Payer: Page 5
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Elevance outperforms in third quarter but warns of Medicaid challenges
The Indianapolis-based company is the first major insurer to release earnings this cycle. Elevance did well in the quarter, but hinted that profits could be constrained in 2026.
By Rebecca Pifer Parduhn • Oct. 21, 2025 -
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OpinionBeyond one-size-fits-all: How ICHRA empowers employees and employers
ICHRA plans, a nascent form of health coverage, are gaining traction, argues an executive of Centene subsidiary Ambetter Health.
By Alan Silver • Oct. 16, 2025 -
Rebecca Pifer/Healthcare Dive
Oz reiterates need to improve Medicare Advantage payment accuracy
The CMS administrator’s comments at an industry event in D.C. reflect the difficult tightrope regulators in the Trump administration walk as they pursue MA reform.
By Rebecca Pifer Parduhn • Oct. 15, 2025 -
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California passes laws targeting PBMs, private equity
Gov. Gavin Newsom signed an array of healthcare bills into law last week that crack down on pharmacy benefit managers and beef up the review process for deals involving private equity firms.
By Susanna Vogel • Oct. 15, 2025 -
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Healthcare AI investment focused on profit margins, ROI: report
As providers and payers navigate an increasingly challenging financial environment, executives are targeting AI tools that show a clear return on investment, according to a report by Klas Research and Bain & Company.
By Emily Olsen • Oct. 15, 2025 -
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Senate Finance Committee probes Medicaid contractors over faulty systems
Top Democrats are airing related concerns that the IT chassis underpinning states’ Medicaid operations may not be robust enough to withstand the added pressure from looming work requirements.
By Rebecca Pifer Parduhn • Oct. 15, 2025 -
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Humana loses Medicare Advantage stars lawsuit for a second time
A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment. A spokesperson for Humana said the insurer is considering “all available legal options.”
By Rebecca Pifer Parduhn • Oct. 14, 2025 -
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Top Democrat questions Medicare Advantage insurers on AI claims denials
The letter from Sen. Richard Blumenthal comes one year after a Senate investigation criticized major MA payers for using predictive technology to deny post-acute care.
By Emily Olsen • Oct. 14, 2025 -
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Sponsored by West MonroeNavigating the perfect storm: Cost pressures and regulatory challenges
Healthcare’s perfect storm: soaring costs, shifting regs and AI’s role in survival.
By Esteban López, MD, MBA Partner, Healthcare • Oct. 13, 2025 -
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Winners and losers from 2026 Medicare Advantage star ratings
Humana and Aetna saw enrollment in highly rated plans fall, while Elevance’s and Centene’s stars improved and UnitedHealthcare’s stayed stable.
By Rebecca Pifer Parduhn • Oct. 10, 2025 -
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Pharmacy groups defend Iowa PBM law amid legal challenge
The state passed the law in June in a bid to protect independent pharmacies from certain harmful pharmacy benefit manager practices, but it was quickly tied up in litigation.
By Rebecca Pifer Parduhn • Oct. 9, 2025 -
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UnitedHealthcare swipes at Johns Hopkins, Capital Women’s Care in contract brawl
The insurer accused the health systems of putting business interests over patient well-being in recent failed contract negotiations.
By Susanna Vogel • Oct. 8, 2025 -
Sara Samora/Healthcare Dive
Influential PBM lobby appoints top Express Scripts executive as board chair
Adam Kautzner will oversee the PCMA’s strategy as chair of the board, including its defense of pharmacy benefit managers amid growing scrutiny of their role in rising drug costs.
By Rebecca Pifer Parduhn • Oct. 8, 2025 -
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Oz speaks out about shutdown, Medicaid cuts, Medicare Advantage audits and more
Six takeaways from the CMS administrator’s appearance at a D.C. think tank — including why he supports a clean funding bill to reopen the government.
By Rebecca Pifer Parduhn • Oct. 7, 2025 -
Courtesy of UnitedHealth Group
Shareholder group calls on UnitedHealth to decouple CEO from board chair
Stephen Hemsley is the chairman of UnitedHealth’s board and its CEO. The Accountability Board says that undercuts corporate governance at a turbulent time for the company.
By Rebecca Pifer Parduhn • Oct. 6, 2025 -
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No Surprises dispute resolution remains operational despite shutdown
However, a prolonged lapse in funding could affect other activities underpinning implementation of the law that holds consumers blameless for unexpected out-of-network bills.
By Rebecca Pifer Parduhn • Oct. 6, 2025 -
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Medicaid enrollees at risk of disenrollment report multiple chronic conditions: study
About 41% of beneficiaries who could lose coverage due to federal work requirements signed into law this summer have three or more chronic conditions, according to new JAMA research.
By Emily Olsen • Oct. 6, 2025 -
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Humana’s Medicare Advantage star ratings slip for 2026
Humana is giving investors an early look at stars data after a CMS slip-up led some information to be inadvertantly shared online. The results are in line with expectations but still unsatisfactory, Humana said.
By Rebecca Pifer Parduhn • Oct. 2, 2025 -
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UnitedHealthcare, Humana, Aetna scale back Medicare Advantage plans for 2026
The coverage landscape for the privatized Medicare plans will look significantly different next year, giving smaller players a chance to snap up market share but likely creating confusion for seniors.
By Rebecca Pifer Parduhn • Updated Oct. 3, 2025 -
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ACA premiums could rise 114% if enhanced subsidies lapse: KFF
Extending the more generous financial assistance is at the center of a funding fight between Democrats and Republicans on Capitol Hill that shut down the federal government this month.
By Emily Olsen • Oct. 1, 2025 -
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Top healthcare conferences to attend in 2026
These are the events healthcare leaders should plan for this year, covering topics like digital health, rural care and financial management.
By Healthcare Dive staff • Updated 20 hours ago -
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Medicare Advantage enrollment projected to fall in 2026: CMS
Nearly 1 million fewer people could sign up for the privatized Medicare plans next year, according to the CMS, marking the first time in years MA enrollment could decline.
By Emily Olsen • Sept. 29, 2025 -
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Sponsored by Quest DiagnosticsGetting the picture: How comprehensive member-based lab data helps payers close gaps and optimize care
Learn more about how member-based data helps payers.
Sept. 29, 2025 -
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Sponsored by Sutherland GlobalLeveraging automation and AI to transform payer operations
How AI and automation can help payers drive revolutionary new efficiencies in provider lifecycle management (PLM), medical management and member outreach and support.
Sept. 29, 2025 -
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Judge vacates Medicare Advantage audit rule in win for industry
On Thursday, Texas Judge Reed O’Connor threw out a Biden-era rule that would have recouped billions of dollars in overpayments to MA plans.
By Rebecca Pifer Parduhn • Sept. 26, 2025
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