United MA Troubles Cloud MA Industry Prospects
The fallout from UnitedHealth Group’s poor quarterly financials is creating worry throughout the industry. While Elevance Health reaffirmed its earnings forecasts, some are wondering if United is just the first shoe to drop as investor calls for the quarter roll out. United blames some of the problems at its insurance and service entity on the new risk model that was rolled out in Medicare Advantage (MA) along with major utilization. Previously, United indicated it was not too worried about the change.
The United financials and similar trends expected in some other MA plans show that the 5% hike for 2026 will not cure all ills in the industry. It helps with the financial realignment of many, but discipline will still be needed to get back to profitability.
Additional article: https://www.beckerspayer.com/payer/unitedhealth-shifts-tone-on-medicare-advantage-as-cms-changes-impact-earnings/
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#medicareadvantage #unitedhealthcare #rates #margins #elevancehealth
https://www.modernhealthcare.com/insurance/unitedhealth-group-medicare-advantage-earnings-2025
Trump Pushes Cost Audits For Hospitals
A leaked budget document suggests that health systems would be subject to greater oversight. The White House wants to expand hospital cost report audits as audits of other providers have led to reduced rates and rate trends. The White House has asked the Centers for Medicare and Medicaid Services (CMS) to report on past audit activities and to weigh in on increases for such audits.
Additional article: https://insidehealthpolicy.com/daily-news/trump-administration-eyes-tighter-oversight-hospital-cost-reports
(Articles may require a subscription.)
#hospitals #medicare #rates #fwa
https://www.modernhealthcare.com/policy/draft-white-house-budget-hospital-audit
Broker Executive Pleads Guilty In Exchange Enrollment Fraud
An insurance brokerage firm executive pleaded guilty to his role in a scheme to submit fraudulent applications to enroll individuals in ACA plans. The scheme was to obtain millions of dollars in commission payments from the insurance company that operated the ACA plans. The federal government paid at least $133.9 million in subsidies for fraudulently enrolled beneficiaries.
#aca #exchanges #enrollment #marketing #fwa
BCBSMA Stops GLP-1 Obesity Coverage
After suffering major losses, Blue Cross Blue Shield of Massachusetts will no longer cover GLP-1 drugs for weight loss as part of its standard benefits. The company will continue to cover GLP-1 drugs for diabetes. BCBS Massachusetts will also give large employers the choice of whether to continue coverage of the drugs for weight loss.
BCBS Michigan stopped GLP-1 medication coverage for weight loss in its fully insured, large group commercial plans at the beginning of 2025.
#glp1s #weightlossdrugs #drugpricing
https://www.beckerspayer.com/payer/bcbs-massachusetts-drops-glp-1-coverage-5-things-to-know
— Marc S. Ryan
