Now that President-elect Donald Trump has revealed his picks for two top health officials — Mehmet Oz, M.D., as CMS administrator and Robert F. Kennedy Jr. as HHS secretary — the multibillion-dollar industries regulated by those agencies are...

As CVS Health Corp. looks to revamp its struggling Aetna health insurance business, the company plans to significantly reduce its Affordable Care Act exchange footprint and raise premiums. Speaking at the Wolfe Research Healthcare Conference on...

Just weeks into the 2025 Annual Election Period (AEP), several major insurers stopped paying broker commissions for new enrollments into certain Medicare Advantage products. Now, sources say more are following suit, including smaller regional...

President-elect Donald Trump on Nov. 19 named author and cardiac surgeon Mehmet Oz, M.D., aka television personality Dr. Oz, as his choice for CMS administrator, overseeing both the Medicare and Medicaid programs. Industry observers suggest the...

During the UBS Global Healthcare Conference on Nov. 12, Elevance Health, Inc. Chief Financial Officer Mark Kaye attempted to reassure investors that the company is on the right track despite recent struggles in its managed Medicaid business....

Ending nearly a year of “will-they-or-won’t-they” speculation, The Cigna Group on Nov. 11 confirmed it is not pursuing an acquisition of Humana Inc., thus ending the possibility of a “Cigmana,” as some analysts called it. ...

CVS Health Corp.’s third-quarter 2024 earnings call — which it held on the same morning when many Americans woke up to learn Donald Trump had won the presidency — focused largely on how the firm’s new management aims to turn around its struggling...

Alignment Healthcare, Inc., Clover Health Investments Corp. and Oscar Health, Inc., which are commonly referred to as “insurtechs” for their focus on technology, each recently posted solid third-quarter financial results, especially compared with...

With Donald Trump declared the winner of the 2024 presidential election and Republicans controlling at least one chamber of Congress, experts are divided about the myriad ways in which the new balance of power in Washington might affect health...

Garnering 295 electoral votes as of Nov. 6, Donald Trump is headed for a second term in the White House. Although health care was not a top priority of Trump's campaign, industry analysts agree that major insurers have the most to gain from a...

Humana’s third-quarter 2024 earnings results were better than many analysts feared, driven by higher-than-expected Medicare Advantage (MA) revenue and outperformance of the company’s CenterWell clinics. ...

The Cigna Group on Oct. 31 posted third-quarter results that exceeded most analysts’ projections, bucking the industry trends that other managed care organizations have revealed in recent weeks. Unlike those insurers, Cigna does not have a...

As the 12th open enrollment period (OEP) for the Affordable Care Act exchanges kicked off Nov. 1, some noteworthy market trends include health insurers expanding into “farm belt” states, lower median deductibles, and a smaller number of plans...

After scuttling merger talks early this year, The Cigna Group is again potentially looking to acquire Humana Inc., according to an Oct. 18 Bloomberg report. The article mentioned the companies have held “informal discussions” about a tie-up but...

Centene Corp. and Molina Healthcare, Inc., two of the largest managed Medicaid insurers in the U.S., both beat expectations in their third-quarter earnings reports. While the companies saw higher care utilization among their Medicaid members,...

UnitedHealth Group, whose earnings reports are often seen as a bellwether for the entire managed care sector, disclosed third-quarter results on Oct. 15 that did not bode well for its fellow publicly traded health insurers. Still, some Wall Street...

Elevance Health, Inc. disclosed in its third-quarter earnings release on Oct. 17 that it significantly lowered profit guidance for this year, citing higher utilization in Medicaid as the primary driver. Although executives said they remained...

After multiple disappointing quarters and amid reports that CVS Health Corp.’s board of directors was considering breaking up the company, CVS said on Oct. 18 that it has named a new CEO. Additionally, CVS disclosed that its third-quarter earnings...

Signaling a departure from previous years of land grabs and benefit enhancements, Medicare Advantage insurers in 2025 are strategically scaling back as they face reimbursement challenges and rising medical costs. AIS Health, a division of MMIT,...

In the weeks following the Sept. 27 release of the 2025 Medicare Advantage and Part D landscape files and other key information, experts taking a deeper look at next year’s plan offerings agree that there’s not one linear story that can be told...

Oct. 10 revealed that 40% of Medicare Advantage Prescription Drug (MA-PD) plans — or 209 contracts — that will be offered in 2025 earned an overall Star Rating of 4 or higher, thus qualifying for quality bonus payments (QBPs) in 2026. That...

A program that provides non-medical interventions for North Carolina’s high-risk Medicaid population resulted in cost savings and fewer hospitalizations, according to a third-party analysis and speakers who participated in a recent Manatt, Phelps ...

CMS released its 2025 Medicare Advantage and Part D Star Ratings on Oct. 10, following outcry and legal challenges to its calculations. After applying the Tukey outlier deletion methodology for the second year in a row and recalculating the much...

In a development that drew mixed reactions from analysts, CVS Health Corp. is reportedly considering breaking up its diversified health care enterprise due to the poor performance of its Aetna health benefits division. ...

“Truly shocking” and “huge setback” were just two of a flood of analyst reactions to Humana Inc.’s Oct. 2 disclosure that its percentage of Medicare Advantage members in plans with 4 or more stars will plummet to 25% next year. That’s down from an...

In its annual release of key premium, benefit and plan information for Medicare Advantage and Part D, CMS on Sept. 27 emphasized stability and robust offerings for 2025, despite repeated warnings from industry trade groups and plans of anticipated...

More than 25 million people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage and over 56 million had their coverage renewed during the Medicaid eligibility redetermination process, according to a KFF analysis of data...

With nearly all states having completed the Medicaid “unwinding process” that shed millions of people from the rolls, a new analysis finds that total Medicaid and Children’s Health Insurance Program (CHIP) enrollment is actually higher than it was...

Although the November elections may alter the balance of power in Congress and change which party controls the White House, Democratic lawmakers this week introduced legislation that would advance a key policy priority for Affordable Care Act...

In August, Highmark Inc. launched a new Medicaid managed care organization in West Virginia, becoming the Mountain State’s first Blue Cross Blue Shield-branded MCO. In doing so, the insurer will confront challenges that MCOs of all stripes are...

Five insurers received the highest scores in the latest National Committee for Quality Assurance (NCQA) Health Plan Ratings, which assess plans based on patient experience and clinical quality. Two of those health plans tell AIS Health that their...

After failing to meet minimum medical loss ratio (MLR) requirements for three years in a row, Centene Corp. is prohibited from enrolling new beneficiaries into its Medicare Advantage Prescription Drug (MA-PD) plan in Missouri, while a...

Elevance Health, Inc. has agreed to acquire Indiana University Health Plans, according to a Sept. 10 press release. ...

Health Care Service Corp. (HCSC), which owns Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, recently rolled out an “alternative health plan” that combines what essentially is a tiered provider network, price...

During the Wells Fargo Healthcare Conference on Sept. 4, executives from Centene Corp. and Humana Inc. shared new details about how the headwinds facing their Medicaid and Medicare businesses are expected to play out. And within those updates,...

The countdown is on until the 2025 Medicare Annual Election Period (AEP), which runs annually from Oct. 15 through Dec. 7, and Medicare Advantage plans are anxiously awaiting intel on how their competitors responded to upcoming Medicare Part D...

After major insurers reported second-quarter financial results that reflected continued medical cost pressure in the government business, analysts revisited their takes on expectations for CVS Health Corp.’s Aetna, Centene Corp. and industry peers...

In an email to contracted brokers on Aug. 23 that has now stirred considerable controversy, Centene Corp. said it would no longer pay new and renewal commissions for enrollments in its stand-alone Prescription Drug Plan (PDP) products. ...

Most people enrolled in Affordable Care Act exchange plans had in-network access to fewer than half of clinicians in their area in 2021, according to a KFF study published on Aug. 26. Matthew Rae, the report’s lead author, tells AIS Health the...

With tens of millions of enrollees now dropped from the Medicaid rolls, a group of 189 health care organizations have taken another step they hope will add permanency to the program. The coalition, organized by the Association for Community...

So far, 2024 has proven to be an eventful year for publicly traded health insurers — and not always in a good way. ...

The summer of 2024 is shaping up to be a hotbed of M&A activity among health systems that operate Medicare Advantage plans. While the year kicked off with Point32Health, Inc.’s planned acquisition of Baystate Health’s Health New England, which...

As evidenced by hotly contested Medicaid contract awards in Florida, Kansas and Texas this year, local and regional health plans are increasingly being shut out of opportunities to serve enrollees in their communities. And though a recent...

For the 2025 plan year, Centene Corp. will not offer Medicare Advantage plans in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island and Vermont, Modern Healthcare reported, citing an Aug. 5 note from investment bank Stephens. ...

While most of the largest managed care organizations have recently reported higher-than-expected utilization that negatively impacted their second-quarter results, the three publicly traded “insurtechs” did not have the same issues. ...

Despite Humana Inc. beating second-quarter earnings and revenue expectations, Wall Street did not react kindly to the insurer’s latest financial results. Humana shares closed at $361.61 on July 31, the day the results were released, a 10.6%...

Although The Cigna Group reported second-quarter results on Aug. 1 that were strong on paper, the company’s decision to reaffirm — not raise — its full-year 2024 earnings guidance and executives’ remarks regarding health care utilization trends...

As publicly traded insurers vie for contracts in an increasingly competitive Medicaid environment, this year has seen a considerable uptick in bid protests and legal challenges with billions of dollars at stake. Dayton, Ohio’s CareSource, one of...

During recent conference calls to discuss second-quarter 2024 earnings, Centene Corp., Elevance Health, Inc. and Molina Healthcare Inc. all discussed the long-term Medicaid growth opportunity despite declining membership resulting from...

According to the latest data from KFF’s Medicaid Enrollment and Unwinding Tracker, more than 24.5 million people have been disenrolled from Medicaid as of July 23. ...

Molina Healthcare, Inc. has agreed to pay $350 million to acquire ConnectiCare, a subsidiary of EmblemHealth that covers about 140,000 medical lives in Connecticut. The July 23 announcement occurred one day before Molina reported second-quarter...

Although multiple Wall Street analysts deemed UnitedHealth Group’s second-quarter financial results “messy,” they also suggested that the company’s near-term stumbling blocks are largely eclipsed by the prospects of a more favorable 2025. ...

Despite reporting a strong balance sheet for the second quarter of 2024, Elevance Health, Inc. faced a selloff that seemed to be prompted by higher-than-expected utilization in the insurer’s Medicaid book of business. On July 17, the day that...

CMS’s recent revision of Medicare Advantage Star Ratings made some health insurers, especially CVS Health Corp.’s Aetna, big winners in the eyes of Wall Street. A number of insurers received higher bonus payments from CMS for the 2024 plan year...

In recent letters to two federal watchdog agencies, Republican leaders of key House committees demand an investigation into “widespread” improper enrollment in Affordable Care Act exchange plans, citing the findings of a paper from Paragon Health...

The share of people without health insurance coverage reached an all-time low of 7.2% in 2023 but is projected to rise to 8.9% in 2034, according to the Congressional Budget Office. ...

Medicare Advantage membership growth during both the 2024 Annual Election Period (AEP) and the Open Enrollment Period (OEP) was largely driven by major insurers (namely, CVS Health Corp.’s Aetna) and some of the insurtechs, according to a recent...

Legal odds are growing long for the Affordable Care Act’s preventive services coverage mandate after a June 21 appeals court decision, which didn’t resolve a lawsuit that could undermine the legal authority of federal preventive services experts...

Recent analyses from the Congressional Budget Office (CBO), Centers for Disease Control and Prevention (CDC), and the Urban Institute all demonstrate the impact that’s been made by the supersizing of Affordable Care Act exchange subsidies — as...

CalPERS, the California state agency that administers state and local government employees’ benefits and retirement programs, on June 12 selected Blue Shield of California to administer the agency’s statewide PPO plan, which is projected to have...

During Oscar Health, Inc.’s recent Investor Day presentation, CEO Mark Bertolini declared that “ICHRA’s time has come,” referring to Individual Coverage Health Reimbursement Arrangements, which the insurer said it believes is the key to expanding...

Although improving Medicare Advantage margins has been the hottest topic recently in managed care, executives at Elevance Health, Inc. at a recent investor conference made some noteworthy comments about the firm’s commercial and Affordable Care...

Months after rumors of a brewing deal with Humana Inc. generated a spate of headlines, The Cigna Group’s chief financial officer is signaling clearly that the company isn’t eager to jump into the mergers and acquisitions game until the conditions...

Although UnitedHealth Group CEO Andrew Witty caused a brief health insurer stock selloff with his remarks about a Medicaid “disturbance,” both his company and other managed care powerhouses have since been busy trying to reassure jittery investors...

CDPHP, a not-for-profit managed care organization serving Medicare Advantage members primarily in Upstate New York and the Hudson Valley, is one of several provider-led insurers that carried a strong growth trajectory from the Medicare Annual...

Medicare Advantage enrollment grew by 350,000 members during the 2024 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. That’s a 31% drop from last year, which saw 507,000 sign-ups from February...

Compounded by known challenges in estimating Medicare Part D costs stemming from the Inflation Reduction Act (IRA), the process of finalizing Medicare Advantage insurers’ bids for the 2025 plan year was an “extra wild ride” due to a variety of...

CDPHP and the Lifetime Healthcare Cos. have agreed to an affiliation in which Lifetime would become the parent company of CDPHP, according to a May 22 press release. ...

During the Bernstein Strategic Decisions Conference, CVS Health Corp. executives directly addressed the company’s rumored desire to find a private equity partner to fund the growth of its Oak Street Health clinics. Meanwhile, managed care stocks...

CMS on May 9 extended through June 2025 waivers meant to help states and Medicaid managed care organizations navigate the unwinding of COVID-19 pandemic-related eligibility rules. The waivers, which include provisions allowing MCOs to reach out to...

Although first-quarter performance was decidedly mixed for the country’s largest publicly traded health insurers, three startup “insurtechs” — Oscar Health, Inc., Alignment Healthcare, Inc. and Clover Health Investments Corp. — largely impressed...

Although insurers have bet big — and cashed in — on privatized Medicare and Medicaid plans, recently those business lines have shown some signs of distress. ...

Ousting CVS Health Corp.’s Aetna from the current roster of Medicaid managed care organizations serving the Kansas Medicaid program, Elevance Health, Inc.’s Healthy Blue was chosen as the third insurer for new KanCare contracts starting Jan. 1,...

A federal judge on May 2 ruled that the majority of claims against Centene Corp. can move forward in a lawsuit that accuses the insurer of defrauding customers via its marketing of Affordable Care Act exchange plans. ...

A group of lawmakers is urging federal regulators to investigate UnitedHealth executives’ sale of company stock right after learning that the health care firm was the target of a Dept. of Justice (DOJ) investigation concerning its provider...

Higher-than-expected medical loss ratios (MLRs) in Medicaid were a common — albeit minor — pain point for both Centene Corp. and Molina Healthcare, Inc. when the companies reported their first-quarter 2024 financial results. ...

In its first quarter results, The Cigna Group’s low care utilization numbers and focus on stock repurchases garnered the commercial insurance giant positive reviews from Wall Street analysts — despite a net first-quarter loss that executives...

CVS Health Corp.’s poor Medicare Advantage results in the first quarter of 2024 made the diversified health care and retail company the object of Wall Street’s ire. Analysts were highly critical of the firm’s performance, and the company’s stock...

For Medicaid-focused insurers facing the headwinds of the post-pandemic disenrollment backlog, a contract win can cause a major sigh of relief. That’s particularly true for Centene Corp., the largest managed Medicaid insurer in the U.S., which...

Although Humana Inc. beat Wall Street’s expectations with its first-quarter 2024 earnings per share (EPS), the recently finalized 2025 Medicare Advantage and Part D rate notice nonetheless cast a shadow over the insurer’s longer-term financial...

With Humana Inc.’s share price slumping in recent months, one Wall Street analyst points out that conditions may be better than ever for a possible takeover of the Medicare Advantage insurer by The Cigna Group. ...

Elevance Health, Inc. posted solid results in the first quarter of 2024 and announced an agreement to build a new primary care-focused provider unit with financing from private equity firm Clayton, Dubilier and Rice LLC (CD&R). Wall Street...

Although UnitedHealth Group is facing a host of headwinds — including responding to a massive cyberattack and managing elevated care utilization — Wall Street analysts largely deemed its first-quarter earnings report on April 16 “better than...

After pushing for new limits on broker compensation and other changes to ensure seniors are guided to Medicare Advantage and Part D plans that best meet their needs, the Alliance of Community Health Plans (ACHP) on April 4 celebrated a victory...

Millions of seniors report needing long-term services and supports that can assist with daily activities and disease management, but many don’t qualify for Medicaid, the primary source of LTSS coverage. Medicare Advantage plans have stepped up to...

Since last summer, major health insurers’ reports of unusually high outpatient care utilization have proven to be a thorn in the industry’s side — inflating medical loss ratios and forcing Humana Inc. to significantly downgrade its 2024 earnings...

Sending informational emails helped lead to some California residents switching to superior Affordable Care Act exchange plans, according to a study published on March 29 in JAMA Health Forum. However, Marina Lovchikova, Ph.D., the trial’s lead...

Although NeueHealth Inc. — formerly known as Bright Health Group Inc. — still owes a substantial sum of money to health insurers and is struggling to stay afloat, its CEO received a $1.95 million cash bonus last year, according to a new regulatory...

The April 1 release of final rate projections for Medicare Advantage and Part D plans was largely uneventful as CMS maintained the same all-in estimate of what plans can expect to see, on average, in terms of a reimbursement update next year. But...

More than 21.4 million people have signed up or were automatically re-enrolled in Affordable Care Act marketplace coverage during the 2024 open enrollment period, a 31% increase compared to 2023 OEP, according to CMS. ...

As it marked the 14th anniversary of the Affordable Care Act, the Biden administration in recent days announced several new steps that aim to build on the Medicaid coverage gains achieved by the ACA — and reduce the coverage losses due to Medicaid...

Since 2021, just three consumer operated and oriented plans (CO-OPs) have remained operational out of the original 23 nonprofit insurers created by the Affordable Care Act. Now, one of the three survivors — Common Ground Healthcare Cooperative ...

Nearly a year into the massive nationwide effort to reverify Medicaid eligibility after a pause in redeterminations during the COVID-19 pandemic, about 40% of renewals have yet to occur. With millions of people estimated to have lost coverage...

The software-focused startup insurers known as “insurtechs” last year made tangible strides toward reaching profitability, according to their full-year earnings reports, backing up their executives’ statements that 2024 may see break-even results...

Speaking at an AHIP conference in Baltimore on March 13, two state’s top Medicaid officials shared frank views about the tensions that arise from working with private managed care plans to run their Medicaid programs — especially as scrutiny of...

UnitedHealth Group faces a crisis as the fallout from the hack of its Change Healthcare subsidiary continues to spread. The firm is rumored to have paid $22 million to the hackers who may have caused the breach, even as it faces falling stock...

Each year, AIS Health does a deep dive into the enrollment shifts that took place regionally and nationally over the Medicare Annual Election Period (AEP) and explores the myriad drivers of growth (or attrition). From benefit enhancements to...

Nearly 33 million individuals were enrolled in Medicare Advantage as of February, demonstrating a year-over-year increase of 7.1% and Annual Election Period growth of 4.0%, according to AIS Health’s analysis of the latest AEP data. Those figures...

The U.S. Dept. of Justice (DOJ) has opened an antitrust investigation into UnitedHealth Group, according to an internal company document shared with AIS Health and a Wall Street Journal report citing unnamed people familiar with the matter. ...

Although Blue Cross Blue Shield plans’ margins started rising again in 2023 after a two-year slump, industry analysts say that a diverse array of factors could prevent continued margin expansion among the Blues this year. ...

This week, a growing chorus of criticism from state officials effectively stopped two proposed health insurer combinations in their tracks. ...

More than a year after unveiling their intent to form HealthRight Group, SCAN Group and CareOregon have abandoned their plans to combine. ...

Centene Corp.’s results for the fourth quarter of 2023 were largely positive, earning mild praise from Wall Street analysts. While Centene was the latest health insurer to face higher-than-expected Medicare Advantage utilization, executives...

CVS Health Corp. on Feb. 7 lowered its earnings per share (EPS) guidance for 2024, citing high Medicare Advantage cost trends. Wall Street analysts expected the announcement because other insurers, such as UnitedHealth Group and Humana Inc.,...

Capping off months of rumors that such a deal was brewing, The Cigna Group on Jan. 31 said it has agreed to sell its Medicare business to Health Care Service Corp. (HCSC). Industry observers say that given the near-term headwinds Medicare...

After reportedly vying with Elevance Health, Inc. for the purchase of The Cigna Group’s Medicare Advantage business, Health Care Service Corp. (HCSC) will buy Cigna’s MA, Medicare Supplemental, Medicare Part D and CareAllies assets for a total...

Elevance Health, Inc. reported stronger results for its 2023 fourth quarter earnings than its other publicly traded managed care peers so far, driven by relatively low utilization across its diverse mix of business lines. The results received...

Although a recent Humana Inc. regulatory filing had already prepared the market for a lackluster fourth-quarter earnings report, Wall Street analysts appeared to be shellshocked on Jan. 25, when the Medicare Advantage-focused insurer detailed just...

Although 2024 seems far removed from the height of the COVID-19 pandemic, the ripple effects associated with that disruptive global crisis are still influencing how this year will turn out for the U.S. health insurance sector, two top credit...

If the market reactions to a Humana Inc. regulatory filing and to UnitedHealth Group’s latest earnings report are any indication, concerns about elevated care utilization that cropped up in the second half of 2023 have followed health insurers...

Although executing mergers and acquisitions (M&A) is an important part of health insurers’ growth toolkit, industry insiders tell AIS Health, a division of MMIT, that companies could face challenges completing deals in 2024 due to factors such as...

Bright Health Group, Inc. finalized the sale of its Medicare Advantage business to Molina Healthcare, Inc. on Jan. 1. On that same day, Bright repaid JP Morgan $298.7 million to close its credit facility with the bank, an amount that Bright...

At least 13.3 million people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage and another 24.9 million had their coverage renewed as of December 2023, according to the KFF Medicaid enrollment and unwinding tracker....

UnitedHealth Group will sell its Brazilian subsidiary, Amil, the integrated managed care giant on Dec. 29 revealed in a filing with the Securities and Exchange Commission (SEC). Other publicly traded insurers have similarly divested international...

While major Medicare Advantage insurers are bracing for potential revenue reductions stemming from upcoming changes to the risk adjustment model, three insurers presenting at their recent investor conferences appeared bullish on the prospect of...

After merger talks fizzled in September, Elevance Health, Inc.’s agreement to acquire Blue Cross and Blue Shield of Louisiana is back on, according to the New Orleans Times-Picayune. ...

Bright Health Group, Inc. suffered another blow on Dec. 13, when the foundering startup insurer revealed that Molina Healthcare, Inc. will pay less than originally planned for Bright’s California Medicare Advantage business. Molina now plans to...

While deal talks between The Cigna Group and Humana Inc. have reportedly fizzled, Cigna’s desire to sell its Medicare Advantage business is apparently still alive and well. Health Care Service Corp. and Elevance Health, Inc., are the two...

During their Dec. 12 investor day, Centene Corp. executives promised 12% to 15% in annual earnings growth and declared victory in their multiyear value creation and cost-cutting plan. Wall Street analysts responded warmly to the firm’s...

Call it the blockbuster deal that never was. The Wall Street Journal reported on Dec. 10 that The Cigna Group abandoned merger talks with Humana Inc., ending a multiweek stir over a report from the same publication that the companies were...

If the recent activity of Humana Inc.’s private jet is any indication, The Cigna Group may have to compete with Walmart Inc. in its reported bid to combine with the Medicare Advantage-focused insurer. ...

Leading up to the 2024 Annual Election Period (AEP) that started on Oct. 15 and concluded on Dec. 7, major Medicare Advantage insurers unveiling geographic expansions signaled their continued pursuit of dually eligible Medicare-Medicaid...

Nearly 4.6 million people have enrolled in Affordable Care Act marketplace coverage since the start of the 2024 open enrollment period on Nov. 1, a 36% increase compared to the same point during the 2023 OEP, according to CMS. This year’s open...

The Cigna Group is reportedly discussing a multibillion-dollar deal with Humana Inc. that would create a diversified health insurance giant capable of going toe-to-toe with UnitedHealth Group and CVS Health Corp. ...

Three quarters into 2023, Moody’s Investors Service says the predictions it made at the start of the year for the health insurance sector — namely, earnings growth in the mid-to-high single digits — have largely proven accurate. However, while...

In 2024, managed care organizations will have to manage more complex care coordination requirements and compliance with ambitious equity goals in many states — even as Medicaid programs have been forced to step up reimbursement rates across many...

The beleaguered startup insurers known as “insurtechs” continued to post losses during the third quarter, but executives from Oscar Health, Inc., Clover Health Investments Corp. and Alignment Healthcare, Inc. all said they expected to at least...

The Cigna Group could be fielding offers for its Medicare Advantage book, according to a Nov. 6 Reuters report. Experts say that a spinoff is plausible given the small size of Cigna’s MA book and Cigna’s heavy focus on commercial insurance — and...

In the third quarter, CVS Health Corp. performed well overall, but the firm’s health insurance division was a drag on profits due to higher-than-expected utilization, especially in Medicare Advantage. However, a big gain in MA Star Ratings could...

The Cigna Group posted results for the third quarter of 2023 that impressed Wall Street, driven by a lower-than-expected medical loss ratio (MLR). However, Cigna executives faced questioning from analysts on potential PBM regulations. ...

Humana Inc.’s stock dipped after its third-quarter 2023 earnings report, with analysts largely blaming the firm’s revised estimate of its full-year medical loss ratio (MLR). The Medicare Advantage-focused insurer said that while it had been...

Ahead of the 2024 open enrollment period for Affordable Care Act exchange plans that began on Nov. 1, major U.S. health insurers issued a spate of press releases touting their plan options and listing new areas in which they’d offer coverage....

UnitedHealthcare will offer ACA exchange plans in four new states next year. With the addition of New Jersey, New Mexico, South Carolina and Wisconsin, the insurer said on Oct. 24, its total ACA marketplace footprint will comprise 26 states. ...

Centene Corp. reported sterling results in the third quarter of 2023, with the firm exceeding its quarterly earnings target and executing $773 million in share repurchases in that time. Executives promised further improvement on Medicare Advantage...

While the managed care stock story in the first half of 2023 revolved around care utilization concerns, the company that first fueled those worries — UnitedHealth Group — eased investors’ minds considerably when reporting third-quarter earnings. ...

Elevance Health Inc., the parent company of Anthem, enjoyed a strong third quarter, raising its end-of-year earnings guidance and completing a round of stock buybacks. The firm cited a strategic review — which involved layoffs and slashing real...

Only 42% of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2024 achieved an overall rating of 4 stars or higher, compared with approximately 51% of contracts in 2023, according to the latest Medicare Part C and Part...

Payer anxieties about lower Star Ratings for the 2024 plan year came to fruition last week with CMS’s release of the annual Part C and Part D quality measurements. The average Medicare Advantage Prescription Drug (MA-PD) contract scored a 4.04,...

States are struggling to complete Medicaid redeterminations: CMS has said that there are potentially millions of Medicaid and Children’s Health Insurance Program members who were improperly disenrolled due to administrative problems. Some in the...

Medicaid eligibility redeterminations are in full swing, but many states have struggled to fulfill automated enrollment requirements mandated by CMS, leading to finger pointing and — at a minimum — hundreds of thousands of members getting kicked...

North Carolina will launch its Medicaid expansion program on Dec. 1, state officials announced on Dec. 25, capping a yearslong effort to push through that policy. ...

Elevance Health, Inc.’s planned acquisition of Blue Cross and Blue Shield of Louisiana (BCBSLA) has been put on hold as political opposition to the deal intensifies. The deal, which was announced in January, was already troubled due to...

CMS will reinstate coverage for approximately 500,000 Medicaid and CHIP enrollees, mainly children, after they were improperly disenrolled from the safety net insurance programs.  ...

During a Sept. 20 KFF webinar, presenters and panelists seemed to agree on one thing: Regulations aimed at curbing misleading Medicare Advantage TV ads are a welcome fix for a mounting problem. Even an executive from the largest health insurance...

