# Medicare Advantage * **Definition:** A type of health insurance plan in the United States that provides Medicare benefits through private insurance companies, often including additional services beyond standard Medicare. * **Taxonomy:** Healthcare Topics / Medicare Advantage ## News * Selected news on the topic of **Medicare Advantage**, for healthcare technology leaders * 15.5K news items are in the system for this topic * Posts have been filtered for tech and healthcare-related keywords | Date | Title | Source | | --- | --- | --- | | 5/23/2025 | [**Bill Aims to Crack Down on Medicare Advantage Prior Authorizations for LTC, Including Nursing Homes**](https://skillednursingnews.com/2025/05/bipartisan-bill-aims-to-crack-down-on-medicare-advantage-prior-authorizations-for-ltc-including-nursing-homes/) | [[Skilled Nursing News]] | | 4/23/2025 | [**WebMD Ignite to Enhance Health Plan Care Management Engagement - - HIT Consultant**](https://hitconsultant.net/2025/04/23/webmd-ignite-to-enhance-health-plan-care-management-engagement/) | [[HIT Consultant]] | | 4/10/2025 | [**Trump Administration Reinforces Medicare Advantage's Dominant Position - Forbes**](https://www.forbes.com/sites/joshuacohen/2025/04/10/trump-administration-reinforces-medicare-advantages-dominant-position/) | [[Forbes]] | | 4/8/2025 | [**Rural Hospitals Question Whether They Can Afford Medicare Advantage Contracts**](https://www.healthleadersmedia.com/payer/rural-hospitals-question-whether-they-can-afford-medicare-advantage-contracts) | [[HealthLeaders Media]] | | 4/7/2025 | [**Clover Health Appoints Industry Veteran as Chief Medical Officer of Medicare Advantage**](https://www.globenewswire.com/news-release/2025/04/07/3057207/0/en/Clover-Health-Appoints-Industry-Veteran-as-Chief-Medical-Officer-of-Medicare-Advantage.html) | [[Globe Newswire]] | | 4/7/2025 | [**Clover Health Appoints Industry Veteran as Chief Medical Officer of Medicare Advantage**](https://finance.yahoo.com/news/clover-health-appoints-industry-veteran-200500465.html) | [[Yahoo Finance]] | | 4/7/2025 | [**Medicare Advantage plans get larger pay bump than proposed**](https://www.modernhealthcare.com/policy/medicare-advantage-pay-rate-2026) | [[Modern Healthcare]] | | 4/7/2025 | [**CMS grants Medicare Advantage $25B funding increase**](https://www.beckershospitalreview.com/finance/cms-grants-medicare-advantage-25b-funding-increase/) | [[Beckers Hospital Review]] | | 4/3/2025 | [**Medicare Advantage under pressure as GOP looks to fund tax cuts**](https://www.modernhealthcare.com/politics-policy/medicare-advantage-trump-tax-cuts) | [[Modern Healthcare]] | | 4/3/2025 | [**Medicare Advantage is covering more and more Americans some because they don't get ...**](https://theconversation.com/medicare-advantage-is-covering-more-and-more-americans-some-because-they-dont-get-to-choose-251796) | [[The Conversation]] | | 2/28/2025 | [**If you're not happy with your Medicare Advantage plan, experts offer these tips to find better benefits**](https://www.aol.com/not-happy-medicare-advantage-plan-005200224.html) | [[AOL]] | | 2/28/2025 | [**If you're not happy with your Medicare Advantage plan, experts offer these tips to find better benefits**](https://www.yahoo.com/news/not-happy-medicare-advantage-plan-005200658.html) | [[Yahoo]] | | 2/20/2025 | [**Medicare Advantage plans are hurting rural hospitals: Report**](https://www.chiefhealthcareexecutive.com/view/medicare-advantage-plans-are-hurting-rural-hospitals-report) | [[Chief Healthcare Executive]] | | 2/3/2025 | [**Taxpayers spend 22ore per patient to support Medicare Advantage**](https://www.sfchronicle.com/news/article/taxpayers-spend-22-more-per-patient-to-support-20144698.php) | [[SF Chronicle]] | | 2/3/2025 | [**Taxpayers spend 22ore per patient to support Medicare Advantage - the private alternative to Medicare that promised to cost less**](https://www.houstonchronicle.com/news/article/taxpayers-spend-22-more-per-patient-to-support-20144698.php) | [[Houston Chronicle]] | | 1/22/2025 | [**Medicare Advantage denials top Orlando Health's revenue priorities**](https://www.beckershospitalreview.com/finance/medicare-advantage-denials-top-orlando-healths-revenue-concerns.html) | [[Beckers Hospital Review]] | | 1/14/2025 | [**Researchers