Payer: Page 62
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CMS requires government, most private plans to cover COVID-19 vaccines
Commercial payers are likely already modeling costs. Anthem CEO Gail Boudreaux said Wednesday the insurer considered multiple variables when determining pricing and will follow CMS guidance.
By Shannon Muchmore • Updated Oct. 29, 2020 -
Brian Tucker/Healthcare Dive
Final rule requires health plans to make negotiated rates public
CMS Administrator Seema Verma fought back against claims the regulation will stifle competition. "Don't be fooled ... such complaints are all about protecting a considerable profit special interest reaped from business as usual," she said.
By Shannon Muchmore • Oct. 29, 2020 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Anthem beats in Q3, but profit plummets amid rising costs
The payer also reported a $594 million payment toward a federal antitrust settlement reached with Blue Cross Blue Shield plans that is still awaiting approval by a judge.
By Shannon Muchmore • Oct. 28, 2020 -
Task force proposes lowering colorectal cancer screening age to 45
The U.S. Preventive Services Task Force recommendations are used to decide services that have to be covered at no copay under the Affordable Care Act.
By Nick Paul Taylor • Oct. 28, 2020 -
Samantha Liss/Healthcare Dive
Centene Q3 profit skyrockets on WellCare close, ACA settlement
Lower utilization of healthcare services during the quarter was partially offset by higher testing and treatment costs for COVID-19, the payer said. Analysts called the results "good enough."
By Samantha Liss • Oct. 27, 2020 -
Master Sgt. Hecht, Matt. (2020). [Photograph]. Retrieved from Flickr.
4 healthcare storylines overshadowed by COVID-19
The magnitude of the crisis has all but stopped some efforts, like a ban on surprise billing. But other policies are forging ahead, including price transparency requirements for hospitals beginning Jan 1.
By Shannon Muchmore • Oct. 22, 2020 -
Envision, Cigna avert out-of-network status in Florida
A deal between the private equity-backed staffing group and insurer ensures that thousands of clinicians remain in network during a deadly pandemic, averting potential for surprise medical bills.
By Samantha Liss • Oct. 22, 2020 -
COVID-19 has sparked more concerns about healthcare costs, insurance, TransUnion says
More people, especially those in younger generations, are using insurer websites to conduct cost research, the annual survey found.
By Ron Shinkman • Oct. 21, 2020 -
ACA plan premiums to fall 2% in 2021, CMS says
The price easing comes despite the Trump administration's efforts to chip away at the law, including support for the case to overturn it now before the Supreme Court. But affordability remains a challenge for some who don't get subsidies.
By Rebecca Pifer • Oct. 20, 2020 -
CVS wants pharmacy techs to administer COVID-19 vaccine, plans to hire 10,000 more
This week the Trump administration released guidance authorizing pharmacy technicians and pharmacy interns to administer coronavirus vaccines and COVID-19 diagnostic tests.
By Rebecca Pifer • Updated Oct. 23, 2020 -
MA plans see more minorities, dual eligibles signing up
Medicare Advantage has been a key revenue driver for big payers like UnitedHealth and Cigna, which are expanding their footprints.
By Shannon Muchmore • Oct. 16, 2020 -
Brian Tucker/Healthcare Dive
CMS grants Medicaid waiver to Georgia; exchange opt-out remains on table
The agency has approved a modest Medicaid expansion waiver for Georgia, and is apparently nearing OK of a second waiver that would allow the state to stop using the Healthcare.gov insurance exchange.
By Ron Shinkman • Oct. 15, 2020 -
Alex Wong via Getty Images
CMS expands Medicare emergency telehealth coverage with 11 new services
The agency also said more than 36% of those in traditional Medicare used a virtual visit between March and August and usage among Medicaid members has skyrocketed.
By Rebecca Pifer • Oct. 15, 2020 -
UnitedHealth says Q3 volume rebounds, net income down on consumer price breaks
Still, the first payer to report quarterly earnings bested Wall Street expectations and saw a lower-than-expected medical cost ratio of 81.9% for the third quarter.
By Samantha Liss • Oct. 14, 2020 -
Payer competition shrinks in already scarce markets, AMA survey finds
The five insurers with the biggest share in the most markets were Anthem, Health Care Service Corp., UnitedHealth Group, Florida Blue and Highmark.
By Hailey Mensik • Updated Oct. 15, 2020 -
Brian Tucker/Healthcare Dive
Teladoc-Livongo make first combined sale to Guidewell Health
The Florida Blue plan, which has been a Teladoc client for several years, will now offer Livongo's diabetes platform to some 50,000 members. Executives claimed more interest behind the scenes Monday at HLTH.
By Rebecca Pifer • Oct. 13, 2020 -
Medicare coronavirus vaccine pay rule predicted by month's end, Verma says: HLTH 2020
It's unclear whether CMS has the regulatory power to reimburse for a vaccine if approved by the FDA under an emergency use authorization, as public health officials expect. The rule will likely tackle that.
By Rebecca Pifer • Oct. 13, 2020 -
Employer healthcare costs stable in 2020, COVID-19 impact still unclear, KFF says
Still, despite modest premium growth, the annual Kaiser Family Foundation Employer Health Benefits survey notes costs for family coverage rose double the rate of inflation over the past five years.
By Ron Shinkman • Oct. 8, 2020 -
Medicare Advantage enrollees in 4-star or higher plans to drop in 2021
Cigna appears a winner as about 88% of its members will be in plans with four or more stars. Hitting higher scores gives plans the chance to nab lucrative bonuses.
By Samantha Liss • Oct. 8, 2020 -
Most employers won't turn to healthcare cost shifting in 2021, Mercer says
Months into a public health crisis, the outlook for employer-sponsored healthcare could shift significantly due to deferred care.
By Ryan Golden • Oct. 8, 2020 -
Walmart enters Medicare broker market, threatening incumbents
The massive retailer plans to sell MA, supplement and prescription drug plans from major insurers like UnitedHealthcare and Humana during this year's annual enrollment period.
By Rebecca Pifer • Oct. 7, 2020 -
Courtesy of Target
More than 14M may have lost health coverage after historic job losses, study finds
Not all lost jobs result in a loss of coverage, so researchers have been keen to figure out how historic unemployment has ultimately affected insurance status.
By Samantha Liss • Oct. 7, 2020 -
MA startup Clover Health goes public in blank check deal valuing it at $3.7B
The transaction expected to close in early 2021 is the latest in a string of IPOs and deals for digital-focused healthcare companies.
By Rebecca Pifer • Oct. 6, 2020 -
Medicare advisers toy with MA payment overhaul as major payers expand for 2021
MedPAC commissioners floated a new methodology in the Medicare Advantage program blending local and national spending, but pushback from payers is likely if the change is finalized.
By Rebecca Pifer • Oct. 5, 2020 -
UnitedHealth, Cigna to expand Medicare Advantage footprints, touting telehealth for 2021
Humana, Anthem and Aetna are also moving into new geographies with the popular and lucrative program. In addition, smaller player Clover Health is partnering with Walmart to offer plans in Georgia.
By Shannon Muchmore • Oct. 2, 2020
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