Beneficiary switching from fee-for-service (FFS) Medicare to Medicare Advantage more than tripled between 2006 and 2022, contributing to the MA enrollment boom that’s taken shape over the past two decades, according to a study published this month...

Medicare Advantage insurers can’t share the juicy details of their new plan offerings until Oct. 1, but they are taking steps to prime the market and help boost enrollment during the 2024 Annual Election Period (AEP) with “preheat” strategies....

Idaho is the first state to complete its Medicaid eligibility redeterminations process, the state’s Medicaid agency announced on Sept. 8. ...

Executives from health insurance firms Centene Corp. and Humana Inc. on Sept. 6 pitched investors on rosy projections for the rest of the year at the 2023 Wells Fargo Healthcare Conference — despite ongoing Medicaid eligibility redeterminations...

CMS is growing increasingly concerned that people, particularly children, are being disenrolled from Medicaid and Children’s Health Insurance Program (CHIP) coverage even though they still meet eligibility requirements. ...

The proposed acquisition of Blue Cross and Blue Shield of Louisiana (BCBSLA) by Elevance Health, Inc., the parent company of Anthem, faces deepening legal and political opposition from Louisiana elected officials and other stakeholders. The deal...

The $2.5 billion deal between Elevance Health, Inc. and Blue Cross and Blue Shield of Louisiana is facing some hiccups, per the New Orleans Times-Picayune. ...

A survey of people enrolled in Affordable Care Act marketplace plans in California found that 28% had difficulty paying their premiums in 2021, according to a study published last month in Health Affairs. While that is an improvement from 40% in a...

When the Biden administration celebrated the one-year anniversary of the Inflation Reduction Act on Aug. 16, the focus — from a health care perspective — was largely on the IRA’s unprecedented drug pricing reforms. While those provisions are...

Effective April 1, states were allowed to begin disenrolling people from Medicaid who no longer qualify after a multiyear pause during the COVID-19 public health emergency (PHE). Yet data from the federal government suggests many people are losing...

Although health insurers have been vocal about their desire to transition people into Affordable Care Act marketplace plans if they lose Medicaid during the resumed redetermination process, a new “secret shopper” survey suggests those customers...

Three of the four startup “insurtech” health plans made progress toward profitability in the second quarter of 2023, according to Wall Street analysts and one health care industry insider. But Bright Health Group, Inc., the highly leveraged firm...

More than 710,000 people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage in April, and about 55,000 of those individuals have transitioned to Affordable Care Act marketplace coverage, according to CMS’s first data...

At first blush, The Cigna Group’s second-quarter financial results largely impressed equities analysts, with a higher-than-expected risk adjustment payable representing one of the few headwinds reported by the company. ...

Although the topic of Medicaid eligibility redeterminations loomed large over the second-quarter earnings calls held by Centene Corp. and Molina Healthcare, Inc., the companies’ Affordable Care Act marketplace business lines offered a positive —...

CVS Health Corp. beat Wall Street’s consensus second-quarter earnings projections, but it raised concerns among analysts by lowering its earnings guidance for 2024. Humana Inc., meanwhile, also beat the Street’s second-quarter earnings estimate....

Government-focused publicly traded insurers reporting second-quarter 2023 earnings in July devoted a fair amount of discussion to the impact of Medicaid redeterminations on enrollment and rate adjustments, while analysts were interested in the...

Medicare Advantage enrollment growth has exploded in recent years, topping 31 million lives as of July 2023, according to AIS’s Directory of Health Plans. But a new analysis from McKinsey and Company warns this free-for-all won’t last forever, and...

Provider groups that want to sponsor a Medicare Advantage plan have multiple avenues of entering the market and competing with large national players — including building a plan from scratch. But funding, state licensure and other regulatory...

As health insurers decide how to price their Affordable Care Act exchange plans for the 2024 plan year, inflation, COVID-related costs and Medicaid redeterminations are some of the major factors influencing their calculations, according to a new...

Elevance Health, Inc. reported positive second-quarter 2023 results, powered by solid commercial performance and promising returns from its Carelon health services division, which was launched last year. ...

UnitedHealth Group saw higher-than-expected utilization in the second quarter, driven by seniors and those seeking behavioral health care. However, the company kept its full-year adjusted earnings per share (EPS) guidance intact, indicating that...

New data from Deft Research suggests that Medicare Advantage plans continue to struggle with retaining their dual eligible members, mainly because of problems associated with the supplemental benefits offered to address social needs. Published on...

In a new proposed regulation, the Biden administration seeks to reinstate limits on short-term, limited-duration insurance (STLDI) plans that the Trump administration had loosened — a move that health policy experts predict will have a small but...

The return of Medicaid redeterminations, which the managed care sector expected to be a daunting challenge, has proven even more difficult to handle than anticipated. States have begun to seek more time and resources from CMS to manage staggering...

After a long history of serving Medicare and Medicaid beneficiaries in New York State, Schenectady, N.Y.-based MVP Health Care in 2022 launched a Dual Eligible Special Needs Plan (D-SNP) through a joint venture with Belong Health, which...

After two months of shopping around its Medicare Advantage business, Bright Health Group, Inc. on June 30 unveiled plans to sell its remaining insurance assets to Molina Healthcare, Inc. in a deal worth approximately $600 million. The transaction...

As of June 27, at least 1.5 million Medicaid enrollees had lost coverage since eligibility redeterminations started back up, according to the Kaiser Family Foundation (KFF) Medicaid Enrollment and Unwinding Tracker. ...

Friday Health Plans Management Services Company, Inc. is in the death throes of its life as an Affordable Care Act exchange insurer — regulators are stepping in to take over its operations, and it’s laying off all employees in its home state of...

North Carolina and Colorado recently became the latest in a string of states that have taken over the reins of Friday Health Plans Management Services Company, Inc.’s subsidiaries in a bid to ensure consumers and providers aren’t harmed by the...

Late last year, nonprofit, government-focused carriers SCAN Health Plan and CareOregon announced plans to merge and form the HealthRight Group. CareOregon manages nearly 550,000 Medicaid enrollees in Oregon, while SCAN covers over 280,000 lives in...

To succeed with value-based behavioral health care contracts, Medicaid managed care plans need to tailor those pacts to the unique needs of a given provider, MCO executives say. And plans may not be able to use risk-based contracts with individual...

For the second time in recent history, New York City Comptroller Brad Lander is refusing to register the city’s contract with a Medicare Advantage insurer. But this time it’s not just legal challenges that has the comptroller questioning the city...

Medicaid resumed eligibility redeterminations in April after a multi-year pause related to the pandemic. This has profound implications for Medicaid managed care organizations, which could lose a large portion of their membership — and it is a...

Friday Health Plans Management Services Company, Inc. — a Colorado-based insurer that offers Affordable Care Act exchange plans in seven states — is in a downward spiral. Concerned by the company’s deteriorating financial situation, state...

Venture-backed Friday Health Plans Management Services Company, Inc. “will begin to wind down its business activities throughout the country, working in close conjunction with state regulators,” the Colorado Division of Insurance (DOI) said on...

Medicaid redeterminations resumed in recent weeks after years of pandemic-related policies that suspended income verification for the safety net health insurance program, and some states — particularly Florida — seem to be moving faster than...

Medicare Advantage enrollment grew by more than 507,000 lives during the 2023 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. That’s a significant increase from last year’s OEP, when plans...

Challenges with finding transportation is keeping many U.S. adults from accessing necessary health services, according to a recent report from the Urban Institute. Health policy experts tell AIS Health, a division of MMIT, that providing non...

Although multiple states have set up some version of a public option — a government-established insurance plan — on their Affordable Care Act exchanges, two researchers are striving to convince policymakers to consider a public option program in...

A spate of deals and new initiatives from Kaiser Permanente, CareSource and Blue Cross Blue Shield of Michigan highlight the race for nonprofit insurers to expand and diversify in increasingly competitive markets, as well as the rise of value...

Although executives during The Cigna Group’s first-quarter 2023 earnings call put a heavy emphasis on the firm’s evolving PBM business model, Cigna’s ability to control health care costs was a noteworthy —albeit less headline-grabbing — highlight...

Not one, not two, but three insurtechs that have gone public in recent years reported their first-quarter earnings on May 9 — and each took the opportunity to detail how they’re stepping away from unprofitable parts of their businesses and...

Due to the early close of its deal to purchase Oak Street Health, CVS Health Corp. when reporting first-quarter 2023 results said it would lower its full-year earnings per share (EPS) estimate from a range of $8.70 to $8.90 down to $8.50 to $8.70....

Blue Cross Blue Shield of Michigan and Blue Cross and Blue Shield of Vermont, the largest health insurers in their respective states, have struck an agreement that will see the Vermont Blues plan become a subsidiary of BCBS of Michigan. The...

Integrated insurer-provider Kaiser Permanente (KP) will acquire Geisinger Health, the Pennsylvania-based integrated health system and health insurance plan, as part of a new Kaiser venture that will aim to take over other regional nonprofit...

Kaiser Permanente plans to acquire Geisinger Health in a transaction that would combine two powerful nonprofit health care organizations boasting care delivery and health insurance assets. ...

Centene Corp. exceeded earnings projections during the first quarter of 2023 and raised its guidance, moves that were made possible by growth in Affordable Care Act exchange enrollment. But the carrier cut its guidance for 2024, mainly due to...

Although the managed care earnings season kicked off with concerns about rising medical costs, equities analysts appeared optimistic about Humana Inc.’s prospects after the insurer reported its first-quarter 2023 financial results on April 26....

Republicans in the U.S. House of Representatives have passed legislation that would require about one-third of Medicaid enrollees to be employed or looking for work, which would be a radical shift in the safety net program’s mission and operations...

Although UnitedHealth Group’s executives touted “strong and well-balanced” growth in the first quarter of 2023, the company’s stock dropped following its April 14 earnings report. Equities analysts suggested that a decline in the days claims...

Elevance Health, Inc. reported increased premium revenues in the first quarter of 2023 and strong results from its fast-growing PBM and services division, Carelon. While Wall Street analysts were mostly positive about the results, some expressed...

The Biden administration will make Medicaid coverage available to incarcerated people for the first time through a new category of Section 1115 waivers, building on a demonstration program that has been active in California since January. Experts...

During a recent panel discussion featuring equities analysts who cover the health care sector, analysts expressed skepticism that the rapid rate of mergers and acquisitions occurring in the industry will slow down in the near future — and they...

While “benchmark” Affordable Care Act premiums rose in 2023 after declining for multiple years, greater insurer competition in heavily populated regions is still helping to keep rates in check, according to a new analysis from the Urban Institute....

North Carolina Gov. Roy Cooper, a Democrat, on March 27 signed the law expanding Medicaid under the Affordable Care Act; the state projects “more than 600,000” North Carolinians to enroll. After North Carolina’s action, only 10 states have yet to...

The return of Medicaid redeterminations and the resulting changes in the risk pool could mean a more expensive-to-cover mix of members for managed care organizations, according to a recent webinar convened by the American Academy of Actuaries....

Nearly 16.4 million people selected or were automatically reenrolled in coverage during the 2023 open enrollment period for Affordable Care Act marketplace plans, the Biden administration said on March 23. ...

Struggling health insurer Bright Health Group Inc. raised eyebrows with its recent announcement that CEO George Mikan III and other top executives earned more than $3.7 million in performance bonuses — despite posting a net loss of more than $600...

Many Medicaid agencies’ “frontline eligibility” divisions and call centers are understaffed, according to the Kaiser Family Foundation’s (KFF) just-released annual survey of state Medicaid officials, which was fielded in January. That could...

North Carolina at press time was close to passing legislation that would allow it to become the 40th state to expand Medicaid under the Affordable Care Act. The state transitioned to a Medicaid managed care structure in 2021, but recent public...

Amid mounting pressure from Democratic lawmakers and advocacy groups, a rule could be coming as soon as April that rolls back Trump administration regulations expanding the availability of short-term, limited-duration insurance (STLDI) plans....

Washington’s “public option” has had a substantive downward impact on premium rates on the state’s individual exchange, according to state officials — encouraging news for policymakers who have tinkered with the insurance program after it...

Medicaid eligibility redeterminations will restart in just a few weeks, on April 1, but few beneficiaries know that they could lose health insurance benefits in the coming months, according to a new poll from the Urban Institute and Robert Wood...

Three publicly traded startup insurers all posted losses for the full year 2022, and one firm — Bright Health Group, Inc. — may be on its last legs. A managed care insider tells AIS Health, a division of MMIT, that while Oscar Health, Inc. may...

Medicare Advantage enrollment is approaching 31 million lives as of February 2023, a 7.4% increase from this time last year, according to AIS Health’s analysis of data that included enrollment from the 2023 Medicare Annual Election Period (AEP)....

CareSource, an Ohio-based, nonprofit Medicaid MCO, will work with Michigan nonprofit insurer Health Alliance Plan (HAP) on a new Medicaid joint venture. One managed care insider tells AIS Health, a division of MMIT, that the deal is evidence that...

Humana Inc. will exit the commercial insurance business and focus exclusively on government books of business, the company said on Feb. 23. Industry analysts say it was a wise strategic move, and experts tell AIS Health, a division of MMIT, that...

Confirming a tie-up that had been rumored for months, CVS Health Corp. on Feb. 8 revealed that it struck a $10.6 billion deal to buy Oak Street Health, which owns primary care centers catering to Medicare-eligible patients. Executives of the two...

Each year, Deft Research surveys a panel of Medicare beneficiaries to better understand consumer decision making during the Medicare Annual Election Period (AEP) and help carriers and their partners strategize for the next plan year. Deft’s 2023...

With nearly all the 2023 open enrollment period data now tallied, it appears that something curious is happening in states that run their own Affordable Care Act exchanges: Enrollment levels are on track to decline compared to 2022. That trend...

Blue Cross Blue Shield of Michigan this year launched full-risk reimbursement arrangements with six physician groups in the state. The deals cover members enrolled in the insurer’s Medicare Advantage PPO and Blue Care Network MA plans. ...

With Democrats now in charge of both chambers of the Minnesota legislature and the governor’s office, a key priority for policymakers will be to give everyone in the state access to low-cost coverage through MinnesotaCare. ...

Centene Corp. had a tough fourth quarter in 2022, with the insurer posting a $282 million loss for the period. The company’s executives attributed the rough ride to high administrative costs and lower-than-expected enrollment in Medicare Advantage...

Medicaid managed care organizations (MCOs) face a daunting challenge this year as the safety-net insurance program is poised to resume eligibility checks that had been suspended during the COVID-19 public health emergency (PHE). Insurers tell AIS...

The COVID-19 public health emergency (PHE) will end on May 11, the Biden administration said. ...

During its fourth-quarter and full-year 2022 earnings call on Feb. 1, Humana Inc. said that it will have strong adjusted earnings per share (EPS) growth and see a significant increase in its individual Medicare Advantage (MA) enrollment this year....

Three years after states’ annual efforts to verify enrollees’ Medicaid eligibility were paused because of the COVID-19 public health emergency (PHE), states as of April 1 may begin terminating Medicaid coverage for individuals who no longer...

Medicaid managed care organizations this year will have their hands full as they support state efforts to resume eligibility redeterminations and try to help members avoid gaps in coverage, or “churn” historically associated with failing to meet...

Elevance Health, Inc. on Jan. 25 reported adjusted earnings per share (EPS) of $29.07 in 2022, representing a 12% increase from 2021. Gail Boudreaux, the company’s president and CEO, told analysts on a conference call that it was the fifth...

Elevance Health, Inc. on Jan. 23 announced a deal to acquire Blue Cross and Blue Shield of Louisiana, breaking what one analyst called a nearly two-decade “ice age” in which no major consolidation among Blues took place. Experts say it’s unclear...

The number of seniors who switched from traditional Medicare to Medicare Advantage increased annually from 2016 to 2020, according to new research published in JAMA Health Forum. The switch rate from traditional Medicare to MA grew to 6.8% in 2020...

After a lackluster 2022 open enrollment season characterized by churn associated with its external marketing channels, Humana Inc. is touting above-industry growth after the 2023 Annual Election Period (AEP) that concluded last month. Presenting...

Medicare Advantage now enrolls more than 30.6 million individuals, including more than 25 million in individual MA plans, according to the latest monthly enrollment data from CMS. ...

During the company’s recent conference call to discuss fourth-quarter and full-year 2022 financial results, UnitedHealth Group executives touched on subjects ranging from the historically bad flu season to the future of the company’s data...

Right before the holidays, the U.S. Dept. of Defense (DOD) offered a gift to Humana Inc., renewing its contract to manage health care services for TRICARE beneficiaries via a new $70.9 billion pact that begins in 2024. Yet Centene Corp. received...

This year, a variety of headwinds and tailwinds are likely to buffet the health insurance industry, including inflation, a possible recession, the return of Medicaid eligibility checks, potential policy changes in Medicare Advantage, a split...

Three years into the COVID-19 pandemic, enrollment in both commercial health coverage and public health insurance continued its growth. Managed Medicaid membership jumped from 61.4 million in December 2020 to 74.0 million in 2022, while Medicare...

SCAN Group, parent company of SCAN Health Plan, said last week that it plans to combine with CareOregon to become HealthRight Group. But the deal has yet to be approved by regulators — and because of Oregon’s strict antitrust laws and proactive...

While making their financial projections for 2023, health insurers have had to acknowledge that the timing of a major headwind — the resumption of Medicaid eligibility redeterminations — continued to be a question mark. Now, if a newly released...

Of the approximately 30.2 million seniors currently enrolled in Medicare Advantage, more than 5.2 million receive their coverage through an employer-sponsored group MA plan, according to the latest CMS enrollment data. That’s roughly the same...

SCAN Group, the parent company of not-for-profit Medicare Advantage insurer SCAN Health Plan, on Dec. 14 said it will combine with another not-for-profit organization, CareOregon. For more than 25 years, CareOregon has provided health services and...

In a move made at a critical juncture in the annual Affordable Care Act open enrollment period, Oscar Health, Inc. recently said it will “temporarily stop accepting new members in the state of Florida.” ...

While Americans are shopping for 2023 Affordable Care Act marketplace plans, CMS is already looking ahead to the next plan year, as the agency on Dec. 12 issued its annual omnibus proposed rule governing marketplace plans for 2024. ...

Almost 450,000 people in Georgia could gain health coverage if the state expands Medicaid eligibility to nonelderly individuals with incomes up to 138% of the federal poverty level, according to an Urban Institute analysis. ...

When UnitedHealth Group completed its acquisition of Change Healthcare, Inc. in early October — a move made shortly after a federal judge dismissed an antitrust complaint against the deal — it seemed as though the companies could finally close the...

UnitedHealth Group at its annual Investor Day projected strong Medicare Advantage membership growth of 9% next year, overall revenues in the range of $357 billion to $360 billion and earnings per share between $24.40 and $24.90. ...

A new behavioral health venture that sprung from an innovative Horizon Blue Cross Blue Shield of New Jersey initiative is focused on embedding its integrated approach within other health plans and provider groups. NovaWell, a Horizon affiliate...

Centene Corp. said on Nov. 17 that it reached a deal with Evolent Health, Inc. to sell the insurer’s subsidiary Magellan Specialty Health. ...

Influenza cases and hospitalizations — which dipped in 2020 and 2021 as the public took steps like masking and staying home to slow transmission of COVID-19 — are back this year with a vengeance. ...

The American Medical Association (AMA) released a report on Nov. 1 that found 79% of metropolitan statistical areas (MSAs) in the U.S. had low levels of competition in the Medicare Advantage market. The trade group for physicians and medical...

Startup insurers that have gone public in recent years continued to lose money in the third quarter of 2022, although Oscar Health, Inc., Bright Health Group, Inc. and Clover Health Investments Corp. all varied in their performance on individual...

Humana Inc. posted strong third-quarter results, beating the Wall Street consensus earnings projection. The firm credited its lower-than-expected medical loss ratio (MLR), financial tailwinds from merger and acquisitions (M&A) and its yearlong...

CVS Health Corp., the parent company of insurance firm Aetna, reported solid results in the third quarter, beating Wall Street earnings projections. However, the company also acknowledged headwinds including declining Medicare Advantage Star...

Cigna Corp. on Nov. 3 reported third-quarter adjusted earnings per share (EPS) of $6.04, beating the Wall Street consensus expectation of $5.72 and getting a nod from one equities analyst for delivering “well-controlled medical costs.” During the...

As Medicare Advantage organizations market a host of new products and benefits for the 2023 plan year, large and regional insurers alike are boosting their Dual Eligible Special Needs Plan (D-SNP) presence. And while those plans continue be the...

Centene Corp. managed to beat Wall Street’s earnings expectations in the third quarter of 2022 while also reporting lower-than-expected Medicare Advantage Star Ratings and MCO contract struggles in California and Florida, two of the Medicaid...

At some point in the next year, it’s likely that Medicaid eligibility redeterminations will resume — a process that will be kicked off when the Biden administration declares an end to the COVID-19 public health emergency (PHE). Medicaid has hit...

When the 2023 open enrollment period for Affordable Care Act exchange plans officially begins on Nov. 1, health insurers will be offering plans in a market full of contrasts: where, for example, rising premiums are masked by enhanced subsidies,...

Centene Corp. will expand its ACA marketplace footprint by more than 60 counties across 12 states where it already has a presence in 2023, as well as enter Alabama for the first time, the company said on Oct. 17. ...

During UnitedHealth Group’s recent conference call to discuss third-quarter 2022 financial results, executives discussed a variety of topics in addition to the company’s earnings — including broad-based trends like inflation and the looming return...

Elevance Health, Inc. (formerly Anthem) released its third-quarter financial results on Oct. 18, beating Wall Street consensus earnings projections and receiving praise from financial analysts. The insurer — which claims it passed UnitedHealth...

As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher for 2023 saw a dramatic drop from 2022,...

A little over half of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2023 received an overall rating of 4 stars or higher, according to Medicare Parts C and D Star Ratings data released by CMS on Oct. 6. As expected...

Bright Health Group, Inc., a startup health insurer that has struggled to reach profitability, said on Oct. 11 that it will fully exit the Affordable Care Act exchanges next year and only sell Medicare Advantage products in Florida and California....

As the U.S. population ages and as payers and providers increasingly embrace home-based care — especially in light of the COVID-19 pandemic — a program that one expert calls the “best-kept secret in health care” seems poised to finally have its...

Recently, the Biden administration approved a pair of wide-ranging Medicaid waiver demonstration programs in Massachusetts and Oregon, granting those states authority to test unique policies such as keeping certain populations enrolled in Medicaid...

Medicare beneficiaries in nearly every state will have more Medicare Advantage plans to choose from and see lower premiums this fall when shopping for coverage, according to CMS’s recently released landscape files for the 2023 plan year. And both...

Recently, UnitedHealth Group and Change Healthcare Inc. received welcome news when a federal judge ruled that their $13 billion deal could proceed despite the U.S. Dept. of Justice’s contention that it would illegally stifle competition. While it...

Humana Inc. will spend between $450 million and $550 million in debt and cash to gain full control of a group of primary care clinics that it launched with private equity firm Welsh, Carson, Anderson and Stowe (WCAS), and company executives said...

The uninsured rate dipped slightly between 2020 and 2021, and while private insurance continued to be the most common type of coverage, it decreased in prevalence while government coverage increased, according to new data from the U.S. Census...

Walmart Inc. and UnitedHealth Group will launch a co-branded Medicare Advantage plan in Georgia, license Optum-branded analytic and decision-making tools to existing Walmart Health clinics in 15 Florida and Georgia locations, and use Optum...

Galvanized by a growing, stable Affordable Care Act exchange market and a looming dropoff in Medicaid membership, some of the country’s largest health insurers in 2023 are once again expanding their ACA marketplace footprints. At the same time,...

For the 2023 benefit year, Cigna Corp. plans to expand its Affordable Care Act exchange footprint to three new states — Indiana, South Carolina and Texas — and enter additional counties in three other states: Georgia, Mississippi and North...

With a law finally passed that extends enhanced Affordable Care Act subsidies for another three years, health insurers and government agencies can now start their consumer-outreach campaigns for the upcoming open enrollment period in earnest. But...

With a law finally passed that extends enhanced Affordable Care Act subsidies for another three years, health insurers and government agencies can now start their consumer-outreach campaigns for the upcoming open enrollment period in earnest. But...

HHS is currently projecting that 17.4% of Medicaid and Children’s Health Insurance Program (CHIP) enrollees — or about 15 million people — will move out of those programs when the COVID-19 public health emergency (PHE) ends. ...

Despite worrying macroeconomic trends, health insurers have done well this year so far, with all the largest publicly traded health insurance firms posting year-over-year earnings growth in the first half of 2022. Experts tell AIS Health, a...

Despite a challenge earlier this year to its longstanding pact with Mississippi Medicaid, Centene Corp. on Aug. 10 said its Magnolia Health Plan subsidiary was selected to continue serving the Mississippi Coordinated Access Network (MississippiCAN...

As Medicare Advantage insurers gear up to compete for enrollment during the 2023 Annual Election Period (AEP) that begins on Oct. 15, a handful of companies have already unveiled service area expansions that are pending CMS approval. Several of...

Fresh off of touting its organic Medicaid growth during its second-quarter 2022 earnings call, Humana Inc. recently unveiled an acquisition that will help the insurer grow its Medicaid business inorganically as well. Industry analysts say it’s a...

The four publicly traded startup health insurers — Oscar Health, Inc., Bright Health Group, Inc., Clover Health Investments Corp. and Alignment Healthcare, Inc. — continued to post losses in the second quarter of 2022, but two out of the four lost...

CVS Health Corp. is on the verge of making a bid on home health care provider Signify Health, Inc., according to an Aug. 7 report from the Wall Street Journal. Health care insiders tell AIS Health, a division of MMIT, that CVS’s rumored move —...

Molina Healthcare, Inc. posted solid results in the second quarter of 2022, earning favorable reviews from Wall Street despite posting a high medical loss ratio (MLR). Executives from the Medicaid- and marketplace-focused carrier touted a recent...

Although many people still associate CVS Health Corp. with its ubiquitous retail pharmacy locations, executives during the company’s second-quarter 2022 earnings call highlighted the Health Care Benefits segment — which houses legacy health...

Cigna Corp.’s ability to rein in medical costs during the second quarter of 2022 impressed equities analysts and led the health insurer on Aug. 4 to surpass the Wall Street consensus earnings per share (EPS) estimate while raising its full-year...

Humana Inc. delivered robust financial results in the second quarter of 2020, with earnings far outstripping the Wall Street consensus. The Medicare Advantage-focused insurer credited lower-than-expected utilization for the strong result, provided...

Despite facing several headwinds over the next year, including anticipated deterioration in Medicare Advantage star ratings and falling Medicaid enrollment, Centene Corp. increased its full-year 2022 earnings projections and unveiled the latest...

During the past two years, the number of people enrolled in Medicaid and marketplace plans has significantly increased thanks to legislation meant to help people as the COVID-19 pandemic continues. But millions of those people may lose their...

Suddenly, the U.S. Senate may be about to pass a drug price reform package and extend enhanced individual marketplace subsidies through 2025. West Virginia centrist Democrat Joe Manchin — who has almost singlehandedly held up progress on the Biden...

With a focus on value-based care, health equity and social determinants of health, Delaware this month selected three managed care organizations to serve some 280,000 Medicaid and CHIP recipients through the statewide Diamond State Health Plan and...

Starting as early as next year, UnitedHealth Group expects to have no co-pays or out-of-pocket costs for members in its UnitedHealthcare division’s standard fully insured group plans who take several medications, including insulins. The managed...

Elevance Health Inc. (formerly known as Anthem, Inc.) posted strong results for the second quarter of 2022, raising its end-of-year earnings projection and earning praise from Wall Street. However, the company’s strong results — which were driven...

Premiums on the individual marketplace are set to increase by an average of 10% nationally, according to an analysis by the Kaiser Family Foundation (KFF) of the first batch of preliminary premium rate filings sent to state exchange regulators....

Following its own pattern of strategic yearly expansions, Alignment Healthcare plans to expand its Medicare Advantage footprint into two new states, Florida and Texas, and into additional counties in the four states it currently serves. ...

Molina Healthcare Inc. will acquire Medicaid MCO My Choice Wisconsin for $150 million in cash. ...