find Medicare Advantage beneficiaries do not receive more dental, vision or hearing care**](https://medicalxpress.com/news/2025-01-medicare-advantage-beneficiaries-dental-vision.html) | [[MedicalXpress]] | | 12/26/2024 | [**The Medicare Advantage Program: Public Money Insurance Companies**](https://www.jdsupra.com/legalnews/the-medicare-advantage-program-public-2206337/) | [[JD Supra]] | | 12/18/2024 | [**The pros and cons of Medicare Advantage plans**](https://www.aol.com/finance/pros-cons-medicare-advantage-plans-160945729.html) | [[AOL]] | | 12/17/2024 | [**The pros and cons of Medicare Advantage plans - Fortune Well**](https://fortune.com/well/article/medicare-advantage-part-c-plans-pros-cons/) | [[Fortune]] | | 12/17/2024 | [**The pros and cons of Medicare Advantage plans - Yahoo**](https://www.yahoo.com/lifestyle/pros-cons-medicare-advantage-plans-160945541.html) | [[Yahoo]] | | 11/27/2024 | [**Biden administration pushes prior authorization reform in Medicare Advantage plans**](https://www.chiefhealthcareexecutive.com/view/biden-administration-pushes-prior-authorization-reform-in-medicare-advantage-plans) | [[Chief Healthcare Executive]] | | 11/26/2024 | [**Taxpayers spend 22 percent more per patient to support Medicare Advantage**](https://news.yahoo.com/news/taxpayers-spend-22-percent-more-095530180.html) | [[Yahoo News]] | | 11/7/2024 | [**Out-of-pocket costs found to be substantially lower in Medicare Advantage than traditional Medicare**](https://medicalxpress.com/news/2024-11-pocket-substantially-medicare-advantage-traditional.html) | [[MedicalXpress]] | | 8/19/2024 | [**Saul Anuzis: Hospital financial tactics threaten seniors' health (and seniors vote)**](https://www.post-gazette.com/opinion/Op-Ed/2024/08/19/out-of-network-strategy-hospitals-medicare-medicaid-rising-costs/stories/202408190009) | post-gazette.com | ## Topic Overview (Some LLM-derived content — please confirm with above primary sources) ### Key Players - **Better Medicare Alliance**: An organization emphasizing the importance of Medicare Advantage and advocating for its beneficiaries. - **Anthem Blue Cross Blue Shield**: Provides various Medicare Advantage plans and has reversed controversial reimbursement policy changes. - **UnitedHealthcare**: The largest Medicare Advantage insurer, serving nearly 30% of all Medicare beneficiaries. - **Aetna**: A significant player in the Medicare Advantage market, offering various plans. - **UCLA Health**: Recently launched a Medicare Advantage Plan in LA County, focusing on patient outcomes and community care. - **Blue Cross Blue Shield**: A well-known insurance provider with a range of Medicare Advantage offerings. - **CMS**: The Centers for Medicare & Medicaid Services, responsible for overseeing Medicare Advantage and implementing new rules to reduce denials. - **Humana**: A major provider of Medicare Advantage plans, known for its extensive coverage options. - **Centers for Medicare & Medicaid Services (CMS)**: The federal agency overseeing Medicare and Medicaid programs, responsible for funding and regulatory changes affecting Medicare Advantage. - **Centers for Medicare and Medicaid Services (CMS)**: The federal agency responsible for overseeing Medicare Advantage plans and ensuring compliance with regulations. - **Zing Health**: A Medicare Advantage insurer focused on underserved seniors, recently raised funding to expand its services. - **HIMSS**: An organization focused on improving healthcare through information technology, monitoring regulatory changes affecting Medicare Advantage. - **Braven Health**: A New Jersey-based provider offering Medicare Advantage plans with a focus on comprehensive healthcare coverage. - **Clover Health**: A Medicare Advantage insurer focused on leveraging technology to improve healthcare access and outcomes for seniors. ### Partnerships and Collaborations - **DarioHealth and Medicare Advantage**: DarioHealth has secured a contract with a national Medicare Advantage health plan to launch its behavioral health initiative, Twill by Dario, starting January 2025. - **HealthPartners and UnitedHealthcare**: HealthPartners exited the UnitedHealthcare Medicare Advantage plan due to high denial rates and slow payments. - **Hackensack Meridian Health