overcoding

Are the doubters or supporters right about Medicare Advantage? The Cigna Group officially closed its $3.3 billion sale of its Medicare lines of business to Health Care Service Corporation (HCSC) on March 19. The deal includes Medicare Advantage (MA) lives, Medicare Part D lives, its Medicare supplement business, and its CareAllies physician entity. HCSC jumps to 950,000 members from about 240,000 members as of March 1, 2025. It is a phenomenal development for HCSC, a mutual non-profit Big Blue in the Midwest. It is now the seventh largest MA plan by membership. If you look at the old Cigna enrollment and the old HCSC enrollment, they largely do not overlap and HCSC now has a nice national MA footprint. What does this tell us about MA? But what does this big MA life sale tell us about the industry and its perceived value to insurers? The sale certainly shows a

SNPs are seeing huge growth despite the financial crisis hitting MA The Medicare Advantage (MA) industry is going through very tough financial times. A variety of factors, including rate cuts, an increase in utilization, and a new risk scoring model, forced plans to reduce benefits and exit many geographies in 2024 and 2025. Even a proposed slight increase in rates in 2026 (unless changed by the new Trump administration) will likely lead to more benefit reductions and contraction in 2026. What MA plans did was shed unprofitable geographies and products, including more rural and suburban areas of the country and certain more-expensive preferred provider organization (PPO) products. But along the way, MA plans have doubled down on Special Needs Plan (SNP) investments. The investment in SNPs is driven by a few factors: So, SNPs offer MA plans the ability to improve health outcomes while also registering a healthy margin. But

February to March enrollment grows after dismal enrollment season In a February 27 blog, I detailed the growth in Medicare Advantage (MA) from January 2024 to February 2025 after a long delay from the Centers for Medicare and Medicaid Services (CMS) in posting the annual data. As I noted, the January enrollment statistics were up for a short time only to be taken down due to errors and presumably the transition in the White House. As I explained in the blog, the final January data still did not seem quite right, so I compared January 2024 to February 2025 instead. To summarize, the statistics show some of the financial struggles the industry continues to have. Growth is way down compared with prior years in the 2020s due to major geographic contractions as well as plan benefit reductions by major MA players. As the chart below shows, January 2024 to February

Dr. Mehmet Oz’s confirmation hearing shows where the Trump administration is going on Medicare drug prices and Medicare Advantage (MA). The confirmation hearing last week of Dr. Mehmet Oz, who is slated to be administrator of the Centers for Medicare and Medicaid Services (CMS) is a lesson in changing political dynamics. It also tells us that sometimes the people most supportive of a given program may be most apt to reform it. Let’s break down what occurred at Oz’s confirmation hearing in front of the Senate Finance Committee. What is interesting is that many of the lawmakers on Finance are also members of the other healthcare committee of cognizance, the Health, Education, Labor, and Pensions (HELP) committee. We cannot touch all of the ground covered at the hearing in this blog, but let’s hit the top issues and why in most cases Oz’s responses run contrary to what we may

The Health Equity Index (HEI) replaces the Reward Factor for Star Year 2027. Will the complex initiative last under Donald Treump’s anti-DEI campaign? Note: Published in collabortion with Lilac Software. If you are in need of Medicare Advantage (MA) Stars technology and expertise, visit https://lilacsoftware.com . The Health Equity Index (HEI) is officially here. Why? Well, it replaces the Reward Factor in the Medicare Advantage (MA) Star bonus prorgam for Star Year (SY) 2027, but we are smack in the middle of the measurement years that help MA plans to qualify for the new reward. Why is that? Because as opposed to measure performance, the HEI is a blend of two years of data and lags the usual measurement period a bit more. In the case of SY 2027, the HEI measurement period is a blend of measurement years (MY) 2024 and 2025. The Centers for Medicare and Medicaid Services

Reining in provider taxes is not an unreasonable way to achieve some Medicaid savings As the House Energy and Commerce Committee begins its debate over Medicaid cuts to hit an $880 billion spending cut bogey, the issue of provider taxes is sure to be raised and galvanize a great deal of controversy. GOP leaders in each chamber and President Trump have given commitments publicly that Medicaid coverage will not be cut. That seems to take off the spending cut table a massive restructuring of Medicaid (maybe, as some rightists still want this) as well as overt reductions in percentage reimbursement to states (maybe, again some rightists still want this). But the GOP is arguing that it will take a bite out of the size of Medicaid by eliminating fraud, waste, and abuse (FWA). Whether you use estimates by government authorities or external think tanks, the FWA and imporer payments numbers

Savings guide from Blue Cross Association is worthy of Congress’ consideration The Blue Cross and Blue Shield Association (BCBSA) has issued a very good report on reasonable healthcare savings that could save nearly $1 trillion over the next decade. I have raised a number of these issues in past blogs, but felt covering them again would be good as the House begins debating spending reductions to hit an $880 billion savings target in the budget reconciliation blueprint passed by the chamber in a very tight vote. BCBSA features ten policy proposals. You can view them in detail at the third link at the end of the blog. As BCBSA notes, the $1 trillion figure over a decade is not federal budget savings alone. It breaks down as such: Site neutral payments As I have suggested on numerous occasions, BCBSA proposes sweeping adoption of site neutral payments in Medicare. BCBSA says

The seven publicly traded national plans had a rough 2024 and hope to realign in 2025 I often talk about the nine major health insurers prominent at the national level in Medicare Advantage (MA). Seven of them are publicly traded while two – integrated delivery system Kaiser Permanente and Big Blue mutual Health Care Service Corporation — are non-profits. Four of the seven actually are owned by large vertically integrated companies. With the close of 2024 and reporting of final results, I thought it would be good to recap performance of the seven publicly traded big national companies. The Healthcare Dive had a great article summing it all up. I substantially based this blog on its analysis, which is at the link at the end of this blog. The insurers The results by and large show the seven insurers had a fairly troublesome 2024 but hope to realign and improve

Medicare Advantage plans’ financial woes hit 2025 enrollment growth in a big way The long delayed 2025 Medicare Advantage (MA) enrollment season results have finally been published. The January 1 enrollment statistics were up for a short time only to be taken down due to errors and presumably the transition in the White House. This week, both the January and February 2025 results were posted by the Centers for Medicare and Medicaid Services (CMS). In looking at the January results, they do not seem quite right as the growth in enrollment from January to February would be extremely high – rather unprecedented. That leads to my supposition that the January data are still wrong or CMS had major issues processing January 1 applications. As such, I am comparing January 2024 numbers to February 2025 numbers as a proxy for 2024 to 2025 year-over-year growth. The statistics show some of the

My unvarnished and dispassionate take on Trump’s assertion of executive authority Many of you are aware of my service in state government in the executive branch and have asked me about the recent controversy surrounding President Donald Trump’s broad exercise of executive power in Washington, D.C. So, while this is not exactly a healthcare blog per se, the controversy certainly impacts coverage in the nation. We are about a month into Trump 47, so it is a good time to opine on this. As such, I will give you my unvarnished and hopefully dispassionate view of things. Should we feel sympathy for what the executive is trying to do? Is Donald Trump going too far? A little background on me I served in state government in Connecticut from 1995 to 2005. I was a Republican executive appointee and eventually became the Deputy Management Secretary/Deputy Budget Director of the state and