California elected officials approved a controversial plan that will enroll members of Medi-Cal, the state’s Medicaid program, in Kaiser Permanente’s MCO — shifting those same enrollees off the books of the insurers that currently claim them as...

Researchers from the American Academy of Actuaries expect the most notable factors in 2023’s health insurance premium rate-setting will be COVID-19 variants, the expiration of enhanced premium subsidies in the individual marketplace, the...

California will offer Medicaid benefits to undocumented residents, which could swell Medi-Cal rolls by 700,000 members. ...

Colorado received permission from the Biden administration on June 23 to go ahead with the final element of its so-called “public option,” the Colorado Option. Experts tell AIS Health, a division of MMIT, that the program’s design is likely to...

During its investor update on June 17, Centene Corp. announced it had increased its adjusted diluted full-year earnings per share (EPS) guidance to between $5.55 and $5.70, up from its April range of between $5.40 and $5.55. The health insurance...

South Dakota voters just moved their state one step closer to expanding Medicaid through a ballot initiative, with over 67% of voters rejecting a proposed amendment to the state constitution that would have made Medicaid expansion prohibitively...

Scrutiny of health care sharing ministries (HCSMs) is growing, with Colorado becoming the second state to require the entities to submit health care financial data to insurance departments amid stepped-up scrutiny from regulators nationwide....

Health insurers will likely issue about $1 billion in medical loss ratio (MLR) rebates this year, according to data from the Kaiser Family Foundation (KFF) and Mark Farrah Associates. That amount is a drop from both 2020 and 2021, which set the...

Launching a venture-capital (VC) fund has become commonplace for many health insurers, even smaller ones, industry insiders tell AIS Health. They typically do not disclose returns — and many of these funds are so new that there haven’t been enough...

With the COVID-19 public health emergency presumably continuing into October, state Medicaid agencies and their partners theoretically have more time to communicate with enrollees and prepare for the inevitable resumption of eligibility...

Medicare Advantage enrollment reached nearly 28.8 million as of May, reflecting an overall increase of about 1% during the three-month Open Enrollment Period (OEP) that ended on March 31, according to the latest update to AIS’s Directory of Health...

Health insurers have ramped up their use of digital tools to improve customer satisfaction, but still have more work to do — particularly as utilization returns to normal two years after the pandemic’s start. Customer satisfaction is lagging after...

Republican leaders in North Carolina, one of a dozen states that have yet to broaden access to Medicaid programs, say that they are now ready to embrace expansion, which may be a boon to its managed care organizations. ...

HHS and the Treasury Department on May 19 approved Virginia’s waiver for a state reinsurance program starting on Jan. 1, 2023. Although states have been less aggressive when it comes to applying for reinsurance programs recently, the looming...

Startup insurers Oscar Health, Inc. and Bright Health Group, Inc. have decided they will no longer sell individual and/or family plans in certain states after this year. Ari Gottlieb, a principal at consulting firm A2 Strategy Group, tells AIS...

When the Biden administration ends the COVID-19 public health emergency (PHE), states will disenroll millions of Medicaid beneficiaries — and insurers will have to take Medicaid MCO members off their books. Experts tell AIS Health, a division of...

Oscar Health, Inc. will cease operations in Arkansas and Colorado at the end of this plan year. Chief Financial Officer Scott Blackley defended the decision by saying “they’re really small” markets for the firm in response to a question from...

Cigna Corp. pleased Wall Street with its first-quarter 2022 financial results, touting a solid increase in commercial self-funded membership and a better-than-projected medical loss ratio (MLR) of 81.5%. ...

CVS Health Corp. posted robust financial results in the first quarter of this year, with revenues increasing by 11.2% to $76.8 billion. Wall Street praised the firm — particularly its Aetna health insurance division — for delivering strong results...

Humana Inc.’s financial performance in the first quarter of this year received mostly positive reviews from Wall Street. Revenue growth from the health insurer’s mail-order pharmacy business alongside modest care utilization allowed the firm’s...

Anthem, Inc. reported strong first quarter financial results, prompting the insurer to raise its earnings guidance for the year. The company attributed the change largely to a lower-than-expected COVID-19 impact, as the Omicron variant and the...

The end of the COVID-19 public health emergency (PHE) is likely to significantly downsize Medicaid enrollment around the nation, and managed care organizations (MCOs) must figure out how to keep enrollment steady and maintain continuity of...

Health insurers are taking over home health care providers: Most notably, the two largest Medicare Advantage health insurers, UnitedHealth Group and Humana Inc., have each moved to acquire sizable home care providers in the last year. Health care...

Some insurers are cutting commissions to third-party brokers for selling individual market plans during a new special enrollment period (SEP) enacted by the Biden administration, according to reporting from Kaiser Health News. ...

Both UnitedHealth Group and Change Healthcare Inc. are making it increasingly clear that they aren’t giving up on their proposed $13 billion transaction despite federal regulators’ move to block the deal. However, one antitrust attorney is...

While the Biden administration has proposed a long-awaited fix for the Affordable Care Act’s “family glitch” — potentially making coverage more affordable for thousands — the looming expiration of major ACA subsidy expansion threatens to...

The state said the Medicaid managed care giant mistakenly denied more than 121,000 claims for beneficiaries, including large numbers of children. According to reporting by the Tampa Bay Times, the fine adds up to approximately $75 per mishandled...

Just days before the planned start of Anthem, Inc.’s new contract to serve retired New York City workers and their dependents, the city’s comptroller declined to register the proposed contract and turned it back to Mayor Eric Adams (D) for a...

Tucked into the 174-page Fiscal Year 2023 Budget in Brief document recently issued by HHS is a proposal seemingly aimed at giving the federal government more flexibility and power to sanction out-of-compliance Medicaid managed care plans. ...

The Affordable Care Act (ACA) exchanges have set new records for enrollment, with 14.5 million people enrolling or automatically reenrolling in health insurance during the 2022 open enrollment period, per CMS. ...

Anthem, Inc. said recently that it will rename itself “Elevance” in a bid to be seen a diversified enterprise, known as much for its technology and business services branches as its traditional health insurance business. Anthem isn’t alone in its...

For the country’s major health insurers, an increasing amount of revenue and growth comes from business lines that serve government programs. Industry experts tell AIS Health that they don’t envision this changing anytime soon, but they do see...

If shareholders approve, Anthem, Inc. will change its name to Elevance Health Inc. The rebranding is meant to show that Anthem is moving beyond mainly offering health insurance products. ...

As has been the case in previous quarters, all four of the newly public health insurance startups — Oscar Health, Inc., Bright Health Group, Inc., Clover Health Investments Corp. and Alignment Healthcare, Inc. — reported losses for the final three...

With UnitedHealth Group poised to battle the U.S. Dept. of Justice in court over the fate of its proposed purchase of Change Healthcare, Inc., there’s still a host of unknowns about how that legal case will play out. However, one thing does appear...

Medicare Advantage membership has grown by 8.5% since February 2021 to top 28.6 million lives, according to AIS Health’s analysis of data that included enrollment during the 2022 Annual Election Period (AEP). While nearly two-thirds of all new...

Maine will merge its small-group and individual exchange health insurance markets starting in plan year 2023. Experts tell AIS Health, a division of MMIT, that the move is a bid to stabilize small-group premiums, which have gone up in recent years...

The U.S. Dept. of Justice (DOJ) on Feb. 24 sued to block UnitedHealth Group’s proposed $13 billion acquisition of Change Healthcare Inc., arguing that the deal would stymie competition not only in commercial health insurance markets but also the...

Some Medicare Advantage insurers could take a hit if HHS decides to cancel an increasingly controversial care delivery model that allows participants to share risk and receive capitated payments for serving fee-for-service (FFS) Medicare...

For the fourth quarter and full-year 2021, CVS Health Corp. reported a strong financial performance across its vertically integrated health care business, but its health insurance division Aetna had mixed results. While Aetna delivered higher-than...

Centene Corp.’s shares rose following its fourth-quarter and full-year 2021 earnings release on Feb. 8, with the market seemingly impressed with the insurer’s Medicaid and Medicare Advantage membership gains. Still, one equities analyst sounded a...

Although Cigna Corp. ended 2021 with earnings that exceeded Wall Street expectations, the company also reported continued struggles with elevated medical costs last year. Further, the insurer disclosed that it expects less Medicare Advantage...

Despite Humana Inc.’s recently downgraded Medicare Advantage (MA) enrollment projections for 2022, Wall Street analysts praised the company’s high margins after the insurer reported fourth-quarter and full-year 2021 earnings on Feb. 2. ...

In their public comments about a proposed rule that would bring back standardized plans to the Affordable Care Act exchanges, two health insurer trade groups make it clear that they believe such a move will “stifle innovation” in plan design....

Health insurer Anthem, Inc., reported solid fourth-quarter results on Jan. 26, with some numbers in line with expectations and others hitting above or below expectations. The company also indicated it’s bracing for medical costs to rise above...

Since taking office, the Biden administration has taken a hard line on Section 1115 Medicaid waivers, rescinding multiple demonstrations that were approved by the Trump administration and subsequently becoming ensnared in legal fights with...

For health insurers, the new year has ushered in a mandate to cover at-home COVID-19 tests and a highly transmissible coronavirus variant that is making it clear the pandemic is far from over. During its recent conference call to discuss fourth...

According to a white paper prepared by PricewaterhouseCoopers (PwC), deals in the U.S. health care sector increased by 56%, for a total volume of $203 billion, through Nov. 15, 2021, compared to the same period in 2020. Meanwhile, a report by...

For health insurers that operate in the Affordable Care Act exchanges, 2022 is shaping up to be a relatively stable, profitable year with few regulatory surprises, health policy experts tell AIS Health. Still, there will be some regulatory...

The federal government may be spurred to action on several fronts, from seeking to maintain elevated health insurance exchange subsidies to further extensions of the COVID-19 public health emergency (PHE), which would have beneficial short- and...

Sign-ups for health plans on the individual exchanges have hit a record high six weeks into open enrollment, according to CMS: 13.6 million people have enrolled in coverage for 2022, with a month still left to go in the annual open enrollment...

As Congressional lawmakers consider additional funding for home and community-based services (HCBS) in Medicaid and the pandemic underscores the importance of enhanced support for community-dwelling seniors, a small but growing segment of the...

At the firm’s annual investor conference, CVS Health Corp. executives promoted closer vertical integration and promised to move even further into care provision. CVS, which acquired Aetna in 2018, emphasized virtual care and its retail HealthHUB...

Google Maps will show users searching for health care providers which health insurance practitioners will accept — and health care insiders say that the new product could transform how patients access health care. However, they caution that Google...

UnitedHealth Group’s Investor Day presentation, Wall Street analysts came away with the distinct impression that the company’s Optum division — which now comprises 52% of its overall earnings — was the “star of the show.” ...

As the country continues to grapple with the COVID-19 pandemic, the issue of “long COVID” is becoming increasingly visible — posing thorny challenges not only for the patients suffering from it but also health care providers, payers and...

Anthem, Inc. plans to acquire the New York-based long-term care plan Integra Managed Care, the insurer said on Nov. 10. ...

The third quarter of 2021, to put it mildly, was a tough one for three out of the four startup health insurers that have gone public in the past year. ...

A diversified portfolio was the name of the game late last month as publicly traded insurers discussed third-quarter 2021 earnings and braced for the return of Medicaid eligibility redeterminations, which could happen anytime after the latest...

CVS Health Corp. beat earnings projections for the third quarter, with PBM subsidiary Caremark a main driver of profitability. Aetna, the firm’s health insurance subsidiary, was also profitable, but its results disappointed Wall Street analysts....

Humana Inc.’s earnings for the third quarter beat Wall Street projections, but the firm lowered its end-of-year guidance, citing COVID-19 costs. The Medicare Advantage-focused payer’s executives also said it would sell off much of its hospice...

Cigna Corp. on Nov. 4 reported a higher-than-expected medical loss ratio (MLR) for the third quarter of 2021, which the company blamed on rising medical costs from COVID-19 care and from high utilization among customers who signed up for...

Centene Corp. reported solid results for the third quarter of 2021, achieving Medicare and Medicaid membership increases and raising revenue guidance for the full year. To Jefferies analyst David Windley, the company’s results “reflect an...

When the annual open enrollment period for Affordable Care Act exchange plans kicks off on Nov. 1, consumers will be shopping in a market that is experiencing a surge of insurer competition and consequently, a dizzying array of plan choices. ...

Anthem, Inc.’s third-quarter 2021 financial results — combined with UnitedHealth Group’s strong showing less than a week earlier — have helped to ease investors’ concerns about the Delta variant’s potential impact to insurers’ medical costs,...

Thanks to numerous flexibilities granted to plan sponsors during the COVID-19 public health emergency, nearly 70% of Medicare Advantage Prescription Drug (MA-PD) plans earned an overall rating of 4 stars or higher for 2022, CMS said on Oct. 8....

UnitedHealth Group’s third-quarter 2021 financial results impressed Wall Street, with equities analysts describing the company’s performance as “solid across the board” and “generally positive” even though the company did see health care costs...

As the 2022 Annual Election Period (AEP) approaches, CMS expects the Medicare Advantage program to continue its upward trajectory, with enrollment climbing 10% to an estimated 29.5 million people next year while average monthly premiums will drop...

In the world of government-sponsored health plans, there’s an often-underserved “hidden population” that is long overdue for increased attention from both payers and policymakers, panelists said during a recent session at AHIP’s virtual Medicare,...

JPMorgan Chase Co. has revamped its troubled effort to become a major player in health care by taking an insider approach and staffing its new venture, Morgan Health, with career health care executives — a move that comes after the firm initially...

A recently unsealed whistleblower lawsuit accuses CVS Health Corp.’s Aetna of defrauding the Commonwealth of Pennsylvania and the federal Medicaid program by knowingly misrepresenting the number of pediatricians in Aetna’s Medicaid network. While...

Intermountain Healthcare and SCL Health plan to merge, according to a joint press release from the nonprofit hospital groups. ...

In mid-August, the U.S. Census Bureau released additional results from the 2020 Census that underscored just how diverse the country has become. While people identifying as white remained the largest ethnic group in the U.S., that population has...

Two sizeable regional Blue Cross Blue Shield plans, CareFirst of Maryland, Inc. and Highmark Inc., are teaming up to offer a “new collaboration and health insurance offering” for labor unions. While it’s certainly not the first insurance product...

Puerto Rico recently has become a hotbed of merger and acquisition activity, with two of the territory’s largest health insurers agreeing to be sold to mainland-based companies. Industry analysts say that the deals are motivated by the same...

Cigna Corp. will offer Affordable Care Act marketplace plans in three new states during the upcoming open enrollment period, the insurer said on Aug. 26. ...

GuideWell Mutual Holding Corporation, the parent company of Florida Blue and Capital Health Plan, Inc. last week revealed it has entered a $900 million deal to acquire Puerto Rico-based Triple-S Management Corp. ...

UnitedHealth Group will acquire fellow Minnesota-based health plan PreferredOne from University of Minnesota-affiliated provider Fairview Health Services, according to the Minneapolis Star-Tribune. ...

The return of some deferred care and an uptick in COVID-19-related utilization weighed on the financial results of a variety of managed care companies during the second quarter of 2021 — a trend that was also evident among a quartet of newly...

Health Care Service Corp. (HCSC), the parent company of Blue Cross Blue Shield affiliates in five states, is poised to majorly expand its relatively modest Medicare Advantage footprint. ...

Although the health insurance market catering to small businesses has largely remained stable amid the disruption of the COVID-19 pandemic, some health policy experts say there are reasons to be concerned about the market’s future. One recent...

The Department of Justice (DOJ) is considering taking steps to block UnitedHealth Group’s planned acquisition of Change Healthcare Inc., according to press reports. Experts say the DOJ has a strong case — and that if UnitedHealth’s Optum division...

Cigna Corp. had a better second quarter than equities analysts expected, leading to positive but cautious reviews by Wall Street on the health insurer’s outlook for the rest of the year. Cigna executives credited strong returns from the payer’s...

CVS Health Corp., the parent company of health insurer Aetna, reported higher than expected profits in the second quarter of 2021. The pharmacy, health insurance and retail giant took in $2.42 in earnings per share, beating Wall Street’s estimated...

Centene Corp. and Humana Inc. both reported slightly better-than-expected second quarter 2021 results, which Wall Street met with cautious optimism. While executives from both health insurers preached caution due to the Delta variant-driven...

Although health insurance companies in the past decade have significantly grown and diversified — thus strengthening their businesses — their credit ratings haven’t benefitted very much, at least according to one prominent rating firm. The reason,...

Anthem, Inc.’s stock took a dive after its second-quarter 2021 earnings conference call on July 21, surprising equities analysts who saw the large Blue Cross Blue Shield insurer’s financial performance and outlook as relatively solid. ...

UnitedHealth Group — which in recent months has been tightening the screws on spending drivers like unnecessary emergency care and out-of-network utilization — is signaling that its greater goal for cost containment comprises much more than simply...

In President Joe Biden’s new executive order aimed at promoting competition in the American economy, he directs HHS Secretary Xavier Becerra to “implement standardized options in the national Health Insurance Marketplace” in a bid to “ensure that...

From lingering COVID-19 impacts to potential enrollment increases from expanded subsidies and slimmed-down Medicaid rolls, health plans have had a slew of factors to consider when filing their 2022 rate request for Affordable Care Act exchange...

The Biden administration on June 28 made good on its previous pledge to roll back certain Trump-era regulations regarding the Affordable Care Act exchanges when it issued a proposed rule that CMS deemed a “continuation” of the already finalized...

In Oklahoma, the most recent state to implement a Medicaid expansion under the Affordable Care Act, the state Supreme Court recently struck down a plan pushed by Republican Gov. Kevin Stitt to implement a managed care organization (MCO) model for...

The combined organization created by a merger between Tufts Health Plan and Harvard Pilgrim Health Care will now be known as Point32Health. ...

In a move applauded by health insurers that increasingly view the Affordable Care Act exchanges as an attractive market, the Supreme Court on June 17 ruled 7-2 to uphold the ACA in the latest in a string of high-profile legal challenges. ...

Telemedicine utilization boomed during the COVID-19 pandemic, filling some of the unprecedented gaps in care. But its greatly expanded use uncovered some areas where more investment is needed to encourage adoption, while at the same time creating...

Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which...

The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid...

Lowering the Medicare eligibility age to 60 could add as many as 24.5 million individuals to the program, an analysis from Avalere finds. However, shifting people ages 60 to 64 to Medicare actually could have a mixed effect on coverage overall,...

Across the country, conservative state officials are going further than ever to thwart Medicaid expansion, taking steps to reverse successful ballot initiatives, reforming processes to block ballot measures before they reach voters — and erecting...

Three startup health insurers that became public companies this year — Oscar Health, Inc., Clover Health Investments, Corp. and Alignment Healthcare, Inc. — recently unveiled their first-quarter 2021 financial results, with all posting substantial...

Paramount Advantage, a health plan subsidiary of integrated health system ProMedica, is suing the Ohio Dept. of Medicaid over the state’s decision to not renew its Medicaid managed care contract. ...

While Cigna Corp. credited its Evernorth health services division as the primary driving force behind its strong first-quarter 2021 earnings, the company’s management and equities analysts alike seemed satisfied by the performance of Cigna’s...

CVS Health Corp. impressed Wall Street analysts with strong first-quarter 2021 financial results, which were largely driven by the performance of its PBM and health benefits segments. Evercore ISI analysts, for example, gushed that the diversified...

Humana Inc. plans to fully acquire home health provider Kindred at Home from private equity firm Welsh, Carson, Anderson & Stowe (WCAS) and TPG Capital, the insurer said on April 27. (WCAS owns a controlling stake in MMIT, AIS Health’s parent...

Centene Corp.’s two dominant business lines — managed Medicaid and the Affordable Care Act exchanges — both were sources of significant headwinds and tailwinds in the first quarter of 2021, underscoring the often-contradictory impact of the COVID...

Industry analysts say they expect the environment for mergers and acquisitions in the health insurance sector to be “favorable” this year, and thus they anticipate “robust M&A activity” among firms that are eager to diversify their assets and...

Molina Healthcare, Inc. reached an agreement on Apr. 22 to purchase Cigna Corp.’s Medicaid contracts in Texas. Cigna’s Medicaid and Medicare/Medicaid dual-eligible plans serve 48,335 members in the Hidalgo, Tarrant and Northeast service areas. ...

Anthem, Inc. reported strong membership growth in its Medicare and Medicaid segments along with a lower-than-expected medical loss ratio (MLR) of 85.6% in its 2021 first-quarter earnings report. The MLR results, which handily beat analysts’...

CMS on Apr. 16 revoked an eleventh-hour Section 1115 waiver the Trump administration had granted to Texas, which makes the shape of the second-most populous state’s Medicaid program after 2022 an open question. Experts say that CMS’s action is an...

assively depressing routine and elective care — executives warned that the majority of the unfavorable COVID impact they’re expecting will transpire in the second half of the year. ...

After 2020 proved to be a banner year for initial public offerings, three separate startup health insurers — Alignment Healthcare, Clover Health and Oscar Health — rode the wave and launched IPOs in the early months of 2021. Now, Bright Health Inc...

Both insurers and the federal government are pushing hard to promote the special enrollment period for the federal health insurance exchange: America’s Health Insurance Plans (AHIP) is launching an online decision tool for consumers, while CMS...

With the passage of the American Rescue Plan (ARP), states that haven’t expanded Medicaid have an extra reason to do so: the COVID-19 relief bill offers financial incentives to states that increase Medicaid eligibility under the Affordable Care...

Centene Corp.’s handling of pharmacy benefits in its managed Medicaid contracts has now become the subject of separate investigations in two states. Following the news of Ohio’s attorney general suing Centene over an alleged breach of contract, it...

UnitedHealth Group’s deal to acquire Change Healthcare Inc. will receive extra scrutiny from the Dept. of Justice, according to a recent filing. Regulators’ decision regarding the deal could have significant implications in the broad digital...

Orange, Calif.-based Alignment Healthcare, Inc. just became the third startup insurer in recent months to go public. Banking on the strong value proposition of Medicare Advantage, Alignment said it already has a “national expansion strategy” that...

Millions of people in the United States have lost their employer-sponsored health insurance as a result of the pandemic and have had to find new sources of coverage — if they have been able to get insurance at all. While experts are still working...

For an individual health insurance market that is already hitting its stride, the new pandemic relief legislation’s expansion of Affordable Care Act (ACA) subsidies is yet another positive catalyst that should make the exchanges more attractive to...

Although health insurers typically try to emphasize the strength of their financial performance when issuing quarterly and annual earnings reports, the COVID-19 pandemic’s largely positive effect on managed care margins in 2020 has led some...

Oscar Health Inc., the perennially buzzy startup health insurer, saw its shares slide almost 11% during its first day as a publicly traded company on March 3. But Oscar’s underwhelming debut doesn’t come as a surprise to some industry consultants,...

If Chiquita Brooks-LaSure is confirmed as the next CMS administrator, the managed care industry can expect to see a thoughtful and experienced leader helming an agency that wields vast regulatory power over some of insurers’ most lucrative...

Although CVS Health Corp.’s stock price dropped about 5% after the company reported its fourth-quarter and full-year 2020 financial results on Feb. 16, equities analysts seemed to be unshaken in their view that the firm — which owns health insurer...

In recent weeks, the Biden administration has begun the process of rescinding Trump-era waiver programs authorizing Medicaid work requirements. Experts say that the new administration has a strong legal position in doing so, even though it faces...

Executives at CVS Health Corp. revealed on Feb. 16 that its Aetna insurance division plans to return to the Affordable Care Act exchanges starting in 2022, a move that health care policy experts say underscores the increasing attractiveness of the...

Centene Corp. said it would eliminate 4,500 jobs, including 3,000 current employees and another 1,500 open positions, as it focuses on “innovation, growth and agility” after posting a $12 million fourth-quarter loss. However, its overall fourth...

Anthem, Inc. will acquire MMM Holdings, LLC, Puerto Rico’s largest Medicare Advantage plan and second-largest Medicaid plan, from InnovaCare Health, L.P. ...

Although the COVID-19 pandemic has had a largely positive impact on health insurers’ bottom lines — given the sheer magnitude of deferred routine and elective care — two publicly traded payers’ recent fourth-quarter earnings results show that they...

Effective July 1, 2021, Humana Inc. will become the fifth Medicaid managed care organization to contract with South Carolina, the insurer said on Jan. 27. ...

President Joe Biden on Jan. 28 launched his Affordable Care Act-centric health insurance agenda with an executive order that will reopen the federal health exchange for a special enrollment period. The administration also directed federal agencies...

In the fourth quarter of 2020, health care spending patterns experienced by the country’s largest health insurer “returned to seasonal baselines” even as COVID-19 cases surged all over the U.S. Such is one major takeaway from UnitedHealth Group’s...

With the new Congress largely in place, and the new presidential administration set to take power on Jan. 20, health care insiders are beginning to make sense of what legislation and rulemaking the Biden administration and Democrats intend to...

Oscar Insurance Corp. revealed on Dec. 21 that it has taken the first step toward going public. ...

Three years after they unveiled a joint venture tasked with lowering the cost and improving the quality of employee health care, Amazon, JPMorgan Chase & Co. and Berkshire Hathaway are disbanding the company called Haven. ...

Although 2021 has just begun, major health insurers appear to be wasting no time when it comes to spending the influx of cash that they’ve collected as a result of reimbursing lower-than-normal medical claims during the COVID-19 pandemic. ...

Equities analysts are bullish on the health insurance industry in 2021, despite the challenges caused by the COVID-19 pandemic. Wall Street also expects more mergers and acquisitions will take place in 2021 than the previous year, particularly...

The University of Pittsburgh Medical Center is the largest employer in the Pittsburgh area, with hundreds of job openings on any given day. At the same time, the integrated network’s UPMC Health Plan covers nearly one in five Medicaid...

The U.S. Dept. of Justice (DOJ) will require Tufts Health Plan to sell its commercial health insurance business in New Hampshire — called Tufts Health Freedom Plan Inc. — in order to proceed with its merger with Harvard Pilgrim Health Care. ...

With unpredictable risk caused by the intensifying COVID-19 pandemic, estimating claims and enrollment will be more difficult than ever for health insurance companies in 2021, and the task has particularly high stakes for smaller payers. ...

Health care insiders praised President-elect Joe Biden’s decision to nominate California Attorney General Xavier Becerra, a Democrat, to be the next HHS secretary. Though he is not a specialist in health care, experts say Becerra brings relevant...

With Pfizer Inc. and BioNTech’s coronavirus vaccine on the cusp of FDA authorization, Moderna Inc.’s offering not far behind and AstraZeneca plc also touting promising results from its vaccine, in the coming months there will undoubtedly be a...

Humana Inc. on Dec. 3 unveiled that it will acquire the remaining 50% of iCare, a Wisconsin-based Medicaid plan that it already owned in part. ...

In a proposed rule released on Nov. 25, CMS floated some ambitious changes to the regulations governing the Affordable Care Act (ACA) exchanges, most notably allowing states to ditch a centralized health plan marketplace and instead rely on...

Reinsurance programs can help lower premiums in the individual insurance market, but they’re not enough by themselves — states will need to experiment with broader measures to impact underlying health care costs, particularly for unsubsidized...

Centene Corp., which has come to dominate the Affordable Care Act exchange market by continuing to expand even when other carriers pulled back, is facing more competition now that the market has stabilized and insurer participation has increased....

Now that the presidential race has been called for Joe Biden, policy experts are predicting that his administration’s health care agenda will be accomplished mainly through executive action. That’s a consequence of the likelihood of a divided...

CVS Health Corp. on Nov. 6 reported that its third-quarter 2020 adjusted earnings per share (EPS) was $1.66, beating the Wall Street consensus estimate of $1.33. ...

Cigna Corp.’s new segment Evernorth, which includes the company’s Express Scripts PBM business, drove strong third-quarter earnings that beat analysts’ expectations. ...

While Humana Inc., like other health insurers, has seen its profits swell as members avoided non-coronavirus-related care during the pandemic, the company is making it crystal clear that those financial gains will be erased before the year is over...

The health systems Intermountain Healthcare and Sanford Health, which both operate insurance plans, said on Oct. 26 that they are planning to merge. ...

Anthem, Inc.’s third-quarter 2020 earnings were not as robust as investors had hoped at the start of the year due to the insurer’s obligation to pay out its $594 million share of a recently settled lawsuit against Blue Cross Blue Shield plans....