and Horizon Blue Cross Blue Shield**: Created a joint venture called Braven Health to improve care quality metrics for Medicare Advantage members. - **Enhabit and Insurers**: Enhabit has negotiated contracts with insurers to improve Medicare Advantage reimbursements, benefiting both the company and enrollees. - **Sutter Health**: In early stages of establishing strategic partnerships with Medicare Advantage plans to diversify revenue. - **Pennant Group and Signature Healthcare**: Acquisition aimed at enhancing operational footprint and negotiating better rates with Medicare Advantage plans. - **Clover Health and Technology Providers**: Clover Health utilizes advanced data-driven solutions and technology to enhance its Medicare Advantage operations. - **Inovalon and Medicare Advantage Star Ratings**: Inovalon's Converged Quality Solution has helped clients achieve a 5% increase in Medicare Advantage Star Ratings. - **Essentia Health and UnitedHealthcare**: Essentia Health announced it would cease being an in-network provider for UnitedHealthcare's Medicare Advantage plans due to excessive prior authorization requirements. - **Ontrak and Intermountain Health**: Collaboration to provide behavioral health solutions to Medicare Advantage members in Nevada, enhancing care delivery. - **Kaia Health and eternalHealth**: Collaborating to provide digital therapy solutions for pain management and physical function for Medicare Advantage members. - **Astiva Health and CMS**: Astiva Health's partnership with CMS has led to a 4-star rating, enhancing its ability to provide quality care. - **SelectHealth and Local Healthcare Systems**: SelectHealth partners with local healthcare systems to provide comprehensive care and promote community health. - **Elevance Health**: Collaborating with healthcare providers to enhance care coordination and streamline patient management. - **WebMD Ignite**: Enhancing its Coach platform for better member engagement through advanced SMS capabilities. - **Ontada and Datavant**: Partnered to integrate oncology data into Datavant's health data ecosystem, enhancing access to critical insights. - **Zing Health Funding**: Zing Health raised $140 million in funding to expand its services for underserved seniors, with participation from various investors. ### Innovations, Trends, and Initiatives - **Customer Satisfaction**: Recent studies show that Medicare Advantage plans significantly outperform commercial member health plans in customer satisfaction, driven by factors such as ease of finding care and low out-of-pocket costs. - **Medicare Advantage Growth**: Enrollment in Medicare Advantage plans has surged, with projections indicating that nearly 60% of beneficiaries will enroll by the end of the decade. - **Growth in Enrollment**: As of 2024, over 54% of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans, indicating a significant trend towards this coverage option. - **Medicare Advantage Star Ratings**: A system that evaluates the quality of Medicare Advantage plans, with recent declines in ratings indicating challenges in care quality. - **CMS New Rule**: Introduced to reduce prior authorization denials in Medicare Advantage plans, improving access to necessary healthcare. - **Increased Funding**: CMS announced a $25 billion funding increase for Medicare Advantage plans in 2026, reflecting a significant rise in payments. - **Value-Based Contracts**: Emerging trend in partnerships aimed at aligning incentives and improving care quality for Medicare Advantage members. - **Dental Benefits Expansion**: Nearly 97% of Medicare Advantage beneficiaries are enrolled in plans offering dental benefits, indicating a significant expansion in coverage. - **Digital Health Tools**: Efforts to leverage digital health tools to improve member engagement and address health equity in Medicare Advantage. - **Data Utilization in MA Plans**: Medicare Advantage plans are encouraged to improve data integrity and utilize social determinants of health (SDOH) data to enhance care delivery. - **Digital Therapy Solutions**: Innovative digital therapies are being introduced to improve health outcomes for Medicare Advantage members. - **Payment Increases**: The Trump administration announced a 5.1% increase in payments