, 2016

CA insurance commissioner not so hot on Aetna-Humana merger

Over the past three years, Aetna has raised the ire of state health officials for ‘unreasonable’ increases in insurance premiums.

By Meg Bryant • April 29, 2016

Obama administration extends Medicaid coverage to 96K ex-inmates

New HHS guidance clarifies how individuals living in community halfway houses can receive Medicaid benefits.

By Ana Mulero • April 29, 2016

Report shows wide variations in prices for common procedures across U.S.

A review of 242 common medical services found prices were highest in Minnesota and Wisconsin and lowest in Florida and Minnesota.

By Meg Bryant • April 29, 2016

Maryland co-op triumphant in profitable first quarter

Evergreen has long been a bright spot among the troubled ACA health cooperatives.

By Heather Caspi • April 28, 2016

Pfizer settles Wyeth Medicaid rebate case for $784.6M

The Justice Department claimed Wyeth failed to accurately rebate Medicaid for two drugs. Pfizer purchased Wyeth in 2009, about three years after the alleged conduct ended.

By Nicole Gray • April 28, 2016

OIG report: More data security gaps at Medicare administrative contractors

The Office of Inspector Genera's annual review of health IT security programs for MACs showed an 8% increase in data security gaps from 2013 to 2014. 

By Nina Flanagan • April 28, 2016

PacLife has eyes for Genworth's term-life business

Genworth suspended its term-life insurance to focus on long-term care policies.

By Meg Bryant • April 27, 2016

Centene post-Health Net acquisition Q1 financials shares optimism for ACA markets

The company gained many of its 683,000 first quarter exchange members through its Health Net deal.

By Heather Caspi • April 27, 2016

CMS releases MACRA implementation final rule proposal

The rule has so far received mixed reviews from AHA and AMA.

By Jeff Byers & Ana Mulero • April 27, 2016

California considers selling coverage to undocumented immigrants

With no state or federal funding requested to back the legislation, the state's bill stands a good chance.

By Heather Caspi • April 27, 2016

UnitedHealth adds Iowa, Kentucky to ACA market exit list

The number of states being dumped by UnitedHealth is mounting.

By Heather Caspi • April 27, 2016

Anthem Q1 earnings drop 19% year-over-year

The insurer's Q1 earnings slipped to $2.63 per share despite increased revenue, with increased medical costs cited as the reason for the drop.

By Ana Mulero • April 27, 2016

Study questions ACA plans' sustainability when reinsurance ends

Insurers will have to count on premiums alone to cover health costs in 2017.

By Heather Caspi • April 26, 2016

State health exchanges report big drop in enrollment

Five states report enrollment in exchanges dropped more than 14% since open enrollment ended on Feb. 1. 

By Nina Flanagan • April 26, 2016

CMS Medicaid managed care final rule caps medical-loss ratio at 85%

The rule is the first overhaul of Medicaid and CHIP managed care regulations in more than a decade.

By Jeff Byers • April 25, 2016

New legislation aims to help rural hospitals get paid

A new measure is intended to correct a payment formula that results in low Medicare reimbursement to hospitals in rural and low-wage areas.

By Julie Henry • April 25, 2016

Survey: Individuals with ACA plans more likely to get care they need than those with employer plans

Enrollees in marketplace plans have similar experiences as those with an employer-based health plan, according to the Urban Institute-funded study.

By Heather Caspi • April 25, 2016

Employers provide free surgeries in bundled payment experiments

Some large companies beat Medicare to the game and are sharing their lessons learned.

By Heather Caspi • April 25, 2016

Former Capital BlueCross employee accused of $300K fraud scheme

The claims were filed with Capital BlueCross, CareFirst, and Excellus Health Plan - all members of the Blue Cross Blue Shield Association.

By Heather Caspi • April 25, 2016

Oregon health plan to exit market amid steep competition, falling revenues

LifeWise’s existing members will continue being served through the duration of their current plan year.

By Meg Bryant • April 22, 2016

Anthem continues joint hospital venture efforts with 'unique' Wisconsin model

Alongside Aurora Health Care, the companies will operate the new entity, Wisconsin Collaborative Insurance Company, as 50-50 owners.

By Heather Caspi • April 21, 2016

Medicaid pays for live telehealth in most states but lack of definition creates confusion

Some states are expanding telehealth reimbursement but others are placing more limits and restrictions, a new report finds.

By Nina Flanagan • April 21, 2016