During their third-quarter 2020 earnings conference call, Centene Corp. executives made the case that despite all the challenges related to the pandemic and politics, there are plenty of reasons to believe the company is well-equipped to weather...

With open enrollment for the Affordable Care Act (ACA) exchanges set to begin on Nov. 1 in most states, the COVID-19 pandemic — as is the case with nearly everything in 2020 — is expected to play a role. Health insurers had to decide when setting...

With the 2020 election drawing ever closer, the Trump administration has been approving states’ waiver applications at a brisk pace — greenlighting Georgia’s Section 1115 Medicaid waiver on Oct. 15, and another Medicaid waiver from Nebraska on Oct...

UnitedHealth Group on Oct. 14 reported that its adjusted earnings per share (EPS) was $3.51 for the third quarter, beating the Wall Street consensus of $3.11. According to a company news release, UnitedHealth brought in $65.1 billion in the third...

To the Trump administration, a recently released report on individual insurance market enrollment demonstrates that “people who do not qualify for subsidies continue to be priced out of the market.” Indeed, between plan years 2016 to 2019,...

Although more than three-quarters of Medicare Advantage beneficiaries remain in highly rated plans, the percentage of MA Prescription Drug (MA-PD) plan enrollees estimated to be in contracts receiving 4 or more stars in 2021 fell by approximately...

Star ratings for Medicare Advantage plans declined across the board for 2022, signaling an overall drop of around 5.5% in the number of members enrolled in contracts with 4 or more stars, according to an analysis of MA data. ...

Molina Healthcare, Inc. on Sept. 29 said it entered into a definitive agreement to acquire substantially all of the assets of New York Medicaid managed care organization Affinity Health Plan for approximately $380 million. ...

With its annual release of the so-called landscape files for the Medicare Advantage and Part D programs, CMS on Sept. 24 estimated that enrollment in MA will jump 10% to an “all-time high” of 26.9 million beneficiaries, while the average monthly...

Health insurers will probably have lower health care expenditures in 2020 and 2021 than before the COVID-19 pandemic, according to a new analysis from Willis Towers Watson. However, the white paper, which analyzed several scenarios of the severity...

As state budgets continue to be squeezed by the COVID-19 pandemic and related economic downturn — and as health insurers report large profits due to low utilization of routine health care services — state officials are perhaps understandably...

In a year when a pandemic and a presidential election are already fueling high levels of uncertainty, the Sept. 18 death of Justice Ruth Bader Ginsburg — which could tip the scales in favor of striking down the Affordable Care Act (ACA) — was...

Since at least the 2017 saga when Republicans tried to repeal and replace the Affordable Care Act (ACA), one of the law’s most visible — and politically charged — components has become its protections for people with preexisting conditions. Now,...

Given that enrollment in the Affordable Care Act (ACA) exchanges has basically flatlined at around 11.4 million — a lower level than originally projected and just a small fraction of the overall health insurance market — one might not expect...

Cigna Corp. will offer Affordable Care Act exchange plans in 80 new counties in 2021, reaching 27% more customers in that market, the company said on Sept. 9. ...

The climate for payer mergers and acquisitions (M&A) has cooled substantially at a national level ever since the collapse of the proposed deals between Anthem, Inc. and Cigna Corp. and between Aetna Inc. and Humana Inc., and experts say...

Although federal relief legislation tied to the pandemic required health insurers to waive cost sharing for COVID-19 testing, not treatment, many plans opted to do both anyway. In fact, a recent analysis from the Kaiser Family Foundation (KFF)...

A joint report by the Robert Wood Johnson Foundation and Urban Institute found that “despite millions of Americans losing their job due to COVID-19, changes to people’s health insurance coverage might not be as widespread as anticipated.” ...

While second-quarter 2020 earnings calls centered largely on uncertainty related to the COVID-19 pandemic, insurers with a large Medicare Advantage presence expressed satisfaction in membership growth so far this year and confidence in their...

CVS Health Corp.’s Aetna division — having recently rolled out two new plan designs that aim to ease customers’ cost-sharing burden — is now presenting employers with “a cost-effective offering beyond Aetna’s typical broad network plans” that...

Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of...

With health care claims costs reaching ultra-low levels amid lockdowns, canceled elective procedures and consumers’ fear of contracting the novel coronavirus at clinical sites, publicly traded health insurers saw their margins swell significantly...

New Mexico Health Connections, a consumer operated and oriented plan (CO-OP) that offered health plans on the state’s individual insurance exchange, will shut down on Jan. 1, 2021, according to an Aug. 10 press release. ...

While Aetna is just one part of CVS Health Corp.’s massive health care enterprise, it was disproportionately responsible for the company’s strong financial performance during the second quarter of 2020, thanks to the effects of COVID-19. ...

Humana Inc.’s second quarter earnings exceeded investor expectations due to a drop in utilization, although the insurer expects spending on health care services to rebound somewhat as patients continue to return to medical facilities. ...

Pending regulatory approvals, Oscar Insurance Corp. will offer health insurance in four new states during the upcoming individual market open enrollment period, for a total footprint of 19 states. ...

Nearly two years after Nebraska voters approved a measure to expand Medicaid, the state on Aug. 1 began the process of enrolling eligible adults for coverage effective Oct. 1. Approximately 90,000 Nebraskans will be newly eligible for Medicaid...

Voters in Oklahoma on June 30 and Missouri on Aug. 4 passed ballot initiatives to expand Medicaid coverage to a greater number of low-income adults, continuing a national trend of red state voters supporting increased access to health insurance. ...

Missouri voters on Aug. 4 approved a constitutional amendment to expand Medicaid coverage, reflecting a trend of ballot-driven expansion initiatives in recent years that has been accelerated by the COVID-19 pandemic. Missouri is the second...

While Anthem, Inc. has seen less of an enrollment dip in its commercial business than it originally feared when the COVID-19 pandemic and economic recession first took hold, the insurer’s executives said during a July 29 earnings conference call...

Centene Corp. reported second-quarter earnings in line with its own projections and Wall Street consensus, but also enrolled fewer members than executives had expected. The firm touted revenue growth from its acquisition of WellCare Health Plans,...

Cigna Corp. handily beat analysts’ expectations for its second quarter earnings and posted a record low medical loss ratio of 70.5% as members continued to defer non-emergency medical visits and procedures due to the COVID-19 pandemic. ...

Clover Health is planning to expand to 108 counties across eight states. ...

Enrollment for Nebraska’s Medicaid expansion program will begin Aug. 1, according to local news reports, with coverage slated to begin Oct. 1. ...

Molina Healthcare Inc. said on July 17 that it entered a definitive agreement to buy certain assets of Passport Health Plan. ...

With COVID-19 cases and deaths surging in some U.S. states, it has become clear that the nation won’t be back to normal anytime soon. Still, the country’s largest health insurer is betting that health care utilization, and the costs associated...

With an increasing share of seniors enrolling each year, a healthy rate environment and a meaningful return on scale, Medicare Advantage is largely seen as a safe space for insurers and one that is likely to drive mergers and acquisitions (M&A)...

Not-for-profit integrated health system Advocate Aurora Health is pursuing a partial acquisition of Quartz Health Plan Corp. as the two organizations prepare to launch a Medicare Advantage plan in eastern Wisconsin for 2021. The parties in January...

The Pennsylvania Dept. of Human Services (DHS) on July 8 named the successful respondents to its latest request for applications to serve some 2.6 million HealthChoices enrollees, but the agency said it is unable to move forward with the...

Insurers are taking steps to help providers financially as the COVID-19 pandemic progresses, in part to help stave off more provider consolidation and demands for higher reimbursement, a recent survey from Robert Wood Johnson Foundation and the...

Oklahoma voters on June 30 approved a ballot initiative that expands Medicaid eligibility under the Affordable Care Act, making it the 38th state (including the District of Columbia) to expand Medicaid and the fifth to do so with a ballot...

Between the end of open enrollment on Dec. 15, 2019, through May 2020, 46% more people signed up for plans on HealthCare.gov through a “loss of minimum essential coverage” special enrollment period (SEP), compared with the same time period the...

Cigna Corporation has now partnered with two smaller insurers, Priority Health in Grand Rapids, Mich., and New York-based Oscar, in an effort to increase its share of commercial group business, particularly small groups. ...

Providing updated guidance three months into the COVID-19 pandemic, managed Medicaid leader Centene Corp. last month raised its full year adjusted earnings per share outlook by 20 cents at the midpoint to an EPS range of $4.76 to $4.96. And while...

North Carolina legislators late last month approved a compromise bill that positions the state to finally begin transitioning Medicaid beneficiaries from fee for service to managed care next year, but did not include Medicaid expansion, according...

Centene Corp. said June 30 that its Illinois subsidiary, Meridian Health Plan of Illinois, Inc., agreed to acquire the membership of Next Level Health Partners, Inc. ...

Cigna Corp. and Oscar Insurance Corp. said they will launch their joint venture to offer fully insured small group plans in Atlanta, the San Francisco Bay Area and Tennessee’s largest cities starting in the fourth quarter of 2020. ...

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market...

In a deal that the companies say was validated by the challenges of the COVID-19 pandemic, HealthNow New York Inc. revealed on June 16 that it will become part of fellow Blue Cross Blue Shield licensee Highmark Inc. ...

Indiana on May 29 received CMS approval for a Section 1115 waiver demo that allows residents moving from Medicaid expansion to commercial plans to spend up to $1,000 of funds stored in quasi-HSA accounts on insurance premiums or cost-sharing...

NextLevel Health, a Chicago-based Medicaid managed care plan with about 56,000 members, will close in July, Crain’s Chicago Business reported on June 5. ...

As the COVID-19 pandemic ramped up in the U.S. in early spring, actuaries and analysts raced to develop estimates of how the disease associated with this new coronavirus would impact health care costs. Now, with cases declining in some areas and...

To some policy experts, the COVID-19 pandemic offers a chance to rethink the national debate over universal health coverage — potentially bolstering the case for a Medicare for All system or a public option that provides government-sponsored, less...

CMS has finalized a set of proposals for Medicare Advantage and Part D plans that encourage MA plans to increase their telehealth benefits and give end-stage renal disease (ESRD) patients the right to enroll in regular MA plans. CMS also said it...

The Trump administration recently released guidance that will allow the newly unemployed to retroactively opt into COBRA months from now, which could increase the risk of adverse selection and thus harm fully insured and self-funded employer plans...

UnitedHealthcare will expand its presence on the Affordable Care Act exchanges by offering plans in at least one additional state in 2021. ...

Credit ratings firm S&P Global Ratings Inc. is mildly confident about the financial health of the health care industry. On May 13, S&P analysts gave health insurance companies a stable outlook, and graded payer debt with an A rating. Meanwhile,...

Insurers’ responses to the COVID-19 outbreak dominated recent first-quarter 2020 earnings calls, as did expected declines in utilization this quarter followed by a likely ramp-up of services later in the year, and waning commercial enrollment...

Molina Healthcare, Inc. said on April 30 that it plans to buy Magellan Health, Inc.’s managed care organization, Magellan Complete Care (MCC), for about $820 million. ...

Humana Inc. and Centene Corp. are both maintaining their 2020 earnings outlook despite the emergence of the COVID-19 pandemic and economic contraction at the end of the first quarter. Centene’s earnings fell short of the Wall Street consensus...

Anthem, Inc., and Cigna Corp. both reported slightly better-than-expected medical loss ratios (MLRs) as part of their first-quarter 2020 earnings, in part due to delays in elective procedures resulting from the COVID-19 pandemic. Both insurers...

Bids for the 2021 Medicare Advantage and Part D plan year are due June 1, and new research on the 2020 Annual Election Period (AEP) suggests that seniors are flocking to MA plans primarily because of enhanced supplemental benefits such as over-the...

UnitedHealth Group didn’t see much of an earnings impact from the COVID-19 pandemic in the first quarter of 2020, but the effects will crystallize in future quarters. Such was the overarching message of the company’s April 15 earnings release and...

Facing mounting criticism for deciding not to allow a special enrollment period (SEP) on the federal health insurance exchange amid the COVID-19 crisis, the Trump administration offered up a different strategy to help the uninsured get the care...

Besides all the other ways it’s changing American life, the COVID-19 pandemic is sure to have a major impact on how the health care industry does business going forward, equities analysts said during a March 31 panel discussion hosted by the USC...

Congress has now passed three separate bills to address the ever-worsening COVID-19 crisis in the U.S., spending trillions of dollars to lessen the economic impact and support the country’s overtaxed health care system. But for the most part, this...

Many of the nation’s largest health insurers have now waived patient cost sharing and prior authorization requirements for treatment of COVID-19, the disease caused by the novel coronavirus. Experts praise payers for making the change, but say the...

As states consider new standards for Dual Eligible Special Needs Plans (D-SNPs) that will satisfy statutory requirements beginning in calendar year 2021, the enrollment of dual- eligible beneficiaries in Medicare and Medicaid plans that are...

As the COVID-19 crisis continues to ramp up in the United States, projections about how it will affect various business sectors — including managed care — are evolving rapidly. But one concept that industry analysts seem to agree on is that health...

The COVID-19 pandemic is shaping up to be a stress-test for the post-Affordable Care Act insurance market, which has not yet faced a recession. The crisis has already caused mass layoffs, especially in the restaurant and retail industries, and...

Individual marketplaces under the Affordable Care Act (ACA) have seen premiums stabilize, according to an analysis of 2020 open enrollment data performed by McKinsey & Co Inc. Health exchange experts tell AIS Health that increased payer...

On March 2, the Supreme Court agreed to hear Texas v. United States, the latest lawsuit intended to overturn the Affordable Care Act (ACA). Though health insurance trade groups indicated they are anxious for a resolution in the case, health care...

Florida’s health insurers remain highly profitable as the overall market has grown significantly more concentrated, with companies such as Anthem, Inc. and Florida Blue snapping up numerous smaller HMOs over the past several years, particularly in...

California’s health insurance exchange, Covered California, expanded enrollment by 1.6% year over year for 2020, according to preliminary results released on Feb. 18 — figures that were highly anticipated since the state was testing new policies...

As the concept of a public insurance option gains increasing visibility in the 2020 presidential race, the spotlight is also trained on Washington and Colorado — states that are at different stages of setting up their own versions of a public...

During a Feb. 12 presentation outlining its 2019 financial results, CVS Health Corp. touted a “successful first full year with Aetna,” saying the transaction produced “synergies above expectations” at approximately $500 million. And CVS’s Health...

Health insurers continued to struggle with their medical loss ratios in the fourth quarter of 2019, with Humana Inc. and Centene Corp. each posting MLRs that missed analysts’ expectations and indicated higher medical expenses in specific segments....

Hawaii awarded contracts, worth a total of $17 billion, to four managed care organizations to serve Medicaid members through its QUEST Integration program. ...

Anthem, Inc. continued to struggle with a higher-than-anticipated medical loss ratio (MLR) during the last quarter of 2019, and its earnings per share (EPS) guidance for 2020 fell short of what equities analysts were anticipating as the insurer...

Despite Colorado’s robust insurance market, relative newcomer Friday Health Plans has managed to gain traction in its first few years. The company recently inked a $50 million funding agreement that may help it expand into new territories and...

On Jan. 21, Paula Tregre, Louisiana’s head of procurement, canceled the state’s newest Medicaid contract awards — but not for the reasons you might think. Meanwhile, Kentucky is working through its own bidding controversy after the state’s new...

A Louisiana official canceled Medicaid contracts awarded by Governor John Bel Edwards (D), citing irregularities in the procurement process, the Associated Press reported. ...

Having now satisfied all necessary regulatory requirements, Centene Corp. and WellCare Health Plans, Inc. closed their $17 billion deal on Jan. 23. ...

With Medicaid demonstration programs that include work requirements struck down in three states, it’s become increasingly clear that such waivers may not survive legal scrutiny. So Nebraska, which last month submitted its own Section 1115 waiver...

Democratic Kansas Gov. Laura Kelly and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans. ...

Cigna Corp. launched a partnership with payer Oscar Health to create a new line of insurance products targeting small businesses. ...

Kentucky Gov. Andrew Beshear (D) reissued a request for proposals (RFP) for Medicaid managed care contracts after the state legislature removed enrollee work requirements from the authorizing legislation. Beshear’s administration set Feb. 7 as the...

UnitedHealth Group beat analysts’ earnings-per-share estimate for 2019’s fourth quarter, driven by strong performance in both its UnitedHealthcare and Optum segments. ...

Ohio Medicaid insurer Paramount Health Care this month said serious financial losses are forcing the plan to exit the central and southeast regions of the state, Skilled Nursing News reported. ...

Preliminary enrollment figures from the 2020 Annual Election Period (AEP) indicate that Medicare Advantage enrollment surpassed 24.3 million lives, up 8.8% from 22.4 million posted a year ago. The January enrollment report from CMS reflects...

In a move that may turn heads in other historically red states that have held off on expanding Medicaid under the Affordable Care Act (ACA), Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d...

Molina Healthcare, Inc. agreed to acquire NextLevel Health Partners, Inc., a Medicaid managed care insurer that serves about 50,000 members in Illinois’ Cook County. ...

Startup health care company Bright Health said Jan. 8 that it signed an agreement to acquire the California-based, family-owned health plan Universal Care, which is doing business as Brand New Day. ...

Democratic Kentucky Gov. Andy Beshear “is canceling and rebidding the state’s Medicaid managed care contracts,” according to a Dec. 23 press release. ...

Conservative states are likely to push hard in 2020 for CMS approval of Medicaid waivers that will allow them to implement policies such as work requirements, while voters in some of the 14 states that have not yet expanded Medicaid could tee up...

The pace of health care mergers and acquisitions — which ran at a fever pitch in 2018 and 2019 with multiple high-profile and high-value transactions — likely will cool slightly in 2020, given lofty asset prices, diminishing prospects for...

The business arm of the Navajo Nation plans to contract with Molina Healthcare, Inc., to offer Medicaid managed care as part of a partnership between New Mexico, tribal officials and the insurer. ...

Blue Cross and Blue Shield plans in New Jersey and Michigan are undertaking ambitious efforts at the end of 2019 — one anticipating a shift in corporate form and another introducing a new payment model — aimed at modernizing and enhancing their...

The Kentucky legislature’s contract review committee voted on Dec. 9 to reject the Medicaid contracts recently awarded by the state, the Louisville Courier Journal reported. ...

Diplomat Pharmacy, Inc., which has seen mounting financial losses, agreed to a deal with UnitedHealth Group on Dec. 9 that will see the larger firm’s OptumRx division purchase the midsized specialty pharmacy provider/PBM. ...

UnitedHealth Group spotlighted growth and better cost control in its Medicare Advantage (MA) plans, driven in part by the insurer’s value-based provider network strategy, as company officials reiterated expectations of 13% to 16% growth in 2020...

It’s been a rollercoaster for Passport Health Plan in 2019, with the Kentucky plan first warning it was on the brink of insolvency, only to “find a path forward” after the state approved Evolent Health’s deal to buy a 70% stake in Passport for $70...

Taking advantage of regulations loosened by the Trump administration and a new state law, Idaho Blue Cross is now offering short-term health insurance plans that fall somewhere between robust Affordable Care Act (ACA) policies and traditional,...

CVS Health Corp.’s new agreement to buy Centene Corp.’s Illinois health plan doesn’t fall under the “megadeal” category. But industry experts see broader implications as health care players large and small continue to jockey for position and focus...

Toledo, Ohio-based health system ProMedica is re-evaluating its health insurance subsidiary Paramount’s participation in the state’s Medicaid program after its $102.8 million loss through the first nine months of 2019. ...

Michigan’s health insurers remain strongly profitable amid consolidation that’s being driven at least in part by the prospects for a large Medicaid contract proposal, says the author of a new report on the state’s health care market. ...

In the middle of a budget standoff between the state’s Democratic governor and the Republican-controlled legislature over Medicaid expansion and teacher pay, North Carolina’s plan to transfer some 1.6 million Medicaid enrollees into managed care...

As the concept of a public option insurance plan gains increasing prominence in the runup to the 2020 presidential election, a new health care industry-backed report argues that such a policy could drive many private plans out of the Affordable...

Kaiser Foundation Health Plan/Hospitals reported combined operating revenues of $20.9 billion and operating expenses of $20.3 billion for the quarter ended Sept. 30. ...

In many ways, the Affordable Care Act (ACA) exchange market appears to be stabilizing — with premiums set to decrease in many states next year, greater health plan participation and better margins for insurers. Still, enrollment in 2019 ACA plans...

Humana Inc. pointed to favorable utilization trends in its key Medicare Advantage (MA) segment as it beat analysts’ estimates for its third-quarter 2019 earnings and predicted continued strong membership growth for its individual MA enrollment in...

Just two months after a federal judge signed off on CVS Health Corp.’s purchase of health insurer Aetna Inc. — concluding an unusually rigorous review of the firms’ agreement with the Dept. of Justice — CVS is confidently touting the merits of...

The Affordable Care Act (ACA) individual market looks stable in 2020, with rates decreasing slightly overall and by double digits in a handful of states that have enacted reinsurance programs while various insurers, including Centene Corp., Cigna...

On Oct. 29, the Texas Health and Human Services Commission unveiled the contract awards for the STAR+PLUS Medicaid program, with Anthem, Inc., CVS Health Corp./Aetna, Centene Corp., UnitedHealth Group, Molina Healthcare, Inc., and El Paso Health...

Molina Healthcare, Inc. said Oct. 16 that it agreed to acquire certain Medicaid holdings of YourCare Health Plan, Inc., a not-for-profit subsidiary of Monroe Plan for Medical Care, for $40 million. ...

UnitedHealth Group Inc., buoyed by strong sales at its Optum subsidiary, reported stronger-than-expected third quarter 2019 earnings and upgraded its full year earnings forecast slightly. ...

In the wake of a scandal surrounding the news that Blue Cross and Blue Shield of North Carolina’s CEO was arrested in a drunken driving incident back in June, the insurer has officially called off its planned “strategic affiliation” with Cambia...

Starting next October, the District of Columbia’s Medicaid program will be fully managed by private insurers, Washington City Paper reported. ...

Mary Washington Healthcare (MWH), a not-for-profit health system that primarily serves seven counties in the Fredericksburg, Va., region, has partnered with value- based managed services operator Lumeris to launch a Medicare Advantage plan for...

2020 is shaping up to be another competitive year for the Medicare Advantage program, which will feature an additional 600 plan choices and a continued decline in the average monthly premium. With its annual release of the so-called landscape...

Anthem, Inc. agreed to acquire Nebraska and Missouri Medicaid plans owned by WellCare Health Plans, Inc., in connection with Centene Corp.’s bid to purchase WellCare. ...

Facing a growing firestorm over an alleged drunken driving incident, Blue Cross Blue Shield of North Carolina CEO Patrick Conway, M.D., resigned from his post. Meanwhile, the Blues insurer’s “strategic affiliation” with a fellow payer has been put...

As it’s increasingly clear that the Affordable Care Act has done as much as it can to reduce the U.S. uninsured rate, “policy risk may be increasing rather than decreasing” for health insurers amid a growing appetite for greater health care reform...

Technology-focused Medicare Advantage startup Clover Health said it is planning to enter eight new counties this coming Annual Election Period (AEP), for a total of 34 counties across seven states where it will have MA offerings in 2020. ...

With new insurance startups popping up around the U.S. and the biggest Medicare Advantage players making the biggest enrollment gains, mid-sized and regional health plans marketing during the coming Annual Election Period (AEP) will need to rely...

The year 2020, it seems, will bring more than just a presidential election: It will also mark a banner year of expansion for health insurance startups. One of those is Bright Health, a Minneapolis-based company that sells individual/family,...

After a lengthy, unprecedented review of CVS Health Corp.’s acquisition of Aetna, U.S. District Court Judge Richard Leon officially signed off on the deal in an opinion issued Sept. 4. ...

Grand Rapids-based Priority Health, the second-largest payer in Michigan, on Aug. 28 said it would acquire Total Health Care, a Detroit-based HMO, in the latest in a flurry of vertical and horizontal deals among insurers in Michigan and the...

Between 2016 and 2018, 2.5 million people who didn’t receive premium subsidies left the Affordable Care Act (ACA) individual-market exchange — a 40% drop — and multiple states have seen similar or greater levels of decline, CMS recently reported. ...

Centene Corp. said Aug. 13 it is broadening its footprint in the 2020 Affordable Care Act marketplace in 10 of its existing markets. ...

It’s been a rough August in Medicaid managed care in various ways, as is perhaps best illustrated by two publicly traded giants in the field: CVS Health Corp.’s Aetna Medicaid unit and Centene Corp. Both Aetna Better Health of Louisiana and...

Harvard Pilgrim Health Care, Inc. and Tufts Health Plan said Aug. 14 that they intend to merge — a move that industry experts say will give them the scale they need to compete in an ever-more-consolidated health care market. ...

The Louisiana Dept. of Health unveiled the winners of its managed Medicaid contract awards on Aug. 5, selecting AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana and...

Kentucky’s Passport Health Plan, which warned earlier this year that it was on the brink of insolvency, tells AIS Health it is “on a path forward,” now that a deal with Evolent Health has been approved by the state. It’s also dropped a lawsuit...

CVS Health Corp. reported strong earnings for the second quarter of 2019 across all its business segments, including the Caremark PBM. However, the company said it expects to lose a net $7.4 billion in PBM business for 2020, driven in part by...

Touting “the highest individual Medicare Advantage growth we’ve seen in the last decade,” Humana Inc.’s chief said during a second-quarter earnings call on July 31 that he is confident of long-term growth for his managed care company’s MA HMO, PPO...

Prior to Molina Healthcare, Inc.’s second-quarter earnings call on July 31, previously reporting managed care companies, including Anthem, Inc., downplayed concerns about Medicaid payment rate challenges. Molina’s leadership took a different tack,...

The Florida Healthy Kids Corp. board of directors on July 22 approved contracts for three health insurers to provide subsidized Children’s Health Insurance Program (CHIP) and full-pay health insurance coverage through the Florida Healthy Kids...

A national trade group of 66 safety-net plans recently failed to persuade a federal judge, by its submission of some plan enrollment data, that the Trump administration’s rule promoting the sale of short-term limited duration insurance (STLDI)...

Oscar Health said on July 17 that it is teaming up with Montefiore Health System to launch a co-branded Medicare Advantage (MA) plan in New York, pending CMS approval. ...

UnitedHealth Group led off managed care organizations’ second-quarter 2019 earnings reports by steering clear of political discussions — like the one on Medicare for All that overshadowed the Minnesota-based company’s strong first-quarter...

Appearing to be the only state staying on schedule with reprocuring its Medicaid managed care program, the Oregon Health Authority (OHA) on July 9 said it planned to negotiate pacts with 15 coordinated care organizations (CCOs) to serve the Oregon...

During a July 9 panel discussion about the individual insurance market, one theme was abundantly clear: Different states have had drastically different experiences with the Affordable Care Act (ACA) exchanges, and thus, divergent views on how to...

UnitedHealth Group’s still-unofficial plans to buy health care payments firm Equian LLC, as reported June 20 by *The Wall Street Journal* — along with reported suitors for Magellan Health Inc., and Anthem, Inc.’s agreement to buy behavioral health...

Blue Cross and Blue Shield plans nationwide continue to sport an advantage on administrative-services-only business, enrolling more than two-fifths of all ASO lives in the U.S. market. However, analysts warn that they risk falling behind on the...

Shareholders of both companies on June 24 overwhelmingly approved Centene Corp.’s $15.3 billion deal to buy WellCare Health Plans, Inc. ...

Private equity firm Centerbridge is in talks to buy Magellan Health, Inc., The Wall Street Journal reported June 26. The firms could reach a deal sometime in July, the news outlet said. ...

Centene Corp. is well-positioned to expand in the Medicare Advantage market while continuing strong performance in Medicaid managed care as it works to close its acquisition of WellCare Health Plans, Inc. ...

The Commonwealth of Kentucky recently said it would select up to five managed care organizations to serve its Medicaid and State Children’s Health Insurance Program enrollees starting on July 1, 2020. ...

Kentucky is looking for five managed care organizations to serve its 1.2 million Medicaid and State Children’s Health Insurance Program (SCHIP) members. It joins another three states — Louisiana, Minnesota and Oregon — that also set to choose new...