to Medicare Advantage insurers for 2026, contrasting with the Biden administration's proposed 2.2% increase. - **WEX Medicare Advantage Marketplace**: A digital shopping solution allowing users to purchase grocery and OTC products, enhancing member experience. - **CMS Reforms**: The Centers for Medicare & Medicaid Services (CMS) proposed reforms to Medicare Advantage and Part D programs, focusing on prior authorization and coverage for weight loss drugs. - **Spending Cap Implementation**: Starting January 1, 2025, a $2,000 cap on out-of-pocket costs for prescription drugs will benefit Medicare Advantage enrollees. - **Prior Authorization Reform**: Bipartisan legislation proposed to transition Medicare Advantage plans to an electronic prior authorization system by 2027. - **AI in Claims Processing**: The rise in claim denials for Medicare Advantage plans is partly attributed to the use of AI tools by insurers, leading to concerns about discrimination and bias. - **Star Ratings Adjustments**: Recent changes to the 2025 Star Ratings by CMS aim to improve the accuracy of quality assessments in Medicare Advantage. - **Senate Investigations**: The Senate Permanent Subcommittee on Investigations is focusing on prior authorization requirements and AI use in claims processing within Medicare Advantage. ### Challenges and Concerns - **Access to Supplemental Services**: Studies show Medicare Advantage beneficiaries do not receive more dental, vision, or hearing services compared to traditional Medicare, raising concerns about the value of these plans. - **Access to Services**: Studies indicate that Medicare Advantage beneficiaries have reduced access to quality home health services compared to traditional Medicare beneficiaries. - **Access to Care**: Rural patients on Medicare Advantage often face difficulties accessing and affording care compared to those on traditional Medicare, raising concerns about the effectiveness of these plans. - **Enrollment Complexity**: The enrollment process for Medicare Advantage can be complicated, with significant changes in coverage and benefits. - **Quality of Additional Benefits**: Despite offering additional benefits like dental and vision care, many Medicare Advantage plans do not meet established quality standards. - **Provider Network Limitations**: Medicare Advantage plans often restrict access to specific networks, leading to higher out-of-pocket costs for out-of-network care. - **Inequities in Care**: Research indicates that Medicare Advantage plans may provide fewer benefits to sicker patients, raising concerns about equity in healthcare access. - **Regulatory Changes**: Ongoing regulatory changes and economic pressures are reshaping the Medicare Advantage landscape. - **Financial Strain**: The federal government pays 20% more for Medicare Advantage enrollees than for traditional Medicare, leading to increased costs and scrutiny over the program's sustainability. - **Regulatory Scrutiny**: Ongoing investigations and lawsuits against major insurers highlight concerns about fraud and misrepresentation in Medicare Advantage. - **Overpayments and Funding Issues**: Medicare Advantage is costing taxpayers more than intended, with overpayments leading to financial strain on the system. - **Concentration Risk**: The Medicare Advantage market is dominated by a few firms, raising concerns about concentration risk and its impact on competition and service delivery. - **Administrative Difficulties**: High denial rates for prior authorizations and slow payment processes are leading hospitals to terminate contracts with Medicare Advantage plans. - **Awareness of Benefits**: Only 54% of seniors enrolled in Medicare Advantage are aware of supplemental services like dental and vision coverage. - **Financial Sustainability**: Concerns about inflated costs and overpayments to Medicare Advantage plans, costing taxpayers significantly more than traditional Medicare. - **Market Concentration**: 97% of Medicare Advantage markets are highly concentrated, raising concerns about competition and patient access. - **Declining Star Ratings**: Significant drop in the number of high-rated Medicare Advantage plans, raising concerns about the quality of care provided. ## Related Topics [[Medicare]]