Regional MA Plans Surged In Open Enrollment
Becker’s Payer interviewed several executives at regional plans that grew tremendously during the Medicare Advantage (MA) open enrollment season as most big national plans contracted and shed lives. Medicare Advantage enrollment grew less than 1% for open enrollment, but regional plans grew by 443K while national plans dropped by 328K. Seniors benefited from the continued commitment of the regional plans.
Health Alliance Plan in Michigan added more than 37,000 new enrollees in open enrollment, a 58% increase. Priority Health added more than 35,000 new members in open enrollment. SCAN Group added 127,000 new members during open enrollment. The growth pushed SCAN into the top 10 nationally among MA plans. Alignment Healthcare grew 31% year over year in 2025 to roughly 276,000 total members. Network Health grew 37% during open enrollment to 126,000 total MA members.
#medicareadvantage #enrollment
MA Plans, Including United And Humana, Endorse RA Reform
UnitedHealth Group and Humana endorsed the Centers for Medicare and Medicaid Services’ (CMS) proposed reforms of risk adjustment in Medicare Advantage (MA). As leading analysts speculate, it is largely because they fear worse financial impacts.
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#medicareadvantage #riskadjustment #overpayments
https://www.modernhealthcare.com/insurance/mh-medicare-advantage-cms-chart-review-payment
Elevance Health Frozen Over Risk Adjustment Practices
A pretty significant development on the risk adjustment front for Medicare Advantage (MA) plans. CMS has notified Elevance Health (EH) it will suspend enrollment and marketing as of 3/31 on EH nationwide due to substantial and persistent noncompliance with risk adjustment data submission requirements. It does not impact current members.
Part of this appears technical. CMS alleges Elevance is using a disallowed method to submit data corrections. But CMS alleges systemic issues and failures, including failure to submit data corrections for diagnosis codes it identified as unsupported by medical record documentation through CMS’ required electronic systems; failure to return overpayments; and certifying data accuracy when it was aware of issues.
Elevance can correct issues before 3/31 to avoid the sanctions.
Will we see more of these types of actions from CMS for other MA plans? CMS has been seriously constrained on risk adjustment data validation (RADV) audits due to the striking of the RADV rule by a federal judge. The agency says it will continue to proceed with the audits although it will need to act gingerly.
Could these sanctions actions be a way to send a message to the industry? CMS has always been signaling the need for MA plans to report overpayments and clean up risk adjustment. Overpayments are the hot button on Capitol Hill right now.
Additional article: https://www.cms.gov/files/document/elevancehealthsanction02272026.pdf
#medicareadvantage #elevancehealth #riskadjustment
(Some articles may require aa subscription.)
https://www.modernhealthcare.com/insurance/mh-cms-elevance-health-medicare-advantage-enrollment
Rural Health Funding To Support VBC
An analysis by USofCare finds that 42 states are expanding or establishing new alternative payment models as part of the Rural Health Transformation Program. The $50 billion program ($10 billion per year over five years) was established as part of the One Big Beautiful Bill Act (OBBBA).
#ruralhealthcare #medicaid
CMS Extends Deadline For MFN Medicaid Model
The Centers for Medicare & Medicaid Services said that the application deadline for the new GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) model will be pushed back from March 31 to April 30 to allow pharmaceutical companies greater time to sign up.
#drugpricing #mfn #branddrugmakers
— Marc S. Ryan