Troy Medicare, a small Medicare Advantage plan start-up, aims to shake up the North Carolina MA marketplace during the coming fall open enrollment in an outsized way — by offering a pharmacist-centered delivery model that will pay local,...

Industry observers seem to agree that Anthem, Inc.’s definitive agreement to acquire behavioral health company Beacon Health Options from a private equity firm makes good strategic sense. But some experts diverge on what this latest corporate...

California created its own state-based individual mandate, added help for middle-income consumers purchasing coverage on the individual market, and agreed to pay for Medi-Cal coverage for undocumented young adults in a $213 billion legislative...

Anthem, Inc. said June 6 it agreed to acquire Beacon Health Options, a behavioral health company, from a private equity firm. ...

Humana Inc. says it is not pursuing a merger with Centene Corp., despite persistent rumors and press reports that the two companies were considering such a move. ...

Nearly eight months ago, CMS issued guidance loosening rules on individual- market exchanges for states seeking Section 1332 waivers under the Affordable Care Act (ACA). Agency officials followed up by highlighting four examples of new “waiver...

As Centene Corp. pondered whether to pursue WellCare Health Plans, Inc., Centene’s board moved forward partly due to its belief the combined company —with 22 million members across all 50 states — would have “increased scale, meaningful product...

When Washington Gov. Jay Inslee, a 2020 Democratic presidential candidate, recently signed a bill setting up the nation’s first public option health insurance program, he touted it as a model for the rest of the U.S. Indeed, while states including...

Maryland recently became the first state in the nation to try to guide uninsured low-income residents into Medicaid or a subsidized Affordable Care Act (ACA) exchange plan via their tax returns. The state anticipates launching the program in...

Washington state will offer public-option health insurance covering standard services to all residents, regardless of their income, by 2021. ...

The Department of Justice has intervened on the side of Oscar Health in a lawsuit where Oscar is asking for the “immediate termination” of Florida Blue’s policy prohibiting its Orlando insurance brokers from selling competing individual plans. ...

Despite warnings that increased availability of short-term health insurance policies would erode the overall individual market significantly, the impact of short-term plans has been modest so far, with few individuals abandoning Affordable Care...

Speculation over what comes next in managed care merger and acquisition activity took an interesting turn on May 6 when Reutersreported that two hedge fund stakeholders in Centene Corp may challenge its planned $17.3 billion acquisition of...

As April turned into May, several major publicly traded managed care companies, including some newly merged combinations, quietly reported solid first-quarter 2019 earnings. Medicare for All, a health system overhaul being urged by many...

The HHS Office of Inspector General (OIG) has launched an investigation into Medicaid managed care organization care denials following high-profile news reports of problems in Iowa and Texas in a move that could raise questions about private MCOs...

Although independent evaluations of ongoing demonstrations to integrate care for dual-eligible Medicare-Medicaid beneficiaries are still underway, an April 24 letter from CMS Administrator Seema Verma signaled the agency’s commitment to proving...

Iowa’s managed Medicaid program, IA Health Link, is about to play another round of musical chairs with its managed care organizations when UnitedHealthcare (UHC) exits the program before July 1. Prior to UHC’s notice to the state, Centene Corp....

When it comes to pharma-related matters, Centene Corp., in its first-quarter 2019 earnings call, highlighted its interesting position in an industry awash in multi-layered deal-making. The St. Louis-based managed care giant also gave more broad...

Newly implemented state paperwork requirements caused around 1.6 million Medicaid beneficiaries to lose coverage in 2018, the advocacy group Families USA says, and Medicaid managed care stakeholders say that this additional churn in Medicaid...

Following UnitedHealth Group’s lead, Anthem, Inc. reported strong financial results for the first three months of 2019. The Blues giant cited rising profits and raised its 2019 outlook, with its chief executive touting earnings “driven by our...

With its diversified business portfolio and little involvement with the Affordable Care Act (ACA) exchanges, UnitedHealth Group seems an unlikely company to have its latest earnings report eclipsed by politics. ...

In their latest collaboration, Blue Cross and Blue Shield of North Carolina and Duke University Health System recently announced their joint formation of Experience Health, a new health insurance company created for seniors. ...

New Hampshire will award statewide managed Medicaid contracts to incumbents NH Healthy Families (Centene Corp.) and Well Sense Health Plan (Boston Medical Center Health Plans, Inc.) and new entrant AmeriHealth Caritas. The new five-year contracts...

UnitedHealthcare will exit Iowa’s managed Medicaid program in the next several months after seeking new rates that Gov. Kim Reynolds (R) called “unreasonable and unsustainable.” ...

In what seems like a logical next step for the two government-focused insurers, Centene Corp. on March 27 unveiled plans to purchase WellCare Health Plans, Inc. for approximately $17.3 billion. The combination would create a “premier health care...

A federal judge’s recent ruling, which struck down two key provisions of the Trump administration’s association health plan (AHP) rule, has stymied some organizations’ plans to take advantage of the regulation’s added flexibilities, experts tell...

A federal judge on March 27 struck down programs in Kentucky and Arkansas that impose work requirements on Medicaid beneficiaries — a move that is already leading some to speculate about the impact on Medicaid managed care organizations. ...

Health insurers, working to finalize bids by a June deadline to participate in 2020 as qualified health plans in Affordable Care Act exchanges, are once again facing uncertainty arising from an action taken by the Trump administration. Some...

In a $17.3 billion deal that would make the country’s largest Medicaid managed care organization even larger, give it a greater foothold in the Medicare Advantage (MA) market, and perhaps shield it from uncertainty surrounding the Affordable Care...

The notion of allowing individuals to purchase health insurance across state lines is nothing new. But the reality is that states want to retain regulatory authority over products sold within their borders, and health plans already sell in...

Humana Inc. on March 15 said that it will team up with a Seattle-based company called Accolade to “create a differentiated healthcare and benefits experience for consumers” by combining the insurer’s capabilities with the startup’s data-driven...

With switching rates during the 2019 Annual Election Period (AEP) on the rise after years of decline, experts say it’s hard to predict what will happen during the newly reinstated Medicare Open Enrollment Period (OEP) that ends on March 31. But as...

Amidst uncertainty around the fate of Medicaid work requirements as they are tested in two separate cases this month, Ohio on March 15 became the ninth state to gain section 1115 demonstration authority to tie work-related provisions to Medicaid...

Blue Cross and Blue Shield of North Carolina announced March 12 that it would combine with the Oregon-based Cambia Health Solutions with a goal to “improve quality, lower costs, and deliver an exceptional experience for consumers.” ...

In an era of U.S. health care consolidation, what two major Blues insurers describe as their “strategic affiliation,” announced March 12, would bring together dominant regional not-for-profits with combined net revenue of $16 billion and more than...

Fallon Health joins other not-for-profit plans in its home state of Massachusetts and beyond in recently posting overall positive financial performances for fourth quarter and full-year 2018. Among such plans reporting March 1 in Massachusetts: ...

After more than four decades in business, Fallon Health in Massachusetts credits its strategic investments in government programs and careful management of expenses as helping it continue to adapt and grow in its niche as a community health plan....

Magellan Health Inc. — a company with behavioral health, Medicaid managed care and PBM assets — is striving to turn its business around after a challenging 2018 that has stirred speculation it’s primed for a sale. ...

Two Blues plan-sponsored efforts — a partnership between Blue Cross and Blue Shield of North Carolina and Anthem, Inc. subsidiary Amerigroup, and a bid from Independence Blue Cross subsidiary AmeriHealth Caritas North America, Inc. — won statewide...

After more than two decades of participation in Kentucky’s Medicaid program, Passport Health Plan may be on its way out. The nonprofit insurer warns it is in danger of becoming insolvent unless there is an immediate adjustment related to a...

In November’s midterm elections, Utah was one of three states that approved ballot initiatives to expand Medicaid, signaling to some that the tide had definitively turned toward embracing that provision of the Affordable Care Act (ACA). ...

Despite some skepticism from Wall Street over headwinds primarily arising from its long-term-care pharmacy, along with soft 2019 profit guidance and overhanging debt from its $70 billion acquisition of Aetna Inc., CVS Health Corp. touted its...

Molina Healthcare, Inc. on Feb. 12 released what one analyst called its “fourth consecutive eye-popping earnings report” as the California-based insurer continued its recovery from a rocky 2017 in which it posted multimillion-dollar losses. ...

North Carolina this week awarded Medicaid contracts worth an estimated $6 billion per year to five managed care organizations: ***AmeriHealth Caritas; Blue Cross and Blue Shield of North Carolina;*** Carolina Complete Health, a provider-led...

Even as some recent headlines have reignited concerns about the long-term prospects of the Affordable Care Act (ACA), the CEO of one of the health insurers that has benefited most from the law told investors that he continues to see more reasons...

Anthem, Inc. caused its stock to surge and Wall Street analysts to raise their 2019 and 2020 earnings estimates by revealing during its quarterly earnings call on Jan. 30 that it’s planning to launch its in-house PBM three quarters earlier than it...

Arizona’s Dept. of Corrections notified Centene Corp. subsidiary Centurion of Arizona, LLC of its intent to award it a contract to provide health care services to inmates in the state’s prison system. ...

In a Jan. 23 SEC filing, Cigna Corp., which completed its acquisition of PBM Express Scripts Holding Co. in December, announced its new reporting structure and outlined how business segments have changed under the integration. ...

Arizona on Jan. 18 received CMS’s approval to implement Medicaid work requirements. In late December, the Trump administration approved work requirements for Medicaid programs in Maine and Michigan, though Maine Gov. Janet Mills (D) rejected the...

The Trump administration is reportedly working on a way to let states use waivers to implement a block-grant system in their Medicaid programs — and if those plans come to fruition, Medicaid managed care organizations might not fare so well, some...

UnitedHealth Group, the bellwether of publicly traded managed care companies’ quarterly financial health, reported strong fourth-quarter and full-year 2018 earnings on Jan. 15 — “starting the year off right,” according to Oppenheimer & Co....

Opportunities for managed care plans abound in Medicare Advantage (MA), the popular, competitive program that seems to enjoy bipartisan support, experts tell AIS Health. Nationwide, the market has grown to approximately 3,700 MA plan choices in...

Connect for Health Colorado, one of the dozen state-based ACA exchanges, said Jan. 7 that 2019 health plan selections are running about 3% ahead of the comparable period a year ago, with many rural counties already exceeding the number of plan...

Centene Corp. entered an agreement to buy Arkansas-based QualChoice Health Insurance (aka QCA Health Plan, Inc.), the Arkansas Democrat Gazette reported on Jan. 4. QualChoice operates in commercial and Medicare Advantage markets in Arkansas and...

From a flurry of state Medicaid managed care procurements and Section 1115 waiver activity to more states heading toward Medicaid expansion under the Affordable Care Act (ACA), Medicaid plans face a busy year ahead, experts tell AIS Health. They...

In a Jan. 2 SEC filing, Humana Inc. provided some updates on its annual enrollment period results, revising its Medicare Advantage (MA) growth expectations for 2019. ...

Molina Healthcare, Inc. said Jan. 3 that it will extend its PBM contract with CVS Health Corp.’s Caremark division through 2021. ...

Even amid factors like loosened rules for skimpy health plans and a court ruling that the Affordable Care Act is unconstitutional, experts expect the individual insurance marketplaces to remain on solid footing in 2019 as insurers integrate their...

Preliminary data show enrollment remained steady year over year in federally facilitated Affordable Care Act exchanges, CMS said Dec. 19 as it released the weekly enrollment snapshot through the Dec. 15 deadline of the 2019 open enrollment period....

Cigna Corp. completed its acquisition of Express Scripts Holding Co. on Dec. 20 after receiving its final state regulatory approval from New Jersey. The Dept. of Justice signed off on the deal in September, concluding that it “is unlikely to...

Timing is everything, and in most states, including those using HealthCare.gov, Dec. 15 was the final day of the open enrollment period (OEP) for coverage starting Jan. 1, 2019, through health plans on or off the Affordable Care Act (ACA)...

At this point, CVS Health Corp. and Aetna Inc. were supposed to be well on their way to integrating the many facets of their operations after finalizing a $69 billion deal. Instead, CVS is offering to keep some key parts of the two businesses...

On Dec. 14, a federal judge sent shockwaves into the health care sector by ruling that the entire Affordable Care Act is unconstitutional. While few legal experts expect the ruling to survive scrutiny by higher-level courts — and note that the law...

Fearful of deportation for undocumented household members, an increasing number of immigrant families in Texas haven’t re-enrolled their eligible children into government-sponsored health coverage. ...

On Dec. 4, Tenet Healthcare Corp. completed the sale of its Medicare Advantage HMO, Golden State Medicare Health Plan, to MacArthur Court Acquisition Corp., a holding company affiliated with the management of value-based care delivery company...

According to CVS Health Corp., its acquisition of Aetna Inc. closed on Nov. 28 after receiving the last required approval from a state regulator. But a federal judge appears to have other ideas. ...

Six months after the Trump administration issued final regulations to expand association health plans as an alternative to coverage through Affordable Care Act (ACA) exchanges, AHP sponsorship is slowly moving forward. Such plans are being...

After a federal judge blocked Kentucky from implementing work requirements for certain Medicaid enrollees and kicked its section 1115 demonstration application back to CMS for review, the federal government on Nov. 20 reapproved the state’s...

As CVS Health Corp. finalized plans late last month to take over Aetna Inc., a deal was reportedly brewing between another retail giant and Aetna’s former acquisition target Humana Inc. *The Wall Street Journal* on Nov. 20 reported that Walgreens...

Iowa’s 2016 transition from fee-for-service to managed Medicaid was a hot-button topic this past election cycle as Democrat Fred Hubbell campaigned for governor with the promise of returning the program to a publicly managed system. Though Hubbell...

As Medicare Advantage and Part D sponsors compete for enrollees during the 2019 Annual Election Period (AEP) that began on Oct. 15 and ends on Dec. 7, a major focus this year is the newly reinstated Open Enrollment Period (OEP) during which...

Blue Cross and Blue Shield plans are implementing innovative strategies to keep premiums low on Affordable Care Act (ACA)-compliant individual policies for 2019 as they navigate a changing market that continues to see a poor risk pool and will...

Just days before CVS Health Corp. said it closed its $69 billion acquisition of Aetna Inc., reports emerged that another retail pharmacy giant and health insurer pair — Walgreen Co. and Humana Inc. — are in preliminary talks to take equity stakes...

Wall Street analysts view Humana Inc.’s Medicare Advantage (MA) business as poised for growth after the Louisville, Ky.-based insurer touted its strong MA performance — in terms of quality of care and membership growth — in its Nov. 7 quarterly...

This fall’s open enrollment season for Affordable Care Act (ACA) individual-market plans and, separately, Medicare plans, is marred in some places by what one spam-call-blocking service described to Kaiser Health News as “epidemic levels” of...

With several notable Medicaid managed care contracts up for grabs, publicly traded insurers during recent calls to discuss third-quarter 2018 results showed enthusiasm for new bid opportunities and stressed the importance of having strong...

Health care was a pivotal issue during the recent midterm elections, and with the Democrats on Nov. 6 winning back control of the House, the GOP’s plan to repeal and replace the Affordable Care Act is presumably off the table. And given some key...

Land O’Lakes, Inc. said Nov. 1 it is the first organization to sponsor a self-insured multi-state group health plan under new association health plan regulations issued by the Trump administration this past summer. ...

Thanks in part to the calming effect of a divided government, Medicare Advantage is poised to keep growing in the next two years — and Humana Inc. is one of the companies best positioned to reap the benefits, according to Wall Street analysts. ...

Voters in three historically red states — Idaho, Utah and Nebraska — on Nov. 6 passed ballot initiatives to expand Medicaid to residents living at less than 133% of the Federal Poverty Level. To date, 36 states and Washington, D.C., have decided...

With the November midterm elections in hindsight, and Democrats controlling the House and gaining key governors’ seats come January, a new road map for health care in the U.S. is taking shape — and much of it affords potential business...

With its third-quarter financial results, Molina Healthcare, Inc. continued to showcase a redemption story that contrasted significantly from the situation in 2017, when it experienced multimillion-dollar losses and ousted its two top executives. ...

Similar to a year ago, the open enrollment period for Affordable Care Act exchange plans began Nov. 1 surrounded by political “noise.” And, for the second consecutive year, slashed federal funding for ACA exchange advertising and navigator...

For the biggest expansion of Medicare Advantage plans in the company’s history, Aetna Inc. is offering MA Prescription Drug (MA-PD) plans in 45 states plus Washington, D.C. ...

WellCare Health Plans, Inc. on Oct. 30 reported $3.33 in third-quarter 2018 adjusted earnings per share (EPS), up from $2.70 per share in the prior-year quarter. And the insurer increased its full-year adjusted 2018 EPS outlook by 20 cents on...

In reporting third-quarter earnings on Oct. 23, Centene Corp., the largest player in the Affordable Care Act (ACA) marketplace, said its exchange membership now tops 1.5 million — up from 1.02 million a year ago. The insurer said its major...

The way Joan Alker sees it, Medicaid work requirements — a concept embraced by red states and the Trump administration — add nothing but administrative burden and increased enrollee churn to the Medicaid program. ...

Devoted Health, which bills itself as a “next-generation Medicare Advantage plan,” launched on Oct. 16 and began to enroll members across eight counties in south and central Florida. ...

On Oct. 15, BayCare Health Plans Inc. began enrollment in its first health insurance products — two Medicare Advantage (HMO) plans called BayCarePlus — in four Florida counties. ...

For the first time, Humana Inc. is offering Medicare Advantage (MA) plans in New Jersey. ...

To Anthem, Inc. President of Medicare Marc Russo, Medicare Advantage (MA) plans are clearly doing a good job of delivering value to seniors. ...

Continuing its track record, UnitedHealth Group released solid third-quarter financial results on Oct. 16, emphasizing Medicare Advantage (MA) as an area of strength while promoting its broad competitive strategies and optimistic outlook. This...

Medicare-for-All, a system in which a single, federal government-administered program would provide coverage to all U.S. residents, has long been seen as more of an ideal than a feasible political possibility. However, with some analysts expecting...

CMS is expecting Medicare Advantage enrollment to grow by 11.5% next year, with more than 36% of Medicare eligible consumers projected to be in an MA plan in 2019. And plans are using improved payment rates and new benefit design flexibility from...

In addition to the many enhanced benefits and $0 premium plans that Medicare Advantage insurers will offer in 2019, multiple stories are playing out this Annual Election Period on a regional level. Here are a few areas of the country where...

Centene Corp. on Oct. 10 said that it will enter the Affordable Care Act (ACA) exchange markets in four new states in 2019 and expand its footprint in six states where it already sells plans. ...

The Department of Justice (DOJ) on Oct. 10 gave its blessing to CVS Health Corp.’s $69 billion acquisition of Aetna Inc., contingent upon the insurer divesting its Medicare Part D Prescription Drug Plan (PDP) business. ...

New data from CMS signals an increasingly robust Medicare Advantage market in 2019, with significantly more plan choices per county that are likely driven by a combination of new entrants, geographic expansions and the elimination of meaningful...

As the first state to implement the new work and reporting requirements in Medicaid, Arkansas will drop 4,353 people due to non-compliance with the work rules as of Sept. 9. ...

As Medicare Advantage (MA) plans confront an even more crowded, competitive marketplace this fall, they largely intend to hold steady on premium rates, industry experts tell AIS Health. MA plans also continue to focus on zero-premium offerings and...

As Medicare Advantage organizations and Part D plans approach the Oct. 15 start date of the 2019 Annual Election Period (AEP), many of their marketing activities will carry over from recent years. But how they go about retaining members will be...

Two Blues-affiliated entities — Anthem, Inc. unit Amerigroup Corp. and a joint effort by Blue Cross and Blue Shield of North Carolina and Ameri- Health Caritas — will compete for chunks of North Carolina’s Medicaid business as the Tar Heel state...

On Sept. 26, a subsidiary of WellCare Health Plans, Inc. agreed to buy Aetna Inc.’s entire stand-alone Medicare Part D Prescription Drug Plan business, effective Dec. 31. ...

Numerous press releases are flooding into public view now that the National Committee for Quality Assurance (NCQA) has unveiled its latest annual iteration of health plan ratings based on consumer satisfaction, prevention and treatment. ...

Wall Street analysts expect to hear favorable news soon from the Dept. of Justice about CVS Health Corp.’s plans to acquire Aetna Inc., though this may require both companies to divest some of their Medicare Part D plans. That’s because the DOJ’s...

Beneath the surface of headline-grabbing PBM megadeals lies significant growth opportunity for mid-market players, which are strategizing to remain competitive and acquisitive themselves, industry experts tell AIS Health. For their part, major...

On Sept. 10, Michigan became the latest state to ask the Trump administration to approve work requirements for its Medicaid population. ...

Medica, a not-for-profit health insurer based in Minneapolis, and the Mayo Clinic are teaming up to sell health insurance across the country. ...

Affordable Care Act (ACA) exchange premium increases are on track to moderate significantly in 2019, according to a new analysis — but experts say insurers shouldn’t expect that to materially affect individual market enrollment or plan sales. ...

CVS Health Corp.’s acquisition of Aetna Inc. and Cigna Corp.’s purchase of Express Scripts Holding Co. could receive formal antitrust approval from the Dept. of Justice as early as the next few weeks, The Wall Street Journal reported, citing...

A national collaborative of 17 major health systems recently unveiled a two-year initiative that it anticipates will transform the Medicaid program by leveraging shared digital solutions and innovative care models to improve care for complex,...

Though the expansion of short-term and association health plans (AHP) has garnered considerable attention, some say a different variety of coverage also has the potential to damage the individual marketplaces: health care sharing ministries. ...

After one year of serving Medi-Cal beneficiaries in Sacramento and San Diego counties, UnitedHealthcare Community Plan of California will exit Sacramento County on Oct. 31. The exit impacts about 4,400 Medi-Cal members. ...

WellCare Health Plans, Inc. on Sept. 1 completed its acquisition of Meridian Health Plans, which significantly boosts its Medicaid membership, enhances the insurer’s MA presence and adds the MeridianRx pharmacy benefit manager. ...

Insurers that started up in the Affordable Care Act (ACA) exchange marketplace and sought to differentiate themselves with consumer-friendly technology solutions are now setting their sights on the Medicare Advantage market. After launching MA...

The small-group market, which has been largely stable with single-digit rate increases for Blue Cross and Blue Shield plans despite upheaval in the individual market, could face headwinds driven by two forces: the Trump administration’s moves to...

Centene Corp. said Aug. 27 its subsidiary, Centurion Detention Health Services, LLC, was awarded a contract to provide comprehensive health care services to prisoners in detention facilities in Volusia County, Fla. ...

On Aug. 29, Cigna Corp. submitted a filing with the Securities and Exchange Commission that said both the insurer and Express Scripts Holding Co., which it has agreed to acquire, have gotten approval from 14 states and require 15 more state...

Cigna Corp. said Aug. 24 its shareholders overwhelmingly voted to approve the adoption of the previously announced $67 billion deal to buy Express Scripts Holding Co. ...

State regulators run the gamut in their reactions to the Trump administration’s recent final rules expanding short-term limited duration (STLD) health insurance policies and association health plans (AHPs) in the individual and small-group markets...

Direct-to-employer contracting for integrated delivery systems got a boost this month when Detroit-based Henry Ford Health System launched its first-ever direct-to-employer contract, offering its network to General Motors employees and their...

Though President Donald Trump has reportedly shut down the debate over so-called partial Medicaid expansion until after the midterm elections, a new paper argues that there are greater problems with the idea than the potential political risks. ...

As Priority Health in Michigan looks toward the Affordable Care Act (ACA) exchange’s 2019 open enrollment period, it still awaits state regulators’ confirmation of its submitted premium rates. But, in general, there is not a lot of year-over-year...

From individual and group commercial sales to Medicare Advantage (MA), health insurers are embarking upon new selling strategies and further streamlining the enrollment process as annual sign-up periods approach. In Massachusetts, a former...

Though both deals have recently faced some blowback, Cigna Corp.’s acquisition of Express Scripts Holding Co. and CVS Health Corp.’s purchase of Aetna Inc. are looking more and more likely to close, industry experts say. ...

In what is expected to be a cutthroat procurement process, the North Carolina Dept. of Health and Human Services (DHHS) on Aug. 9 released its long-awaited request for proposals from managed care organizations hoping to be the first to serve the...

With across-the-board improvements in medical cost trend that the company attributed to better medical management and provider contracting, Molina Healthcare, Inc. on July 31 delivered second-quarter 2018 results that far exceeded analysts’...

Centene Corp. and Ascension, the nation’s largest Catholic and non-profit health system, recently signed a letter of intent to establish a Medicare Advantage (MA) plan, which will serve multiple geographic markets beginning in 2020. ...

With a presence in every U.S. region and Puerto Rico, small and medium-sized businesses (SMB) have been playing an important role in the U.S. health insurance market. According to a new Edifecs study, “Insights into the Small & Medium Health...

Centene and Ascension in a July 30 press release added that they will pursue a “preferred model for the respective systems and affiliates.” ...

As second-quarter earnings season kicked into full gear, publicly traded health insurers largely fell in line with the trend of strong results started by UnitedHealth Group and continued by Anthem, Inc. and Centene Corp. ...

The Trump administration’s Aug. 1 release of the final rule for short-term limited duration (STLD) plans allows insurers to begin selling the so-called “skinny coverage” products Oct. 1, subject to individual states’ regulatory action or inaction....

Government business, and Medicare Advantage in particular, continued to be a significant driver of revenue for the major publicly traded insurers reporting second-quarter 2018 earnings at press time. And Anthem, Inc., for one, sees both major...

After unveiling plans earlier this year to enter the Medicare Advantage space in 2019, longtime insurance company Mutual of Omaha on July 17 disclosed that it is preparing to launch the first of its MA products in the greater Cincinnati area....

Similar to first-quarter financial reports, Anthem, Inc. and Centene Corp. posted solid earnings for the quarter ended June 30, thus signaling the continuation of a positive managed care trend for the year. UnitedHealth Group, the first managed...

During a recent panel discussion on “state responses to the individual health insurance market,” hosted by the Alliance for Health Policy, one expert succinctly summed up what the rate-filing season has been like in recent years. ...

UnitedHealth Group reported solid earnings growth for the quarter ended June 30, again driven by its Optum subsidiary — and again embraced by Wall Street as a likely harbinger of strong performance for managed care companies as a whole through the...

A new Avalere Health study analyzing health care cost, quality and utilization of nearly 2.8 million Medicare beneficiaries suggests that Medicare Advantage enrollees with chronic conditions receive higher care quality and have lower inpatient...

In 2019, Minneapolis-based Bright Health will double the number of states in which it participates in the Affordable Care Act (ACA) exchanges. ...

The U.S. Department of Justice (DOJ) is set to approve CVS Health Corp.’s acquisition of Aetna Inc., Bloomberg reported July 12, citing a report from the trade publication Reorg Research. ...

Against heavy odds, the Affordable Care Act (ACA) health insurance exchanges are stabilizing, and plans’ preliminary premium rates for 2019 are falling below last year’s rates, industry consultants and Wall Street analysts say. Credit Suisse...

On July 2, Centene Corp. said it has finalized its $3.75 billion acquisition of substantially all of the assets of Fidelis Care, New York’s largest Medicaid plan, following regulatory approvals. ...

A federal judge on June 29 struck down Kentucky’s plan to implement Medicaid work requirements, answering the question of whether the state’s waiver — the first of its kind to be approved — would hold up under legal scrutiny. ...

In-home primary care is increasingly being used by Medicare Advantage organizations looking to avoid costly emergency room visits and hospital admissions, and new investments and partnerships are popping up every month as insurers make this a key...

Despite a partial rejection of its section 1115 demonstration application for KanCare 2.0, Kansas recently moved forward with a key step in revamping its managed Medicaid program: the awards of three new managed care organization contracts....

After a competitive bidding process, the Kansas Dept. of Health and Environment said June 22 it has chosen three managed care organizations — newcomer Aetna Better Health of Kansas, Inc., along with incumbents Sunflower State Health Plan, Inc., a...

Whether it’s being slammed as the latest effort to undermine the Affordable Care Act (ACA) or touted as a way to broaden affordable coverage options for small businesses, the expansion of association health plans (AHPs) recently took a step...

