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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 -
Permission granted by Aspen Institute
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 Jan. 30, 2026 -
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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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UnitedHealthcare launches direct-to-consumer marketplace for health and wellness programs
The insurance giant is unveiling UHC Store as payers work to shore up eroding consumer trust.
By Rebecca Pifer Parduhn • Sept. 25, 2025 -
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Physician practice acquisitions on the rise: GAO
Consolidation with health systems can lead to higher prices, alongside a decrease or no change in care quality, according to a review from the Government Accountability Office.
By Emily Olsen • Sept. 24, 2025 -
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Aetna expands program curbing hospital readmissions for Medicare Advantage members
One hospital has piloted the program for a few months and seen some early successes that have made other operators interested, an Aetna spokesperson said.
By Rebecca Pifer Parduhn • Sept. 23, 2025 -
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States should be full steam ahead on Medicaid work requirements, experts say
There’s a lot that states want the CMS to weigh in on. But given the tight rollout timeline for the controversial mandates, they shouldn’t delay implementation, experts said during a MACPAC meeting.
By Rebecca Pifer Parduhn • Sept. 22, 2025 -
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Medicare Advantage plans to share provider directories under CMS final rule
The policy was originally proposed by the Biden administration in November, but comes amid a larger push for more transparency around payers’ provider networks from health officials in the Trump regime.
By Rebecca Pifer Parduhn • Sept. 19, 2025 -
Courtesy of Blue Shield of California
Kansas, Hawaii Blues invest in Blue Shield of CA’s health tech sister company
Stellarus was launched as part of Blue Shield of California’s restructuring to sell services to nonprofit plans that they don’t have the resources to build themselves. That pitch has now worked on at least two Blues plans.
By Rebecca Pifer Parduhn • Sept. 18, 2025 -
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How to reform Medicare’s physician fee schedule to reprioritize primary care
America’s primary care chassis is crumbling, and how Medicare pays physicians is partially to blame. Expanding value-based payment arrangements could be the answer, experts say.
By Rebecca Pifer Parduhn • Sept. 17, 2025 -
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Optum Rx hikes payment floor on brand name drugs for independent pharmacies
The move builds on the major PBM’s pivot to cost-based pricing for pharmacies announced earlier this year.
By Rebecca Pifer Parduhn • Sept. 17, 2025 -
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GOP bill extends telehealth flexibilities, sidesteps ACA subsidies
The continuing resolution would preserve virtual care flexibilities through Nov. 21. But it makes no mention of extending more generous financial assistance for people who buy plans on the ACA exchanges.
By Emily Olsen • Sept. 17, 2025
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