ACA Exchange Risk Adjustment Settlements Total $11.7 Billion
Health insurers will shuttle $11.17 billion between them due to the 2025 ACA Exchange risk-adjustment settlements. The settlements recognize differences in risk in the program in a given year. UnitedHealthcare will pay $335 million while Centene will receive $751 million, Elevance Health $312 million, Aetna $216 million, and Oscar Health $189 million.
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#exchanges #riskadjustment
https://www.modernhealthcare.com/insurance/mh-aca-exchange-risk-adjustment-payments-2025/
Exchange Rolls Saw Drops As Long As A Year Ago
According to new data that was quietly published by the federal government, states began seeing steep drops in Exchange enrollment over the past year. Ohio and Oklahoma lost nearly one-third of enrollees. Florida has the most enrollees at nearly 4 million but lost the most at around 443,000. Around 2.6 million fewer Americans had Exchange plans in February compared with the same time last year.
#exchanges #coverage #enrollment
https://www.medpagetoday.com/washington-watch/washington-watch/122067
Dem Bill Targets MA
A House Democratic bill would target major elements of the Medicare Advantage (MA) program. The bill would reform risk adjustment further, including eliminating diagnoses from health risk assessments and chart reviews. It would also eliminate the Star program and adjust for so-called favorable selection. The Democrats are relying on flawed research from both congressional policy arm MedPAC and academics opposed to MA.
#medicareadvantage #riskadjustment #overpayments #stars #quality
KFF Details Proposed Site Neutral Reforms
Healthcare policy group KFF has an interesting Quick Take on site neutral payments. It notes that implementing site neutral in a dramatic fashion would save $157 billion over ten years, while the 2026 change on drug administration saved $5.6 billion and the proposed 2027 change for imaging would save $7.6 billion.
#siteneutral #medicare #hospitals
KFF Covers MA Prior Auth Denials
Healthcare policy group KFF published a briefer on two recent Health and Human Services Office of Inspector General (HHS OIG) analyses of Medicare Advantage (MA) prior authorization denials of post-acute care. The OIG said MA plans deny more than half of all prior authorization requests for the most expensive types of post-acute care. These denial rates are higher than the overall MA prior authorization denial rate. The OIG found substantial variation across insurers.
#priorauthorizations #healthplans #medicareadvantage
— Marc S. Ryan