After Florida’s Agency for Health Care Administration in April unveiled the nine managed care organizations that initially won contracts for its statewide Medicaid managed care reprocurement, the state recently made more awards. ...

Centene Corp. cleared its final regulatory hurdle in acquiring New York Medicare Advantage and Medicaid plan operator Fidelis Care with approval of the New York Attorney General. ...

As plans continue to refine their marketing strategies in an increasingly competitive landscape, recent regulatory changes as well as program modifications being considered by CMS will likely allow greater flexibility in their endeavors to engage...

Medicare Advantage plans, realizing that increased competition in the MA space means they need to stay visible and keep members engaged year-round, are seeing success with a variety of tactics, from mall-based educational centers to Facebook Live...

UnitedHealth Group entered into an agreement to buy Peoples Health, a Medicare Advantage insurer based in Metairie, Louisiana, The Times-Picayune reported, noting the terms of the deal were not disclosed. According to the most recent AIS’s...

Though it’s not yet clear whether CVS Health Corp’s bid to buy Aetna Inc. and Cigna Corp’s planned purchase of Express Scripts Holding Corp. will pass regulatory muster, experts participating in a June 8 panel discussion expressed both skepticism...

A year ago, health plans — though worried by the threatened loss of federal cost-sharing reduction (CSR) payments and by Republican lawmakers’ efforts to repeal and replace the Affordable Care Act — largely decided to stay put and file preliminary...

After a highly watched district court ruling gave AT&T the green light to acquire Time Warner, Wall Street analysts predicted that the CVS Health Corp./Aetna Inc. and Cigna Corp./Express Scripts Holding Co. deals now have a better chance of...

The individual mandate penalty, one of the most divisive provisions of the Affordable Care Act (ACA), is set to disappear in 2019 — a fact the law’s detractors see as a victory but others worry will contribute to higher premiums in the individual...

After several years of political wrangling, another red state made national headlines when its Republican-controlled legislature — as part of the budget that had to pass by July 1 to avoid a government shutdown — recently approved Medicaid...

Anthem, Inc. credited value-based care in part for a 30% jump in earnings in the first quarter as Blues organizations nationwide increasingly are seeing value-based success in the form of improved quality indicators and financial performance. ...

While the conventional wisdom now seems to indicate the Affordable Care Act (ACA) marketplaces are stabilizing, a recent report from the country’s largest health insurer argues that Medicaid expansion — not the exchanges — is the true success...

In a move that some say further illustrates the attractiveness of the Medicaid managed care market, WellCare Health Plans, Inc. on May 29 unveiled a $2.5 billion deal to purchase Meridian Health Plan of Michigan, Inc., Meridian Health Plan of...

Centene Corp. said its subsidiary Iowa Total Care, Inc. was tentatively awarded a statewide contract for the IA Health Link Program, which provides integrated Medicaid managed care coverage to more than 600,000 Iowa Medicaid members. ...

From 2018 to 2019, premiums for Affordable Care Act (ACA) exchange benchmark plans will rise 15%, and an additional 3 million people will be uninsured, both largely because of the repeal of the individual mandate, according to a Congressional...

Up to 10% of individuals currently buying Affordable Care Act-compliant individual policies could jump ship to new, non-ACA-compliant association health plans (AHPs), leading to an increase in premiums of as much as 4% for the ACA-compliant plans,...

With better-than-expected medical cost trends and enrollment gains in the commercial market driving strong first-quarter 2018 results and a favorable full-year outlook, Cigna Corp. on May 3 said it is starting to focus on recapturing momentum in...

Before Cigna Corp. and Express Scripts Holding Co. unveiled their $67 billion deal on March 8, both companies considered combinations with different heavy hitters in the industry, according to a proxy statement filed by the companies. ...

The Louisiana Department of Health & Hospitals this week notified 37,000 Medicaid beneficiaries, most of them elderly or disabled, that they may lose coverage as early as July 1, following a round of budget cuts that eliminated four of the state’s...

As health insurers begin to file their 2019 rate requests for Affordable Care Act (ACA) exchanges, they are sending clear signals that recent legislative and regulatory actions will factor prominently into their calculations. ...

For the quarter ended March 31, UnitedHealth Group proved once again to be a harbinger of solid financial performance for publicly traded managed care companies, as other major players in the industry recently reported their own favorable trends. ...

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, and Tom Price, M.D., former secretary of HHS, are two very different men with different perspectives on the Affordable Care Act (ACA). But they seem to agree on one thing:...

As they reported first-quarter earnings over the past week, major health insurance companies also took the opportunity to stress the value of partnerships and deals, assess the regulatory landscape, react to recent Medicaid contract awards and...

While some publicly traded Medicaid insurers reported better-than-expected earnings for the quarter ending March 31, the reasons appeared to be varied. Centene Corp., for starters, experienced a delay in the funding of its planned deal to acquire...

Florida’s Agency for Health Care Administration (AHCA) on April 24 said it intended to award contracts to nine health plans that will provide Managed Medical Assistance (MMA) and Long-Term Care (LTC) programs to more than 3 million Floridians...

A strong first quarter reflecting membership growth in Medicare Advantage product lines had several publicly traded managed care organizations increasing their expectations for full-year 2018 earnings, which were already lifted last quarter on the...

Though it hasn’t yet released its first-quarter earnings, Humana Inc. has been making headlines recently with the debut of a proposed acquisition, a new partnership, a value-based care initiative and an expanded presence in Florida’s Medicaid...

Two more managed care companies recently reported strong financial results for the quarter ended March 31, both weathering a severe flu season though failing to exit the quarter unscathed. Centene Corp. downplayed the delay and extra regulatory...

Continuing its track record of solid financial performance, UnitedHealth Group again beat Wall Street’s expectations on earnings and revenue in first-quarter 2018. The nation’s largest private health insurer on April 17 reported quarterly revenues...

Connecting low-income and elderly members with available community resources such as food banks and housing programs has become a common part of managed care organizations’ overall strategy to address social determinants of health. One alternative...

Nearly 4.2 million out of 21 million total Medicare Advantage beneficiaries are currently enrolled in an Employer Group Waiver Plan (EGWP), with enrollment in these group retiree options rising by double-digit percentages in the last couple of...

Amid speculation that the nation’s second-largest Medicare Advantage insurer is seeking to further entwine itself with long-time Medicare Part D partner and retail giant Wal-Mart Stores, Inc., Humana Inc. on April 10 said it had acquired Orlando...

With its newly issued final rule for the Affordable Care Act (ACA) marketplaces, the Trump administration said it aimed to reduce the law’s regulatory burden, return more control to the states and stabilize the exchanges. ...

CMS on April 3 issued a final report showing that 11.8 million consumers selected or were automatically re-enrolled in 2018 Affordable Care Act (ACA) exchange coverage nationwide. ...

If Walmart Inc. is in early talks to acquire Humana Inc., or at least to strengthen its Medicare partnership with an insurer that’s worth about $37 billion, as first reported March 29 by *The Wall Street Journal*, industry observers and...

While the final 2019 payment notice and Call Letter for Medicare Advantage and Part D plans posted April 2 contained few deviations from what was proposed in the Advance Notice and draft Call Letter, MAOs were pleasantly surprised to see a sizable...

As the health care landscape transitions to value-based care and Medicare Advantage enrollment reaches new highs, providers are increasingly becoming sponsors of MA plans through a variety of arrangements. And well in advance of marketing for the...

Blue Cross and Blue Shield plans are seeing some headwinds in a large group selling season marked by increased employer interest in high-performing narrower provider panels, improved data systems and carve-ins for specialty pharmacy, consultants...

The Medicaid landscape is undergoing rapid transformation as the Trump administration loosens some benefit and policy limitations and states tackle prescription drug costs with new approaches, according to analysts from health care consulting firm...

Congress’ latest failure to pass an Affordable Care Act (ACA) stabilization package, taken together with policy changes that have chipped away at the law, have renewed concerns about spiking premiums and insurer exits in the marketplaces next year...

Humana Inc. has kept a low profile over the past year after abandoning a proposed acquisition by Aetna Inc. amid antitrust concerns — up until now, that is. Humana is back in the headlines amid a March 29 *Wall Street Journal* report speculating...

UnitedHealthcare reports that it’s seeing increasing client interest in its unique, national accountable care organization (ACO) model as employers look for ways to get more value for their health care dollar. ...

Express Scripts, the last major stand-alone pharmacy benefit manager in the United States, serves 51 health insurance clients that cover over 60.5 million medical members in total. About 22% of its clients are affiliated with Blue Cross Blue...

Express Scripts Holding Co., which is poised to be acquired by Cigna Corp., now faces the challenge of retaining health plan clients that may be uneasy about working with a PBM owned by one of their competitors. ...

From new joint ventures to proposed acquisitions, health insurers are increasingly getting into the care delivery business. Industry experts, though, are split on whether such moves are the best ways to improve quality and control costs. ...

If Cigna Corp. completes its acquisition of Express Scripts Holding Co., the PBM’s health insurer clients will have to decide whether to keep working with an entity now owned by a fellow payer. However, any insurers that do opt to cut ties with...

Expectations, since dashed, were high when Premier Health System in Dayton, Ohio, launched its commercial and Medicare Advantage (MA) insurance products several years ago, joining a wave of provider-sponsored health insurance plans being...

Three states this month informed insurers of their intent to award contracts to coordinate benefits for various segments of their Medicaid populations. Here are the highlights: ...

Marking the second acquisition unveiled in a week and the third since September, Centene Corp. on March 5 said it plans to acquire at-risk primary care provider Community Medical Holdings Corp., a move that analysts say could boost its Medicaid...

As more state Medicaid programs address social determinants of health, housing is becoming a critical piece of insurers’ integrated, patient-centered care strategies. During the World Congress’ 11th Annual Medicaid Managed Care Summit, held from...

HHS sent a warning letter to Idaho officials on March 8, informing them that the state’s move to allow the sale of “state-based plans” may violate the Affordable Care Act (ACA). The letter comes after Gov. C.L. “Butch” Otter (R) issued an...

In an effort to scoop up its off-the-grid members, Health Partners Plans (HPP), a hospital-owned Pennsylvania-based provider of Medicaid managed care, has formed a three-way partnership with Philadelphia FIGHT Community Health Centers and Broad...

The CEOs of three health insurance companies aren’t pleased with some of the Trump administration’s major health care policy priorities, including expanding the use of short-term plans and adding work requirements to Medicaid. ...

Cigna Corp. on March 8 unveiled a $67 billion deal to buy Express Scripts, a transaction that analysts say could strengthen the insurer’s business but also complicate CVS Health Corp.’s pending purchase of Aetna Inc. ...

Shortly after Idaho allowed the sale of health insurance that does not meet all of the Affordable Care Act’s requirements, state lawmakers in Iowa began moving to skirt ACA regulations. ...

In a move that will greatly expand its footprint in the correctional healthcare sector, Medicaid managed care giant Centene Corp. has announced plans to acquire a company called MHM Services. Industry analysts say the transaction is a savvy move...

Iowa recently joined Idaho in efforts to sidestep Affordable Care Act (ACA) requirements, as state lawmakers advanced a bill that would allow the Iowa Farm Bureau Federation (IFBF) to offer non-ACA-compliant — and thus presumably skimpier and...

After a tumultuous 2017 that included firing its top leaders, Molina Healthcare, Inc. recently reported a net loss of $4.59 per diluted share for the fourth quarter of 2017 that it attributed in part to ongoing restructuring expenses, increased...

The final results from the 2018 Annual Election Period (AEP) demonstrate continued growth in Medicare Advantage enrollment as well as MA penetration. Total MA enrollment as of February 2018 grew to 21.08 million members, up nearly 8% from the 19.6...

Anthem, Inc. said Feb. 15 that it completed its acquisition of America’s 1st Choice. ...

If finalized, a proposed rule that aims to broaden the availability of short-term health plans that are non-compliant with the Affordable Care Act, issued Feb. 20 by the Trump administration, likely won’t in itself destroy ACA individual-market...

Molina Healthcare, Inc. on Feb. 12 reported net losses of $262 million for the fourth quarter and $512 million for full-year 2017. That was on premium revenues of nearly $4.7 billion for the quarter and $18.9 billion for the year. In releasing its...

In light of tax reform that will result in lower corporate rates this year, several publicly traded Medicare and Medicaid managed care organizations raised their expectations for full-year 2018 earnings. And during conference calls to discuss...

An early look at enrollment results from the payer-provider joint venture formed last June by Oscar Health and Cleveland Clinic shows that the agreement is paying off, an Oscar executive tells AIS Health. ...

Directors of state-run public health insurance exchanges say innovative and aggressive advertising campaigns are what helped them show growth in the 2018 open-enrollment period, despite widespread confusion over policy, a shorter enrollment period...

Similar to three months ago, Centene Corp. stressed it is “business as usual” in its fourth quarter and full-year 2017 earnings call on Feb. 6 — downplaying the potential impact of the intense influenza season and again touting its still-to-be...

More and more Blue Cross and Blue Shield plans are starting to compete for Medicaid managed care business as they see potential growth opportunities in that arena. To do so, many plans are renting capabilities or buying companies that already...

Cigna Corp. said its fourth-quarter 2017 earnings report showed growth across the company’s health care, supplemental benefits and group disability and life segments. ...

With a new CEO only two months at the helm, Anthem, Inc.’s Jan. 31 earnings call for fourth quarter and full-year 2017 focused on mapping out her priorities going forward. ...

Approximately 8.7 million people selected or were automatically re-enrolled into marketplace plans using the HealthCare.gov platform during the open enrollment period from Nov. 1 to Dec. 15, 2017. Enrollment dropped 5% compared to last year, even...

Despite what state-run marketplace executives called a confusing and challenging shortened enrollment period, 2018 enrollment in these public health insurance exchanges is up. Leaders of the state-run Affordable Care Act (ACA) marketplaces say the...

Views differ widely as to how disruptive Amazon, Warren Buffet’s Berkshire Hathaway and JPMorgan Chase & Co.’s plans to jointly launch an independent health care company will be. While details remain unknown, the barest outline of the new venture...

While states breathed a sigh of relief last month as lawmakers finally passed a continuing resolution (CR) containing long-term federal funding for the Children’s Health Insurance Program, insurers got an extra treat in the form of another holiday...

A week after it was reported that Molina Healthcare, Inc. was not selected to renew its managed Medicaid contract in New Mexico, the state Human Services Dept. (HSD) unveiled the three winners of the new five-year pacts that start in 2019,...

After months of uncertainty, Congress reauthorized the Children’s Health Insurance Program (CHIP) for six years — a move applauded by the National Governors Association in a statement Jan. 23. ...

Centene Corp. said Jan. 22 its New Mexico subsidiary, Western Sky Community Care, was awarded a statewide five-year contract in New Mexico for the Centennial Care 2.0 Program. Blue Cross Blue Shield of New Mexico and Presbyterian Health Plan also...

Much has been assumed about the 11 million-plus adults who became newly insured under the Affordable Care Act’s Medicaid expansion effort starting in 2014. ...

New York Medicaid plans are the latest to see a proposed raid on their reserves as states struggle with soaring health care costs. Gov. Andrew Cuomo (D) has gained national attention for his recent vow that so-called Dreamers won’t lose Medicaid...

With the Trump administration’s approval of Kentucky’s waiver to require work and other qualifications for Medicaid eligibility, health plans have new concerns about churn — and subsequent declines in health status and outcomes — in their Medicaid...

Mutual of Omaha and Lumeris on Jan. 17 said they are teaming up to enter the Medicare Advantage program in select markets in 2019. ...

Citing growth momentum entering 2018, UnitedHealth Group reported strong fourth-quarter and full-year 2017 earnings Jan. 16. Its solid performance came on the heels of its two multi-billion-dollar acquisition deals in December — one in the U.S....

Struggling Molina Healthcare, Inc. intends to be “tactical and practical” in the coming year, focusing on managed care fundamentals like operational execution and financial discipline, “because that’s what’s missing from the Molina story,” the...

Following the lead of UnitedHealth Group and Aetna Inc., Humana Inc. became the third major insurer to part ways with America’s Health Insurance Plans (AHIP), FierceHealthcare reported Jan. 11. An AHIP spokesperson, confirming Humana’s departure...

If changes unveiled by CMS last November to the Value-Based Insurance Design Model take effect for the 2019 program year, MA plans could enjoy more flexibility, which would allow them to tailor benefit designs toward populations with certain...

With the extended battle over health care reform far from resolved, some states are beginning to make long-term plans of their own, and the most recent examples of state actions show the divergent directions states are taking. One health insurance...

Questions lingered until the end of December 2017: Would the Trump administration’s shortened 2018 open enrollment period — and the president’s decision to slash marketing and navigator assistance and halt cost-sharing reduction (CSR) payments to...

Prior to reaching an agreement with CVS Health Corp. to be purchased for approximately $69 billion, Aetna Inc. considered strategic partnerships and/or joint ventures with at least two other “retail and health care industry participants,”...

CMS made mainstream news this month when it issued its first-ever guidance for states seeking to promote work and other “community engagement” activities among so-called able-bodied Medicaid beneficiaries, then immediately granted Kentucky the...

Major employers are focusing increasingly on member-centric benefit designs for commercial health insurance products in 2018 and beyond, industry consultants tell AIS Health. Companies also will be looking at higher deductible plans — though some...

Potential instability in the individual health insurance market represents the biggest challenge for Blue Cross and Blue Shield plans as they enter 2018, Blues plan CEOs tell AIS Health. To counter that, the CEOs say they’re working with...

More than 8.7 million individuals either selected or were automatically re-enrolled in exchange plans in the 39 states using the HealthCare.gov platform during the 2018 open enrollment period, shortened to run from Nov. 1 through Dec. 15, 2017,...

The start of 2017 contained vast uncertainty for Medicaid stakeholders, as a president intent on repealing and replacing the Affordable Care Act (ACA) assumed control of the White House and the GOP counted implementing block grants and doing away...

Following a directionally challenged year for Congress that ended with the Tax Cuts and Jobs Act of 2017 (H.R. 1) killing the Affordable Care Act’s individual mandate penalty — but left a host of other to do’s, including stabilizing the individual...

Individual Medicare Advantage enrollment as of the Dec. 1, 2017, payment date grew 6.4% from the same period last year, while group MA enrollment climbed 13.8% from the prior year, according to CMS data posted Dec. 14. While the December figures...

Centene Corp.’s subsidiary in Washington state recently reached an agreement with state regulators after a tussle over network adequacy issues that temporarily closed its Affordable Care Act (ACA) marketplace plans to enrollment. ...

How much CEO pay is too much CEO pay? Aetna Inc.’s CEO Mark Bertolini is in the spotlight these days since CVS Health Corp. announced a few weeks ago its $69 billion acquisition of Bertolini’s company. If the deal is finalized, Bertolini stands to...

Highmark Health and Aetna Inc. have separately launched new ad campaigns within the last year — to significant success, the plans report — with a focus on patient empowerment and the member’s perspective. One industry insider says video should be...

Undaunted by a year that began with federal regulators nixing mega-mergers between Anthem Inc. and Cigna Corp., and Aetna Inc. and Humana Inc., over anticompetitive concerns, the nation’s major health insurers continue to pursue multi-billion...

Earlier this year, the Trump administration and Congress agreed that the Affordable Care Act (ACA) health insurance exchanges should be stabilized, but now it appears the effort remains in the hands of only a few senators. As the GOP forges ahead...

CVS Health Corp. put an end to rumors and unveiled its $69 billion megadeal to acquire health insurance giant Aetna Inc. on Dec. 3. By and large, industry experts say the retail pharmacy services behemoth’s self-description — as “a company at the...

In keeping with the new administration’s theme of providing Medicare Advantage organizations more flexibility, CMS on Nov. 22 unveiled a set of revisions to the MA Value-Based Insurance Design (VBID) model that grants MA organizations in certain...

After more than a month of speculation, CVS Health Corp. on Dec. 3 confirmed its agreement to acquire Aetna Inc. for about $69 billion, or $207 per share. Although both companies operate multiple lines of business, executives during their first...

Blue Cross and Blue Shield plans leveraged more accurate pricing and tighter network management to post markedly stronger earnings for the first half of 2017, improving on first-half 2016 results that showed half of the 34 Blues plans losing money...

CVS Health Corp.’s deal to acquire Aetna Inc. for more than $66 billion in cash and stock could be announced by Dec. 4, The Wall Street Journal reported Nov. 30. ...

In late November, states began to feel the impact of federal dollars lost when Congress failed to reauthorize the Children’s Health Insurance Program (CHIP) by the Sept. 30 deadline. Some states are scrambling now, trying to maneuver through...

As publicly traded managed care organizations reported earnings for the quarter ending Sept. 30, some carriers highlighted opportunities for growth in Medicare Advantage through new service area expansions, stars improvements that will help them...

The early November deluge of individuals enrolling in Affordable Care Act (ACA) exchange plans far exceeds expectations in a season marked by ongoing political brinkmanship and ensuing public confusion over marketplace stability. Even CMS — which...

In her first major speech on the Medicaid program, CMS Administrator Seema Verma on Nov. 7 informed attendees of the National Association of Medicaid Directors fall conference that the agency is streamlining its approach to reviewing and approving...

In what is being described as an orderly transition, Anthem, Inc. named former UnitedHealthcare executive Gail Boudreaux as CEO and president and appointed her to its board effective Nov. 20. Joseph Swedish, who is Anthem’s current chairman,...

November began as a busy month for Humana Inc. On Nov. 2, the Louisville-based insurer filed a lawsuit against the federal government in the U.S. Court of Federal Claims, seeking just over $611 million in unpaid funds from the Affordable Care Act...

If Aetna, Inc. is negotiating its potential $66 billion-plus sale to CVS Health Corp. and hoping to finalize the deal as soon as December — as sources have confirmed to multiple media outlets since The Wall Street Journal broke the story in late...

Michigan-based McLaren Health Care announced Nov. 2 it has finalized a deal to acquire MDwise, an Indiana insurer that primarily serves the state’s Medicaid population. The acquisition is expected to close by the end of the year, pending...

After months of rate renewal negotiations with the state of Iowa “yielded no agreement on contract rates and terms,” AmeriHealth Caritas Iowa informed state officials it would exit the managed Medicaid program at the end of November. ...

As part of a major overhaul of the MassHealth program, the Executive Office of Health and Human Services (EOHHS) in Massachusetts recently reached agreements with Boston Medical Center HealthNet Plan (BMCHP) and Tufts Health Public Plans. The two...

Since Aetna Inc. in February called off plans to acquire Humana Inc., and Anthem, Inc. and Cigna Corp. in May terminated their own deal, analysts have been speculating on future mergers and acquisitions among the mega-insurers. Aetna’s proposed...

Blues plans in many states will continue to offer individual policies on the Affordable Care Act (ACA) exchanges, but high-profile state withdrawals by insurers such as Anthem, Inc. and Wellmark Blue Cross and Blue Shield will limit the overall...

Magellan Health, Inc. said Oct. 31 it finalized the acquisition of SWH Holdings, Inc. (Senior Whole Health). ...

Beating Wall Street earnings estimates, Cigna Corp. on Nov. 2 reported total revenues up 5% to $10.4 billion in the quarter ended Sept. 30. ...

If Aetna Inc. is negotiating its potential $66 billion sale to CVS Health Corp. — as sources have confirmed to multiple media outlets since *The Wall Street Journal* broke the story Oct. 26 — the insurer kept mum during its Oct. 31 earnings call. ...

Harmony Health Plan, a subsidiary of WellCare Health Plans, Inc., said Oct. 19 it signed a contract to administer Illinois’ new Medicaid managed care program statewide. ...

Metro areas are increasingly being dominated by single health insurers, the American Medical Association (AMA) said in a report released Oct. 23. ...

CVS Health Corp. is in talks to buy Aetna Inc. for $66 billion, or more than $200 per share, sources told The Wall Street Journal on Oct. 26. ...

The Maryland Insurance Administration (MIA) on Oct. 25 unveiled approved amended premium rates for individual-market, on-exchange Silver plans through Maryland Health Connection for coverage beginning Jan. 1, 2018. ...

From gloomy enrollment forecasts to a sternly worded legal decision, much has happened since Oct. 12 when President Trump abruptly halted federal cost-sharing reduction (CSR) payments to exchange plans under the Affordable Care Act (ACA). Industry...

At a time when halted federal subsidies to plans under the Affordable Care Act (ACA) seem to hold sway over the industry, Centene Corp. and Anthem, Inc. focused on a different topic during their respective Oct. 24 third-quarter earnings calls:...

Anthem, Inc. said Oct. 24 it has entered an agreement to buy America’s 1st Choice, a Florida-based Medicare Advantage (MA) insurer. The acquisition, which is expected to close in the first quarter of 2018, will add 127,066 MA and Dual-Eligible...

UnitedHealth Group, the bellwether of publicly traded managed care companies’ quarterly financial health, reported strong third-quarter earnings Oct. 17. The insurer beat Wall Street’s expectations, largely on the performance of its Medicare &...

The Trump administration’s moves to defund cost-sharing reduction (CSR) subsidies to health plans and to promise new rules easing Affordable Care Act (ACA) regulations for employers and individuals could hurt regional insurers that have a...

As the U.S. pharmaceutical industry confronts growing pressure to reduce steep drug costs and improve pricing transparency, a major reshuffling of giants is underway. Most recently, Anthem, Inc., the nation’s second largest health payer, said Oct....

In a prescient move, Covered California said Oct. 11 it is adding the cost-sharing reduction surcharge to silver plans for 2018 to stabilize premiums, in the absence of a federal commitment to make consistent CSR payments. ...

Making good on months of threats, President Trump will end federal cost-sharing reduction (CSR) payments to exchange plans under the Affordable Care Act (ACA), *The Washington Post* reported Oct. 12. His decision coincides with his executive order...

With Affordable Care Act (ACA) exchange open enrollment beginning for individuals Nov. 1 and small employers weighing next year’s benefit plans, brokers and agents have a lot of insight into the health of the individual and small-group markets....

Houston-area health insurance agents anticipate a fall enrollment season unlike any other. They, along with individuals, employers and carriers, are still working to recover from Hurricane Harvey’s devastating hit to their region several weeks ago...

Medicare Advantage average premiums will drop by around 6% next year to $30 and benefits will remain stable as CMS and insurers anticipate strong growth for 2018, according to analyses of the so-called “landscape files” recently posted by CMS...

America’s Health Insurance Plans (AHIP) couldn’t have picked a better week to host its National Conferences on Medicare, Medicaid and Duals in Washington, D.C., as the Senate debated — and ultimately withdrew — a last-gasp effort to repeal and...

Two plans were selected by Delaware’s Dept. of Health and Social Services to provide managed Medicaid and long-term services and supports (LTSS) benefits under the statewide Diamond State Health Plan and DSHP-Plus programs. They are: AmeriHealth...

Independence Blue Cross and Anthem, Inc. each have launched new products aimed at large group customers, adding to what one consultant says has been a successful large group selling season capped by low rate increases for most Blues plans. ...

Blue Cross and Blue Shield plans should prepare for a competitive Medicare Annual Election Period (AEP) as national insurers begin to shift resources from individual commercial marketplaces in various states to the more profitable, more secure...

Anthem, Inc. said Sept. 27 it is pulling out of Maine’s Affordable Care Act individual-market exchange for 2018. However, the insurer will continue to offer off-exchange individual policies and group insurance in the state, according to CNBC on...

President Trump said Sept. 27 he intends to ink an executive order, possibly the week of Oct. 2, allowing health insurers to sell policies across state lines via association health plans. ...

Medica and CHI Health said Sept. 27 they are collaborating on a new health exchange plan option for individuals in 23 counties in Nebraska and two counties in southwestern Iowa, available Nov. 1 for coverage starting Jan. 1, 2018. ...

At the Sept. 26 session of America’s Health Insurance Plans’ (AHIP) National Conferences on Medicare, Medicaid & Duals, moderator Leanne Gassaway, AHIP’s senior vice president of state affairs, interrupted an ongoing session to share some news she...

Four years in, insurers and regulators are still struggling to stabilize enrollment and show savings in the federal integrated care demonstrations for beneficiaries dually enrolled in Medicare and Medicaid, ongoing in 10 states. ...

Turmoil in the Senate the week of Sept. 25 did little to reassure health plans that steps would be taken to stabilize the individual health insurance market, leaving them with tough decisions to make on deadline. Plans had to sign final contracts...

