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Medicare Advantage

Latest Headlines

Latest Headlines

Highmark vs. UPMC: The saga continues

"It's like fourth grade," Judge Dan Pellegrini said of a court hearing Wednesday regarding the ongoing dispute between Pittsburgh health giants Highmark and the University of Pittsburgh Medical Center.

Do state officials have authority over Medicare Advantage insurers?

As Pennsylvania officials have attempted to force Highmark into expanding its Medicare Advantage network, Highmark pushed back by claiming that the state lacks authority over the federal program.

Let's address the dark side of Medicare Advantage plans

Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well. In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have. This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.

Horizon expands patient-centered care programs

Horizon Blue Cross Blue Shield of New Jersey is expanding its patient-centered practices to its newest Medicare Advantage plan. 

HHS official calls for tougher audits of Medicare Advantage plans

The Centers for Medicare & Medicaid Services should implement tighter audit standards to prevent Medicare Advantage plans from using unfair billing practices that lead to excessive reimbursements, a senior official with the U.S. Department of Health & Human Services told the Center for Public Integrity.

CMS' Medicare Advantage Star Ratings on the rise

Overall performance for Medicare Advantage plans with and without prescription drug coverage is on the rise--and the  Centers for Medicare & Medicaid Services  credits its Star Ratings program for driving quality improvement. 

Insurers scrutinized for Medicare plans

Medicare health plans are in the spotlight once again, but not in a good way. Federal officials aren't pleased with the plans, citing  dozens of federal audit reports that indicate the same kind of d eficiencies year after year, reports the  The New York Times.

State: Highmark should include UPMC in its Medicare Advantage network

The Pennsylvania Attorney General and the departments of health and insurance want Highmark to expand its Medicare Advantage plans to include the University of Pittsburgh Medical Center within its network.

Are stricter network standards coming for exchange plans?

A think tank within the Department of Health and Human Services analyzed whether the agency should set new rules requiring stricter standards for provider networks on the health insurance exchanges, reported  LifeHealthPro.

Hospitals sue Highmark over Medicare Advantage payments

A group of Pennsylvanian hospitals filed a lawsuit against Highmark Monday, reports the  Pittsburgh Business Times