Industry lobbying groups voiced surprise and strong concerns the week of Sept. 18 as a bipartisanship effort in the Senate to calm the Affordable Care Act (ACA) marketplace — and fund cost-sharing reduction (CSR) payments beyond a month at a time ...

Anthem, Inc. announced Sept. 20 it has finalized an agreement to acquire Florida-based Medicare Advantage insurer HealthSun Health Plans, Inc. HealthSun currently offers three Medicare Advantage (MA) plans with 39,233 members, according to AIS’s...

Health Alliance Plan (HAP) announced Sept. 15 that it will exit the Health Insurance Marketplace altogether in 2018, citing market volatility. This will impact 10,387 customers in Michigan, just 1.95% of HAP’s membership, according to AIS’s...

Anthem Inc. announced Sept. 15 it has revised its decision to exit the individual exchange market in Virginia, and will now offer individual plans in 63 would-be “bare” counties in Virginia. ...

Sen. Bernie Sanders (I-Vt.) introduced his “Medicare for All” single-payer bill on Sept. 13, drawing support from several likely 2020 Democratic presidential hopefuls. ...

Amid the Trump administration’s dramatic funding cuts for Affordable Care Act (ACA) exchanges’ marketing and enrollment outreach, at least one major insurer is stymied in its efforts: As of mid-September, Molina Healthcare, Inc. hasn’t completed...

Centene Corp. on Sept. 12 said it has finalized a $3.75 billion agreement to purchase all assets of Fidelis Care, which includes the nation’s fifth largest managed Medicaid HMO, New York State Catholic Health Plan. The acquisition will add 1,393...

A new study by the Commonwealth Fund found uninsured rates in the U.S. have increased, but only slightly, except for three subgroups. ...

CareSource has agreed to cover the last bare Affordable Care Act (ACA) exchange county in Ohio. ...

Despite issues with starting up new contracts in some states and an increasing reliance on Medicare Advantage to lift earnings, publicly traded insurers reporting financials for the second quarter of 2017 continued to express interest in vying for...

As part of a major overhaul of its managed Medicaid program, Illinois intends to combine multiple managed care programs and extend them statewide through contracts awarded to five managed care organizations, down from 12 that currently serve the...

For its new program expanding Medicaid managed care statewide, Illinois awarded new contracts on Aug. 11 to six managed care organizations, including subsidiaries of incumbents Blue Cross and Blue Shield of Illinois, Centene Corp., Molina...

After a nine-month hiatus to boost its financial reserves, the Montana Health CO-OP, a nonprofit Consumer Operated and Oriented Plan (CO-OP) created under the Affordable Care Act (ACA), resumed accepting new enrollees on Aug. 12, AP reports. ...

Without fanfare, CMS on Aug. 10 distributed a short memo to Affordable Care Act (ACA) exchange plans that are uniformly struggling with 2018 marketplace uncertainties as final premium-rate filing deadlines approach. Federal regulators outlined...

While most publicly traded insurers with government business reported strong results for the second quarter of 2017, Molina Healthcare, Inc. on Aug. 2 posted earnings that new Chief Financial Officer and interim CEO Joseph White characterized as ...

Anthem, Inc. announced Friday that it will be leaving the Affordable Care Act marketplace in Virginia for 2018. The “Individual market remains volatile” and is “shrinking and deteriorating” the company said in a statement on August 11, citing ...

Nonprofit Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals on Aug. 4 reported net income of $1 billion on combined total operating revenue of $18.1 billion for the second quarter. As of June 30, Kaiser Permanente’s membership...

Cigna Corp. reported Aug. 4 that total revenues increased 4% to $10.3 billion for the quarter ended June 30, similar to other managed care companies’ strong second-quarter earnings performance. Quarterly net income was $813 million, or $3.15 per...

Two of the handful of nonprofit Consumer Operated and Oriented Plans (CO-OPs) created under the Affordable Care Act (ACA) that remain in business recently entered state-controlled receivership. Both HMOs — Maryland’s Evergreen Health, Inc. and New...

Since the July 26 CMS press release detailing health insurance exchange participation by county, the number of U.S. counties without an exchange carrier has decreased 58% from 40 to 17, according to an August 9 coverage map released by CMS. The...

Despite the return of the health insurer fee (HIF), which may be reflected in pricing for some 2018 Medicare Advantage products, publicly traded plan sponsors that recently posted second-quarter 2017 earnings appeared confident in their ability to...

Driven by its Medicare Advantage business and retail segment, Humana Inc. said it beat earnings estimates for the quarter ended June 30. ...

Covered California’s executive director recently unveiled a 12.5% average preliminary premium rate hike year-over-year among the 11 participating plans for 2018. In doing so, he stressed that all plans have opted to remain in the Affordable Care...

Molina Healthcare, Inc. on Aug. 2 disappointed investors by posting a net loss of $230 million or $4.10 per diluted share for 2017’s second quarter. According to Joseph White, chief financial officer and interim president and CEO, the company is...

A federal appeals court ruling Aug. 1 allows a coalition of state attorneys general to join the legal battle over federal cost-sharing reduction (CSR) payments to plans. While the decision is encouraging to insurers in the short term, it won’t...

As of Sept. 1, Amerigroup Louisiana is rebranding as Healthy Blue to reflect its Medicaid partnership with Blue Cross and Blue Shield of Louisiana. ...

For every 10 individuals getting health insurance on Affordable Care Act (ACA) exchanges, four of them aren’t eligible for subsidies. And, given that exchange plan options almost certainly will narrow and premium rates are likely to increase by...

Anthem Inc. highlighted its continuing worries about 2018 participation and pricing in Affordable Care Act (ACA) exchanges during its second-quarter earnings call July 26. The Indianapolis-based health insurance giant touched on its continuing...

The Medicare Advantage (MA) segment has become a hub for startup health plans since the Affordable Care Act was enacted in 2010. In some MA markets, startup insurers are becoming formidable competitors, but in other areas they are suffering from...

To hear Centene Corp. Chairman and CEO Michael Neidorff talk the morning of July 25, the Affordable Care Act’s (ACA) insurance exchanges drove strong second-quarter profits for his company. To hear Senate Republicans talk later that same day, the...

Minnesota-based Medica on July 17 said it intends to expand its exchange footprint. ...

On the same day that Senate Republicans’ health care bill to repeal and replace the Affordable Care Act failed, the nation’s largest health insurer, UnitedHealth Group, studiously avoided much mention of the ACA in its July 18 second-quarter...

A new CMS report calls into question the stability of the Affordable Care Act (ACA) exchanges — but state-based exchanges appear to be holding steady, and some are even flourishing. Officials in these states express optimism about 2018, due to...

Louisville, Ky.-based Humana Inc. and New York-based startup Oscar Health said they have entered into a strategic partnership to offer commercial health insurance to small employers with 50 or fewer workers in nine counties around Nashville, Tenn....

On July 13, Senate Majority Leader Mitch McConnell (R-Ky.) unveiled his proposed revisions to the Better Care Reconciliation Act (BRCA), keeping intact dramatic cuts to Medicaid and adding a proposal spearheaded by Sen. Ted Cruz (R-Texas) to let...

CMS and the Treasury Dept. said July 11 that Alaska’s application for a Section 1332 state innovation waiver, a program under the Affordable Care Act (ACA), is approved. ...

A flurry of recent reports shows that while health insurers this year posted their most profitable first quarter ever for Affordable Care Act (ACA) insurance exchanges, far fewer insurers than previously will participate in federally facilitated...

Medicaid enrollees and states may experience some temporary turbulence when managed care organizations choose to leave a state, but a new study finds that plan exits do not create significant changes in market-level quality or self-reported...

The 2018 fiscal year has already begun for the Iowa Dept. of Health Services (DHS), yet the three managed care organizations contracted to serve the state’s year-old IA Health Link program at press time were still locked in back-and-forth...

Blue Cross and Blue Shield plans considering whether they should offer coverage on the volatile, uncertain individual health insurance exchanges in 2018 have split into two groups: a larger group that is staying put, albeit mainly with significant...

Nonprofit CareSource was set to begin covering nearly 250,000 enrollees in Georgia’s Medicaid managed care program on July 1, which the insurer describes as the largest single-day spike in membership in its 28-year history. ...

On June 27, CMS released its latest update of projected insurer participation in Affordable Care Act (ACA) individual-market insurance exchanges for 2018. ...

Minuteman Health, Inc. (MHI), a Boston-based HMO created under the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program, said June 23 that it will convert to for-profit status under a new name, Minuteman Insurance Co., as of...

When touting future prospects and trying to inform large audiences about what sets them apart from rivals, many companies take the investor day route. Two major health insurers held such events recently, capitalizing on significant publicity of...

It was a tumultuous several days on Capitol Hill in late June. First came Senate Majority Leader Mitch McConnell (R-Ky.)’s June 22 release of his Affordable Care Act (ACA) repeal plan. ...

The highly anticipated and secretly crafted Better Care Reconciliation Act — the Senate GOP’s attempt to repeal and replace the Affordable Care Act — appeared to do much to stabilize the exchange marketplace. But deep cuts to Medicaid and other...

Two days before the June 21 preliminary filing deadline for plans in states with federally facilitated exchanges, Avalere released a report estimating that more than 40% of counties might see only one exchange plan for 2018. ...

Centene Corp. said June 20 that its Mississippi subsidiary, Magnolia Health, was selected by the Mississippi Division of Medicaid to serve Medicaid recipients enrolled in the Mississippi Coordinated Access Network (MississippiCAN). ...

At the eleventh hour, Nevada Gov. Brian Sandoval (R) vetoed legislation that would have created the Nevada Care Plan, a landmark Medicaid-for-All health care delivery model. ...

When Senate Majority Leader Mitch McConnell (R-Ky.) on June 22 released a “discussion draft” of his team’s revisions to the American Health Care Act (AHCA), some observers reacted swiftly to what the *Washington Post* described as “rolling back...

On June 5, the office of New York Gov. Andrew Cuomo (D) issued a press release touting his “aggressive actions to protect access to quality, affordable health care for all New Yorkers.” ...

On June 15, Cleveland Clinic said it will enter the health insurance market for the first time ever. The scheme will partner iconic provider Cleveland Clinic with Oscar Health, a startup that has been making waves for its innovative use of...

In an environment where it is possible to count on one hand the number of nonprofit Consumer Operated and Oriented Plans (CO-OPs) still remaining in the market across the U.S., one plan is staging a comeback of sorts. Evergreen Health, Inc., which...

Melody Health Insurance closed a deal to acquire Colorado Choice Health Plans on June 1, and also unveiled a name change. ...

CMS’s chief actuary on June 13 offered more analysis of the potential financial and coverage effects of House Republicans’ American Health Care Act (AHCA), passed May 4 and aimed at repealing the Affordable Care Act (ACA). ...

After months of reworking the particulars, a four-page bill in Nevada is being touted by some as heavy lifting: promoting a landmark Medicaid-for-All health care delivery model that other states might eventually follow amid coverage worries on...

Centene Corp. said June 13 it is expanding its offerings for 2018 in the Affordable Care Act (ACA) health insurance exchanges. ...

Anthem, Inc. blamed uncertainty over the Affordable Care Act’s cost-sharing reduction (CSR) payments when it said June 6 that it would leave the Ohio individual exchanges for 2018. ...

The New York Health Plan Association is questioning the legality of Democratic Gov. Andrew Cuomo’s move to bar health plans from participating in Medicaid if they withdraw from the state’s individual marketplaces, according to *Modern Healthcare*....

Blue Cross and Blue Shield of Nebraska said it will pull its remaining ACA-compliant individual plans for 2018. ...

CMS says insurers will have until Oct. 31 — one day before open enrollment is set to begin for 2018 — to drop out of the individual exchanges for the 2018 plan year. ...

Blue Cross and Blue Shield of Texas said June 1 that it acquired nearly 20,000 Medicare Advantage and commercial members from Allegian Health Plans, Tenet Healthcare’s wholly owned health plan subsidiary. ...

Publicly, Anthem Inc., as the latest in a line of defectors from various Affordable Care Act (ACA) individual-market exchanges for 2018, blames “continual changes in federal operations, rules and guidance” for leaving counties in Ohio. The carrier...

Cuts included in Texas’ 2018-2019 budget could reduce profit margins for Medicaid managed care organizations serving the state. ...

As part of an ongoing effort to regionalize Medicaid purchasing and provide Apple Health Medicaid beneficiaries with the full continuum of physical and behavioral health services through managed care by 2020, the Washington state Health Care...

As the simmering feud between Anthem, Inc. and Express Scripts Holding Co. looks to finally have an end date, it’s anyone’s guess as to how the PBM industry will look when the dust settles. Evercore ISI, however, offered some potential outcomes...

By partnering with local Blue Cross and Blue Shield carriers on Medicaid managed care business in states including North Carolina and Louisiana, Anthem Inc.’s Amerigroup unit gains robust local provider networks and brings operational know-how to...

The final breakup of Anthem, Inc.’s planned acquisition of Cigna Corp. is likely to spark new merger and acquisition activity for the Blues giant, but it probably will go beyond smaller Blue Cross and Blue Shield plans to target larger carriers....

Anthem Blue Cross and Blue Shield will administer Maine’s employee health insurance plan beginning July 1 after winning the $5.5 million-per-year contract away from Aetna Inc., the *Portland Press Herald* reported. ...

A scant week after the Congressional Budget Office’s May 24 scoring of the latest version of the American Health Care Act (AHCA), a bill that narrowly passed the House without CBO’s input, public signals on the next steps by the Trump...

Far in advance of an RFP for three statewide managed care contracts, insurers are already laying the groundwork for a major overhaul of North Carolina’s Medicaid program. As the state anticipates transitioning its 1.9 million Medicaid enrollees...

BlueCross BlueShield of Kansas says it will participate in the Kansas individual and small group ACA marketplaces in 2018, the *Kansas City Star* reports. ...

UnitedHealth Group said it is closing Harken Health, an individual insurer that promised patients unlimited free primary care visits as long as they used Harken’s clinics. ...

CMS said May 15 it intends to propose rules, taking effect Jan. 1, 2018, that would allow small employers in states with federally facilitated Small Business Health Options Program exchanges under the Affordable Care Act (ACA) to enroll directly...

Oregon start-up insurance company Zoom Health Plan Inc. is winding down operations, according to the Oregon Department of Consumer and Business Services (DCBS). All current Zoom Health Plan individual policies will be canceled effective Dec. 31,...

BlueCross BlueShield of Tennessee told the Tennessee Department of Commerce & Insurance that it will fill anticipated individual market coverage gaps in the Knoxville area for the 2018 plan year. ...

Aetna Inc. says it will not participate in any Affordable Care Act individual exchanges in 2018, Reuters reports. ...

GRINNELL, Iowa — In his office on Main Street, Tom Cirks of Cirks Financial Services describes his efforts to help individuals covered by insurance policies through Iowa’s faltering Affordable Care Act (ACA) exchange figure out what 2018 market...

Government business drove a solid start to 2017, as many publicly traded insurers reported better-than-anticipated earnings for the first quarter and adjusted their outlook for the year. And while Medicare Advantage membership growth is expected...

After contemplating grim 2016 financials impacted by its Affordable Care Act (ACA) exchange products, Molina Healthcare, Inc. on May 2 said it was replacing CEO J. Mario Molina, M.D., and Chief Financial Officer John Molina, sons of company...

Aetna Inc. says it will drop out of the individual health insurance exchanges in Virginia for 2018, according to Reuters. ...

For-profit hospital operator Tenet Healthcare Corp. confirmed May 1 that it remains on track to sell or exit its health plan business in 2017: a segment that generated losses of $16 million for first-quarter 2017, down year-over-year from income...

Investors cheered the decision by Molina Healthcare, Inc.’s board of directors to replace Chairman, CEO and President J. Mario Molina, M.D., and Chief Financial Officer (CFO) John Molina on May 2, with some viewing it as the equivalent of a “For...

Perhaps May 2 might be best described as a day of drama for publicly traded managed care companies. During its morning earnings call, Aetna Inc. contrasted its strong government and large-group commercial business to its continuing woes on the...

Medicaid enrollment has increased over the past year, especially in the managed care market, making it the fastest growing sector in the health insurance industry. Even states like Florida and Texas that did not expand Medicaid eligibility via the...

In the public spat between health insurance giant Anthem Inc. and Express Scripts Holding Co., the nation’s largest PBM, every day brings a new interpretation of what the future holds for their relationship. ...

With the federal rate filing deadline extended to June 21 for health insurance carriers considering whether to participate in next year’s Affordable Care Act (ACA) individual market exchanges, some states, including Colorado and Kentucky, are...

Amid a flurry of strong first-quarter earnings results for several managed care companies, Anthem Inc. also beat Wall Street’s expectations. But, along with glowing reports of growing membership for its commercial and government-sponsored lines of...

Tufts Health Plan was selected by the Rhode Island Executive Office of Health & Human Services as the newest plan option for Rhode Island Medicaid enrollees who receive RIte Care and Rhody Health Partners benefits. ...

UnitedHealth Group started the year off with higher-than-anticipated revenue growth and strong enrollment gains, including the addition of about 675,000 Medicare Advantage members, about half of whom are in employee retiree programs, executives...

UnitedHealth Group reported strong first-quarter 2017 financial results on April 18, beating Wall Street analysts’ estimates — and in keeping with the industry giant’s solid earnings performance in multiple product lines reported three months ago....

While insurers are staying tight-lipped about whether they intend to remain in the Affordable Care Act (ACA)’s individual health insurance exchange markets for 2018, a new survey by Oliver Wyman suggests that insurers are showing “a cautious...

Medicaid enrollment has increased significantly over the past year and is the fastest growing health insurance sector, according to preliminary results from the annual research cycle for AIS’s Directory of Health Plans: 2017. With an average...

After a one-year delay in the implementation of a five-year Section 1115 demonstration to transform its Medicaid program, Alabama was authorized to launch a statewide managed care delivery system run by provider-based Regional Care Organizations ...

After a late-night GOP meeting April 5 failed to produce a breakthrough, the House adjourned for a two-week spring recess April 6 without resuscitating its stalled efforts to replace the Affordable Care Act (ACA). ...

A day after Republicans withdrew the American Health Care Act (AHCA) — their intended replacement for the Affordable Care Act (ACA) — President Donald Trump tweeted on the @POTUS account, “ObamaCare will explode and we will all get together and...

Total enrollment in Medicare Advantage and other prepaid plans grew month-over-month by nearly 38,000 lives to 19,631,399 as of the March 1 payment date, according to CMS data reflecting enrollments accepted through Feb. 3. Enrollment in MA and...

As part of an ongoing process to streamline its managed Medicaid program, the state of Illinois is in the midst of soliciting bids from insurers who will compete for a limited number of statewide contracts to serve a larger swath of Medicaid...

As of Jan. 31, more than 12.2 million consumers either signed up or reenrolled in coverage through federally facilitated exchanges (FFEs) and state-based marketplaces (SBMs)—roughly 9.2 and 3 million, respectively, according to a March 15 CMS...

While large mergers and acquisitions in the health insurance industry have been stymied this year, smaller M&A deals continue to change the commercial landscape in certain parts of the U.S. ...

With action on Affordable Care Act (ACA) repeal-and-replace legislation fluid and fast changing, the only certainty for health insurers — and their investors — is that carriers will see lower volume in future years. That is likely whether the...

The American Health Care Act, introduced March 6 by House Republicans, would have many implications for managed care organizations, including those that would have served an estimated 14 million people that stand to be without Medicaid coverage by...

The long-awaited arrival of the House Republican bill to repeal and replace the Affordable Care Act (ACA) on March 6 did nothing to ease uncertainty in the health plan sector. Although industry trade groups and individual insurers liked some...

UnitedHealth Group’s UnitedHealthcare subsidiary on March 2 finalized its acquisition of Rocky Mountain Health Plans. ...

Oscar Insurance Corp., a venture-backed health insurance start-up, lost nearly $205 million on products that it sold in 2016, Bloomberg reported Feb. 28. ...

Leaders from some of the nation’s largest health plans, along with the industry’s two trade groups, turned up at the White House on Feb. 27 to meet with President Trump — and his recently confirmed HHS secretary — to discuss replacing the...

The ironic Valentine’s Day breakups of two of the biggest proposed health insurance mergers played out like the cover of a gossip magazine, with two partners definitively calling it quits, one suing for divorce and one clinging to its rejecter....

The Virginia Dept. of Medical Assistance selected six managed care organizations to serve the Commonwealth’s first ever Medicaid managed long-term services and supports (LTSS) program. ...

The final results from the 2017 Annual Election Period (AEP) indicate strong growth in Medicare Advantage, in which more than 19.5 million seniors are now enrolled, and imply the MA program is growing at a slightly faster pace than it has in...

During the 2017 open enrollment period (OEP), state-based exchanges increased enrollment between 3.5% and 31.5%, with one exception: Rhode Island. HealthSource RI, Rhode Island’s health exchange, saw enrollment decrease more than 20% from 2016. At...

While there are indications that the public insurance exchanges are beginning to stabilize after four years, public insurance carriers continue to bleed red ink. ...

With Aetna Inc.’s deal to buy Humana Inc. dead and Anthem, Inc. and Cigna Corp. waging a court battle over their failed merger, health plan industry watchers say it’s safe to presume the four companies are drawing up new growth strategies,...

Humana on February 14 said it will withdraw from the individual commercial market in 2018, stating its initial analysis of 2017 open enrollment data pointed to “an unbalanced risk pool.” ...

Centene Corp. ended 2016 with 11.4 million members — up 6.3 million members, or 124%, from the end of 2015, the company said Feb. 7 when it reported its fourth-quarter 2016 earnings. In addition to its Medicare and Medicaid business, the company...

Moving Medicaid to a block-grant program could cut federal spending by $150 billion over five years, while switching to a per capita cap model would trim costs by $110 billion, according to an analysis from Avalere Health. But states, particularly...

A U.S. District Court’s Feb. 8 decision to reject Anthem, Inc.’s $48 billion bid to acquire Cigna Corp. shocked no one (*United States et al. v. Anthem Inc. et al.,* 16-cv-1493). But Anthem says it isn’t giving up without a fight and intends to...

Capital BlueCross plans to expand its growing Medicare presence by acquiring a majority interest in fellow Harrisburg, Pa.-based insurer Vibra Health Plan. ...

Two weeks after a federal judge agreed with the Dept. of Justice’s recommendation to block Aetna Inc.’s planned acquisition of Humana Inc., Aetna is still weighing its options. Chairman and CEO Mark Bertolini during a Jan. 31 conference call to...

Some Medicare Advantage insurers reporting fourth-quarter and full-year 2016 earnings in late January and early February made notable gains in their government business despite continued challenges in the commercial and exchange markets. And...

With the Jan. 31 conclusion of the open-enrollment period (OEP), state-based exchanges (SBEs) say sign-ups are up markedly from a year ago, with a large boost coming during the final two days for some states. ...

Last year’s fourth quarter proved to be a strong one for three major health insurers, with Aetna Inc., Anthem, Inc. and Cigna Corp. all beating Wall Street estimates in posting their earnings for the last stanza of 2016. Even though the trio saw...

It was a rough week for Aetna Inc. On Jan. 26, just three days after a court blocked its proposed $37 billion takeover of Humana Inc., investors filed a class-action lawsuit against the company — prompted by U.S. District Judge John D. Bates...

If there’s one thing health insurers like, it’s predictability. So far, they’re not getting a whole lot of that from the fledgling Trump administration. ...

A 13-day trial to determine the fate of Aetna Inc.’s planned $37 billion acquisition of Humana Inc. came to a shocking conclusion with the Jan. 23 delivery of U.S. District Judge John D. Bates’ opinion in favor of the federal government (Civil...

Medicare Advantage enrollment as of the Jan. 1, 2017 payment date reached 19.4 million beneficiaries, or 33.9% of total Medicare-eligible individuals, according to CMS data posted Jan. 17. While the January figures typically do not provide a...

An executive order issued the first day of President Donald Trump's administration symbolizes his first hit to the Affordable Care Act (ACA), and while it’s rather nonspecific, it’s the broad language contained in it that has some industry experts...

A federal judge on Jan. 24 blocked Aetna Inc.'s proposed $37 billion takeover of Humana Inc., ruling that the resulting merged company would likely "substantially lessen competition" for Medicare Advantage (MA) in areas where the two companies now...

Anthem, Inc. extended its deadline to acquire rival Cigna Corp. by three months as it waits for a federal court to decide if the deal will be allowed, Reuters reported Jan. 19. ...

A major change in risk-adjustment methodology that went into effect for 2017 alleviated a deep concern of many Medicare Advantage plans with large percentages of dual eligibles. But topping their wish list this year is permanent authorization of...

The repeal and replacement of the Affordable Care Act (ACA) — both a longtime dream of newly re-elected House Speaker Paul Ryan (R) and a campaign promise of President-elect Donald Trump — may soon become a reality now that congressional...

Anyone with a stake in government health care is on the edge of their seats as a Republican-controlled Congress contemplates its long-awaited repeal of the Affordable Care Act (ACA) and anticipates the Jan. 20 swearing-in of the first Republican...

As of Dec. 31, 8.7 million people had signed up for coverage through HealthCare.gov — up 1.8% from the same date a year ago, CMS reported Jan. 4. ...

2017 begins with far, far more questions than answers. One thing, however, is certain. More than six years after its enactment, the future of the Affordable Care Act (ACA) is bleak, with the Republican-led Congress already beginning the task of...

Denver-based Catholic Health Initiatives (CHI) — one of the nation’s largest health systems — is pulling back on its insurance business, *The Denver Post* reported Dec. 15. ...

President-elect Donald Trump and Republican lawmakers want to give health insurers the ability to sell individual coverage across state lines. But Minnetonka-based Medica has been doing just that for the past several years. Last year, the regional...

The idea of selling individual and small-group health insurance across state lines first surfaced nearly two decades ago. It’s now being pushed by President-elect Donald Trump and Republican lawmakers as a way to break up insurance monopolies and...

Citing substantial losses incurred this year and a failure to secure actuarially sound payment rates for the second year of a new contract, longtime Minnesota insurer Medica has informed the Minnesota Dept. of Human Services (DHS) that it will...

Evergreen Health Cooperative Inc. — a Maryland-based Consumer Operated and Oriented Plan (CO-OP) — will not issue or renew individual policies for the 2017 plan year, the Maryland Insurance Administration (MIA) announced Dec. 8. Evergreen had...

The future of the Affordable Care Act (ACA) is in limbo, but the Medicaid program might be the insurance industry’s biggest uncertainty. Given President-elect Donald Trump’s selections to lead HHS and CMS, it’s expected that states will be granted...

WellCare Health Plans, Inc.’s planned acquisition of Universal American Corp. (UAM), unveiled last month, came with a whole host of positives, starting with a projected 34% membership boost in its Medicare Advantage business. Analysts say the...

New Medicare Advantage offerings from Johns Hopkins HealthCare, the population health and managed care arm of Johns Hopkins Medicine, will get a boost in their second year of serving 11 counties in Maryland, thanks to a new joint venture with...

As Aetna Inc. and Humana Inc. prepare to go to trial on Dec. 5 to defend their proposed combination after being sued by the Dept. of Justice (DOJ) (*U.S. v. Aetna*, Case No. 1:16-cv-01494), the insurers last week filed a pretrial brief that...

President-elect Trump on Nov. 28 said he intends to appoint Rep. Tom Price, M.D. (R.-Ga.), an outspoken critic of the Affordable Care Act (ACA), to head HHS. Trump also plans to nominate Indiana consultant Seema Verma as CMS administrator. Both...

Two large Blues plans are refunding millions of dollars to customers because they didn’t spend enough on claims under the medical loss ratio (MLR) provision of the Affordable Care Act (ACA). ...

While reporting third-quarter 2016 earnings over the last month, several publicly traded carriers have boasted improved performance in their Medicare Advantage products. But for some, cost pressures on the Medicaid side contributed to increases in...

Donald Trump’s shocking victory on Nov. 8 will spell big changes for all facets of the health care industry, as the president-elect and congressional Republicans — which retained control of both the House and Senate — are expected to repeal much...

WellCare Health Plans, Inc. has entered into a definitive agreement with Universal American Corp. to acquire Universal American for $10 a share, for a total equity value of $600. This move follows WellCare’s Oct. 5 announcement that it had entered...

Without a 60-vote majority in the Senate, it’s unlikely that President-elect Donald Trump — and Republican leaders in Congress — can make good on the promise to quickly repeal and replace the Affordable Care Act (ACA). But a full repeal isn’t...

As publicly traded carriers with multiple lines of business reported third-quarter 2016 earnings from mid-October through Nov. 1, Medicare Advantage products largely helped insurers offset losses in the Affordable Care Act (ACA) exchange...

Medicare Advantage and Part D “landscape” data posted by CMS last month indicated an incredibly stable marketplace in 2017 as the average MA premium will drop by about 4% and the number of products offered nationwide will remain largely unchanged....

WellCare Health Plans, Inc. has inked a deal to acquire Care1st Health Plan (Blue Shield of California) subsidiary Care1st Arizona, which offers Medicaid managed care plans to about 114,000 people. The $157.5 million deal is expected to close by...

After initially submitting products on the 2017 individual market public exchange in Kentucky, Baptist Health Plan is now withdrawing those products, *The State Journal* reported Oct. 3. ...

Arise Health Plan, a WPS Health Solutions subsidiary, Sept. 29 said it will withdraw participation in the 2017 Wisconsin public health insurance exchange, according to the *Milwaukee Journal Sentinel.* ...

UnitedHealthcare subsidiary Harken Health said on Sept. 29 that it is withdrawing its participation on public exchanges in 2017, leaving the exchanges in Illinois and Georgia, where it previously offered plans in Chicago and Atlanta, according to ...

Blue Cross and Blue Shield of Nebraska (BCBSNE) says it has decided to exit the state’s federally facilitated public exchange individual market in 2017, according to a statement on the insurer’s website. ...

Tom Vanderheyden, CEO of Harken Health Insurance Co., has stepped down amid substantial losses, *The Minneapolis Star Tribune* reported Sept. 9. Stevan Garcia, who has been an executive at UnitedHealth since 1998, will take over as the company's...

Health Republic Insurance of New Jersey is the latest Consumer Operated and Oriented Plan (CO-OP) to fizzle. The New Jersey Dept. of Banking and Insurance announced that the insurer has consented to be placed in rehabilitation due to its ...

After another disappointing financial quarter, Maine-based Community Health Options (CHO) announced its decision to withdraw from the New Hampshire exchange market. The Consumer Operated and Oriented Plan (CO-OP) reported losses of $8.4 million in...

HHS’s proposed Notice of Benefit and Payment Parameters for 2018 (CMS-9934-P) could alter the way risk adjustment and other tenets of Affordable Care Act (ACA) exchanges work, but the provisions, unveiled Aug. 29 to keep carriers on the exchanges...

As publicly traded Medicare Advantage insurers late last month and in early August reported earnings for the second quarter of 2016, several touted gains in MA enrollment, higher premium yields and improved medical loss ratios. But those with MLR...

The plus side of the ledger for Medicaid managed care in the second quarter was membership and revenues, which several publicly held managed care organizations (MCOs) said had big gains. But those same gains also contributed to the minus side of...

Magellan Health, Inc. will exit New York’s ailing Fully Integrated Duals Advantage program at the end of this year because of “lower than anticipated FIDA enrollment,” Chief Financial Officer Jonathan Rubin said during the company’s second-quarter...

Less than two weeks after the Dept. of Justice filed a lawsuit to block Aetna Inc.’s planned $37 billion acquisition of Humana Inc., the insurers have a new divestiture plan that they’re hoping will convince the DOJ and the court that their...

While many Blues plans have suffered substantial financial losses on the public insurance exchanges, Horizon Blue Cross Blue Shield of New Jersey is touting record enrollment in the individual market. Between 2013 and 2016 membership in that...

In a move that has Wall Street applauding, UnitedHealth Group on June 9 named John Rex, formerly executive vice president and chief financial officer for its Optum unit, as the CFO for the parent company, effective immediately. ...

UnitedHealth Group unit UnitedHealthcare will participate in only three ACA marketplaces in 2017, down from 34 this year and lower than some Wall Street analyst projections. ...

After losing more than $400 million on the public exchanges in 2014 and 2015, Blue Cross Blue Shield of North Carolina (BCBSNC) considered pulling out. The company says it paid out $1.29 billion in claims for the sickest 5% of its exchange members...

CMS on June 8 proposed several rules to encourage people to buy health coverage that complies with the Affordable Care Act (ACA) and to discourage people from signing up outside of the open-enrollment period. ...

WellCare Health Plans, Inc. on June 1 said it finalized the purchase of certain assets of Advicare Corp.’s Medicaid business, adding approximately 30,000 lives to the 61,000 Medicaid members already served by WellCare of South Carolina. ...

It was nearly a year ago when Fallon Total Care unveiled plans to exit One Care, Massachusetts’s CMS-based Medicare-Medicaid alignment initiative, attributing its decision to the demonstration’s disappointing financial outlook. While only a small...

An *HPW* survey of health insurance industry specialists on what they see as the issues carriers should be most concerned about entering the second half of 2016 into next year reflects the array of challenges these businesses face. From head...

Health plans have a major challenge in front of them in maneuvering in a group marketplace where some large employers are turning away from not only traditional fee-for-service (FFS) contracting for their employee benefits, but also their reliance...

As Aetna Inc. gets closer to obtaining all 20 of the state approvals it needs before shareholders and federal entities sign off on its planned purchase of Humana Inc., the insurers faced a minor setback when the Missouri Dept. of Insurance (DOI)...

On May 26, Ohio became the latest state to close its Consumer Operated and Oriented Plan (CO-OP) formed under the Affordable Care Act (ACA) when Lt. Gov. Mary Taylor (R) was appointed receiver for Coordinated Health Mutual, Inc. ...

After dropping out for the 2016 plan year, Blue Cross Blue Shield of Mexico, a subsidiary of Health Care Service Corp. (HCSC), filed to sell coverage through the state-run exchange for the 2017 plan year, according to the New Mexico Office of...

After sitting on the sidelines for the past three years, Wellmark Blue Cross and Blue Shield will sell individual and small-group coverage through HealthCare.gov when the open-enrollment period begins Nov. 1. For its new exchange products, the...

Leavitt Partners recently released fresh survey data showing more than 250 health plan industry veterans foresee the consolidation trend in their sector to continue for some time, even as one of the two pending mega-deals of Anthem, Inc. and Cigna...

Several states have released premium rate requests submitted by health insurers for the 2017 public exchanges, and initial numbers show sizable increases being sought, like in New York where regulators on May 18 said carriers on a weighted-average...

For the 2017 plan year, neither UnitedHealth Group nor Humana Inc. will sell individual coverage through the state-operated Connect for Health Colorado insurance exchange. ...

Nearly 25% of people who purchased 2015 health coverage through a public exchange stopped paying their premiums at some point during the year, yet most repurchased an exchange plan for 2016….and repurchased the same plan, according to a McKinsey &...

As large health insurance operators mull their future on public insurance exchanges, a wave of venture capital-backed start-ups are jumping in with products they contend are more consumer-focused. Not bogged down by antiquated legacy systems and...

Interim final rules (IFR) released by CMS on May 6 will tighten a loophole that carriers contend makes it far too easy for people to game the enrollment system (81 Fed. Reg. 29146, May 11, 2016). Carriers have complained that lax rules around...

An interim final rule (CMS-9939-IFR) released May 6 could help the surviving Consumer Operated and Oriented Plans (CO-OPs) find their financial footing. ...

UnitedHealth Group’s April 19 announcement that it intends to exit all but “a handful” of public insurance exchanges for 2017 could be an enrollment opportunity for Blues plans, according to equities analysts and ratings firms contacted by AIS....

Arizona Gov. Doug Ducey (R) on May 5 signed legislation to restore KidsCare, a federal Children's Health Insurance Program (CHIP) for children from low-income families, according to the Associated Press. ...

Publicly traded Medicare Advantage plan sponsors see continued enrollment growth in their Medicare products, according to earnings reports and conference calls with investors held in late April and early May. Yet some expressed concerns about...

While neither UnitedHealth Group nor Humana Inc. is a dominant player on the exchanges, they collectively cover about 1.4 million people through the marketplaces. ...

Moda Health Plan, Inc. (MHP) will not sell 2017 individual health insurance in Alaska, the Alaska Division of Insurance (ADI) said May 2. ...

Sen. Maria Cantwell (D-Wash.) and Rep. Jim McDermott (D-Wash.) are calling on state leaders to bring back the state’s Basic Health Plan (BHP), which they contend would create a more affordable health insurance option for the 162,000 Washingtonians...

Seemingly in response to UnitedHealth Group’s intended 2017 exit from most of the 34 Affordable Care Act exchanges where it currently sells coverage, CMS on April 21 issued a draft notice clarifying that insurers cannot automatically enroll former...

Premera Blue Cross subsidiary LifeWise Health Plan is pulling out of Oregon after doing business in the state for more than two decades, the company said April 21. LifeWise Oregon has fewer than 50,000 individual and group members, down from 163...

A handful of Blues plans last month released 2015 financial results indicating the fiscal hit they took from underpriced insurance exchange products. Some reported their first financial losses in more than a decade, while others said losses on the...

As of March 31, Centene Corp. had more than 680,000 members enrolled in coverage purchased through an insurance exchange across 15 states. That number is expected to decline to 550,000 due to normal attrition. ...

UnitedHealth told Iowa state regulators that it will not sell individual insurance coverage — on or off the state’s public exchange — for 2017, the Iowa Insurance Division said April 25. ...

As of March 31, Blues plan operator Anthem, Inc. had 975,000 members enrolled in products sold through public insurance exchanges in the 14 states where it operates, the company reported April 27. ...

Long-term care management is probably the hottest area for managed care in public programs and therefore is drawing tons of interest from both Medicare Advantage and Medicaid plan sponsors. But while the need for managed long-term services and...

UnitedHealth Group on April 19 confirmed the expected when it told investors ¡no más! saying it would exit nearly all Affordable Care Act (ACA) exchanges in 2017 because the bleeding from costlier-than-expected enrollees that has resulted in $1...

Molina Healthcare, Inc. on April 19 said it agreed to purchase Universal American Corp.’s Total Care Medicaid plan in upstate New York. Total Care is a prepaid health services plan that serves nearly 40,000 members under New York’s Medicaid and...

On April 19, UnitedHealth Group executives told investors that it will pull out of exchanges in all but “a handful” of states for the 2017 plan year. ...

Georgia and Arkansas will not have UnitedHealthcare products on their public exchanges in 2017. That is a known after the two states confirmed the double exits on April 8. What is unknown is if the departures are part of a broader exchange...

On April 7, Covered California’s board voted to allow undocumented residents to purchase non-subsidized health coverage through the state-run exchange. Under the Affordable Care Act, undocumented residents are not eligible for federal premium...

Several months after signing up for coverage through Idaho’s insurance exchange, many people have not yet been enrolled in a plan. Moreover, Idaho’s state-run exchange is months late sending hundreds of Idahoans a document they need to file their...

UnitedHealthcare won’t be offering plans on public exchanges in Georgia or Arkansas in 2017, according to news reports. ...

New York began on April 1 the first CMS-backed demonstration for Medicare-Medicaid dual eligibles with intellectual and developmental disabilities (IDD). And the state’s troubled basic Fully Integrated Duals Advantage (FIDA) demo has made...

On April 6, three veteran health plan executives unveiled a new insurer based in Minneapolis led by Bob Sheehy, former UnitedHealthcare CEO (a unit of UnitedHealth Group). Called Bright Health, the carrier is prepared to launch nationally in the...

Fairview Health Services and Medicare Advantage plan sponsor UCare on April 5 said they agreed to combine and that they aim to finalize the transaction by mid-summer 2016. The insurer lost about half of its business this year after Minnesota...

Now that the Centene Corp. acquisition of Health Net, Inc. became a done deal March 24, attention has shifted to the two other — and bigger — pending purchases of insurers with major stakes in Medicare Advantage. And several observers are saying...

The majority of people who purchase insurance through HealthCare.gov stay enrolled in their selected plan for one year or less, according to an analysis from consulting firm Avalere Health LLC. ...

Some people who purchased health insurance through California’s state-run insurance exchange are complaining that they’ve been unexpectedly dropped by their carriers, despite having paid premiums on time, according to an April 5 *Sacramento Bee*...

Pittsburgh-based Highmark Inc. says individual insurance products sold inside and outside HealthCare.gov for 2014 and 2015 were priced too low for the older and sicker members who enrolled. As a result, the company says it lost approximately $773...

Centene Corp.’s acquisition of Health Net, Inc. received approval from both the California Dept. of Insurance (CDI) and California Dept. of Managed Health Care on March 22, allowing the deal to close on March 24, according to statements by the two...

A new health insurer has sprouted up in a market segment where others have stumbled of late in the form of Denver-based Canopy Health Insurance (unveiled earlier this month as Melody Health Insurance). The new player wants to be known as the go-to...

A report released on March 17 by the Government Accountability Office (GAO) said more than 600,000 public exchange members have had their policies discontinued due to the closure of Consumer Operated and Oriented Plans (CO-OPs). ...

Prime Therapeutics LLC won a five-year deal to manage the pharmacy benefits for approximately 300,000 commercial, individual market and Medicare members of Blue Cross & Blue Shield of Rhode Island, effective Jan. 1, 2017. ...

Melody Health Insurance, a Denver-based start-up focused on the individual insurance market, recruited the former CEO of two now defunct Consumer Operated and Oriented Plans (CO-OPs) to head its Western markets. ...

As of Jan. 31, about 12.7 million individuals selected, or were automatically re-enrolled into, 2016 coverage sold through a public insurance exchange, the HHS Assistant Secretary for Planning and Evaluation (ASPE) reported March 11. ...

Horizon Blue Cross Blue Shield of New Jersey on March 10 said an estimated 41,258 of its new enrollees in the individual market who were previously uninsured chose the tiered health plan OMNIA. The OMNIA option created a firestorm in New Jersey,...

On March 8, the Nebraska Department of Health and Human Services’ Division of Medicaid and Long-Term Care changed its recommendation for one of the three insurers previously announced to administer its Heritage Health program. ...

Twenty million adults gained coverage through the Affordable Care Act since its passage in 2010, HHS said on March 3. ...

Executives from five Consumer Operated and Oriented Plans say diversifying beyond the individual exchange market and not relying too heavily on the risk-corridors program kept them clear of the financial abyss that swallowed a dozen other CO-OPs. ...

Bitter rivals Highmark Inc. and UPMC Health Plan both turned in a strong Medicare Advantage enrollment performance in their western Pennsylvania service area during the recently completed 2016 Annual Election Period (AEP). The two Pittsburgh-based...

After just three years, public insurance exchanges have become a $40 billion industry, “bigger than the coffee industry,” acting CMS administrator Andy Slavitt told attendees at America’s Health Insurance Plan’s annual Exchange Forum on March 8. ...

Cleveland-based Medical Mutual of Ohio on March 1 said it acquired the 105,000-member group and individual health insurance business of HealthSpan Partners, a subsidiary of Mercy Health in Cincinnati. ...

In a nod to health insurers’ continued displeasure over loosely managed Special Enrollment Periods (SEPs) for individuals seeking coverage on HealthCare.gov public exchanges, CMS on Feb. 24 took a bolder move in requiring that anyone seeking to...

Mega-mergers among publicly traded insurers have cast a shadow over the industry with the pending combinations of Aetna Inc.-Humana Inc. and Anthem Inc.-Cigna Corp. (as well as the nearly complete Centene Corp. purchase of Health Net, Inc.) having...

The full numbers are in, and Medicare Advantage products had another strong Annual Election Period (AEP) — on the individual-member side. CMS data released Feb. 16 for the Feb. 1 payment date show that MA plans added nearly 263,000 members between...

UPMC Health Plan says it now has more Western Pennsylvania enrollees than Highmark Health, the *Pittsburgh Tribune-Review* reported on Feb. 19. ...

Philadelphia-based Independence Health Group, Inc. is exploring strategic options such as a merger or a consolidation of business functions to better compete with publicly traded competitors that are on the verge of merging, The Wall Street...

Harken Health is what an integrated provider-sponsored health plan looks like, sort of. Spawned from UnitedHealth Group’s innovation lab, the Kaiser-like entity (sort of) has operations in the Chicago and Atlanta metropolitan areas and is...

Mario Schlosser, CEO of Oscar Health in New York, says his startup insurer will likely break even by the end of 2017 as its Affordable Care Act (ACA) exchange individual business matures along with the marketplaces. But he contends that the true...

With 28% market share, Blue Shield of California topped Covered California’s list of participating insurers for the 2016 open enrollment period, closely followed by Anthem Blue Cross of California and Kaiser Permanente, according to enrollment...

In January, concerns about Moda Health Plan, Inc.’s (MHP) “excessive operating losses and inadequate capital and surplus” prompted the Oregon Dept. of Consumer and Business Services (DCBS) to take control of the company’s financial decisions. On...

The Oregon Department of Consumer and Business Services, Division of Financial Regulation, on Feb. 8 issued a consent order outlining a plan for Moda Health Plan, Inc. “to stabilize its financial position and continue to serve its customers.” As...

Even as CMS has promised to eliminate the use of special enrollment periods (SEPs) for HealthCare.gov public exchanges, the agency on Feb. 5 said it would add a SEP. ...

Incumbents Aetna Inc. and UnitedHealth Group should be able to build on their market strength in the Nebraska Medicaid market after the state on Feb. 5 awarded the two insurers contracts for its Medicaid managed care services program, according to...

Two of the smaller publicly held players in the Medicare Advantage market may be looking to grow in it by acquisitions this year. But one of those firms — WellCare Health Plans, Inc. — along with Humana Inc. indicate they will be growing only...

Providers represent 58% of the 19 new Medicare Advantage organizations entering the market in 2016, according to an analysis by consulting and data analytics firm Avalere Health LLC released Jan. 26. ...

Medicaid managed care continued to be a strong performer for publicly held insurers in the fourth quarter of 2015, based on earnings reports and conference calls with investors held by several of the companies in late January and early February....

Centene Corp., a publicly traded Medicaid managed care company, ended 2015 with 146,100 members who had signed up for coverage through public exchanges in a dozen states — that’s up from 74,500 in the fourth quarter of 2014 and a slight drop from...

CMS announced Feb. 4 that 12.7 million people enrolled in 2016 plans during the open enrollment period that concluded Jan. 31 — 3.1 million from state-based exchanges and 9.6 million from the federally facilitated exchange. Nationwide, the agency...

After a handful of setbacks, IA Health Link, Iowa’s new Medicaid managed care program, will launch March 1, pending final CMS approval. The program will coordinate physical, behavioral, in-home and long-term care services for about 560,000...

The merger between Health Alliance Plan (HAP) (MCO 177) and HealthPlus of Michigan (MCO 362) became effective Feb. 1, resulting in a single company that will maintain the HAP name and remain headquartered in Detroit, according to a press release...

The Alaska Division of Insurance has suspended Moda Health from selling health insurance to individuals and businesses in the state, Alaska’s Dept. of Commerce said Jan. 28. ...

Blue Cross and Blue Shield of Minnesota (BCBSMN) gained 162,000 members after a rival insurer lost a state contract, the *Star Tribune* reported on Jan. 26. The Blues plan picked up the new members after UCare lost a large portion of its contract...

Blues plan operator Anthem, Inc. finished 2015 with 38.6 million members — 1.1 million more than it had at the end of 2014 — the company said Jan. 27 when it reported fourth-quarter earnings. Sustained growth in Anthem’s Medicaid managed care...

More than half of the 23 consumer operated and oriented plans (CO-OPs) created by the Affordable Care Act are insolvent. UnitedHealth Group has indicated it might pull out of the exchanges after losing more than $700 million on its individual...

Anthem, Inc., which operates Blue Cross and Blue Shield plans in 14 states, finished 2015 with 791,000 lives covered by policies sold on public insurance exchanges. That number is down 33,000 from the end of the third quarter of the year, but up...

UnitedHealth Group says it lost $720 million on qualified health plans (QHPs) sold on public insurance exchanges for 2015, including $245 million in the fourth quarter. In November, the company predicted it would lose $425 million on the exchanges...

CMS is following up on its vow to crack down on “unintended loopholes” provided by special enrollment periods (SEPs), which provide individuals with opportunities to sign up for public exchange plans outside open enrollment, but also make it...

Aetna Inc. CEO Mark Bertolini on Jan. 12 said he remains certain the insurer’s deal to purchase Humana Inc. will close this year despite reports that 15 state attorneys general have joined the Dept. of Justice review of both the proposed Aetna...

CMS intends to tighten existing rules that allow people to sign up for health coverage outside of the official open-enrollment period. While special enrollment periods (SEPs) have helped boost exchange enrollment numbers, the broad parameters make...

Just three weeks after being sworn in, Kentucky Gov. Matt Bevin (R) sent a letter to HHS Sec. Sylvia Burwell, explaining that his administration would “wind down and cease operation” of Kynect, the state-run insurance exchange, and transition to...

For the 2016 plan year, more than half of the products being sold on public exchanges by Blue Cross and Blue Shield plans are HMOs and exclusive provider networks (EPOs) — an increase of 41% from 2015, according to information released Jan. 13 by...

Aetna Inc. said it expects that enrollment in its individual plans will be "at least flat" for the first quarter of 2016, Credit Suisse equities analyst Scott Fidel said in a research note on Jan. 11. ...

Kentucky Gov. Matt Bevin (R) in a Dec. 30 letter to federal officials stated that he plans to dismantle kynect, the state’s public health insurance exchange, moving the state to the federal exchange for next year. The move would not affect the...

The focus in the ongoing CMS-backed demonstration for Medicare-Medicaid dual eligibles will begin shifting in 2016 from enrollment to actual results. And with that shift plus ongoing actions being taken by CMS’s Medicare-Medicaid Coordination...

HHS on Jan. 7 said more than 11.3 million people have enrolled in coverage on public exchanges across all 50 states and the District of Columbia. This marks the first time the agency has put out numbers for all the exchanges. ...

On Jan. 4, Minnesota’s state-run MNsure exchange announced 67,680 people had enrolled in a qualified health plan (QHP) between Nov. 1 and Dec. 28, 2015. ...

More than 8.5 million people signed up for health insurance through HealthCare.gov since the open-enrollment period began on Nov. 1, CMS said Dec. 30. ...

Several Blues plans say they lost money on the public health insurance exchanges in 2014. Blues plan operator Health Care Service Corp. (HCSC), for example, said it lost $382 million on exchanges last year. Some Blues plans fared better that...

Kaiser Permanente’s planned acquisition of Seattle-based Group Health Cooperative (GHC) could create a more formidable competitor for Regence BlueShield and Premera Blue Cross — Washington state’s top two health plans by enrollment. California...

It was the kind of Annual Election Period (AEP) that Medicare Advantage plans haven’t enjoyed for the past three years, with no major elections or launches of exchanges to distract or confuse seniors or to raise dramatically the costs of...

Kaiser Permanente agreed to purchase Group Health of Seattle, Washington, adding some 500,000 to 600,000 members to the Kaiser portfolio. ...

After methodically expanding its presence on public insurance exchanges over the past three years, UnitedHealth Group stunned the industry Nov. 19 when it told investors that it might exit the exchanges entirely for 2017 due to deep losses. ...

For the 2016 plan year, provider-sponsored health plans (PSHPs) account for 26% of all carriers selling coverage through state and federal public exchanges, according to an analysis of data in PBX, AIS’s Health Insurance Exchange Database....

Community Health Options, the Consumer Operated and Oriented Plan (CO-OP) serving Maine and New Hampshire, will suspend offering new individual coverage for the 2016 plan year before open enrollment for public exchanges ends Jan. 31, 2016....

Market consultants and antitrust experts believe the state-level reviews of pending acquisitions among the largest publicly traded insurers will likely be as tough or tougher than the federal approval process, considering market power concerns...

At a Dec. 1 investor meeting in New York, UnitedHealth Group CEO Stephen Hemsley said his company should have waited longer before expanding its reach through public insurance exchanges. Hemsley told investors that it was, "for us, a bad decision,...

Colorado Access, a 501(c)4 nonprofit health plan, has confirmed that its subsidiary, New Health Ventures (dba Access Health Colorado), is not enrolling new members for 2016. The health plan will also cease offering Medicare Advantage plans next...

Land of Lincoln, Illinois’s Consumer Operated and Oriented Plan (CO-OP), has stopped offering its small group policies on the state’s federal-partnership exchange, the health plan told AIS, confirming a *Chicago Tribune* article explaining the...

Columbia United Providers (CUP) said it will stop offering any new or renewal individual health plans in the Washington state for 2016. Initially, the insurer was offering five plans on the state’s 2016 individual marketplace. ...

Provider-owned insurer Advantage Health Solutions Inc. is terminating its Medicare Advantage products Dec. 31 under an agreement reached with CMS Nov. 4, according to the Indianapolis Business Journal. The publication also said that the Indiana...

UnitedHealth Group dropped a bombshell on Nov. 19 when it told investors that it would take a $425 million (26 cents per share) write-down for the fourth quarter of 2015 to pay for losses on Affordable Care Act (ACA) exchanges for 2015 and...

Avera Health, owner of Avera Health Plans (MCO 352), says it will purchase DAKOTACARE (MCO 353), a move that would push the health system’s enrollment to nearly 200,000 members and make it South Dakota’s second largest insurer, Avera said in a...

The New York State Department of Financial Services (NYDFS) and New York State of Health (NYSOH), the state’s public exchange, have formed agreements with three insurers to auto-enroll Health Republic Insurance of New York marketplace customers...

Molina Healthcare, Inc. on Nov. 12 said it is buying Vancouver, Wash.-based Columbia United Providers, Inc. (CUP). ...

The New York State Department of Financial Services (NYDFS) and the New York State of Health public insurance exchange are taking additional actions to protect people who have health coverage through Health Republic, one of a dozen Consumer...

On Nov. 4, three days after the open-enrollment period began, the Michigan Dept. of Insurance and Financial Services announced Consumers Mutual Insurance, the state’s Consumer Operated and Oriented Plan (CO-OP), would run off its business and not...

The vast majority (77%) of the 259 new Medicare Advantage plans for 2016 will be HMOs, according to an analysis released Oct. 14 by the Kaiser Family Foundation of the CMS “landscape files” for MA. Kaiser also found that 61% of the 203 exiting MA...

Aetna Inc. and Anthem, Inc. posted fundamentally strong third-quarter 2015 earnings, but both carriers raised concerns about the individual Affordable Care Act (ACA) marketplaces, which have developed a darkening cast about them in recent weeks. ...

Ten days before Halloween, Democratic presidential front-runner Hillary Clinton scared health care stocks when she called for tough Dept. of Justice (DOJ) antitrust scrutiny of health care mergers. This led to retreats in health care company stock...

Community Health Alliance (CHA) has opted to wind down its operations and will not offer insurance coverage in 2016, the Tennessee Department of Commerce & Insurance (TDCI) and CHA announced on their websites. The insurer said it currently covers...

Health Republic Insurance, one of Oregon’s two Consumer Operated and Oriented Plans (CO-OPs), said Oct. 16 it will not offer plans in 2016 and will cease operations effective Dec. 31, 2015. Following in the footsteps of two other recently...

The Colorado Division of Insurance (DOI) has closed Colorado HealthOP’s operations, preventing it from selling 2016 plans on the state’s health exchange. The DOI cited concerns about the Consumer Operated and Oriented Plan’s (CO-OP’s) financial...

Tremors in the Affordable Care Act (ACA) exchanges continue weeks after the Oct. 1 announcement by CMS that its risk corridors program aimed at repaying health plans that lost big in the first three years of the new marketplaces would have a...

The health care industry overall is a hotbed of new ventures — research suggests the wearables market will reach $70 billion in the next decade, and the number of health care smartphone apps in the U.S. now exceeds 165,000. But health insurance...

Mirroring moves made across the health plan-provider and employer-provider spectrum, Cigna Corp. said it formed a joint venture with Irvine, Calif.-based St. Joseph Hoag Health to offer Orange County employers integrated HMO and exclusive provider...

Aetna Inc. CEO Mark Bertolini and Anthem, Inc. CEO Joseph Swedish appeared before a Senate Judiciary Committee panel on Sept. 22 to address antitrust concerns tied to their carriers’ pending purchases of Humana Inc. and Cigna Corp, respectively. ...