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Medicare Plans Deliver Awesome Wellness Benefits You’ll Love

Medicare Advantage (MA) is projected to continue growing in 2025, with over 35.7 million beneficiaries enrolled, accounting for more than 51% of the Medicare market. The Medicare annual enrollment period (AEP), from October 15 to December 7, 2024, gives seniors the chance to choose between traditional Medicare and Medicare Advantage plans, with new coverage starting January 1, 2025. Leading insurers like UnitedHealthcare, Humana, Aetna, Elevance Health, Cigna, and Wellcare are offering expanded benefits and new incentives to attract enrollees. Highlights include expanded coverage areas, increased access to dual special needs plans, added dental, vision, and hearing benefits, and innovative tools like digital health apps. With new options and improved services, Medicare beneficiaries will have more choices than ever before to find the plan that best fits their needs.

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Elevance’s $11.9M Expansion Fuels Skyrocketing Growth

Elevance is making a bold move to expand its operations in Indianapolis with a $11.9 million investment across two key sites. This investment will enhance its headquarters on Virginia Avenue and a logistics hub on the southwest side, further solidifying its local presence. Elevance’s expansion is set to create 230 new jobs by 2025, supported by $2 million in tax incentives from the Indiana Economic Development Corporation (IEDC). This initiative will significantly boost the local economy through job creation and increased consumer spending. While details about the types of jobs and specific building plans are still limited, Elevance’s commitment to Indianapolis reflects its long-term strategy to grow within the healthcare sector. The company’s collaboration with IEDC highlights a successful public-private partnership that aims to strengthen both the workforce and the city's economic landscape. Stay updated on the latest payer industry developments by following **DistilINFO HealthPlan**. Join our community today!

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Humana’s Medicare Ratings Surge Unlocks New Achievements

Humana has reported a significant decline in its Medicare Advantage (MA) star ratings for 2025, with only 25% of its members enrolled in plans rated 4 stars or higher, compared to 94% in 2024. This drop, driven by narrowly missing industry benchmarks, could negatively impact Humana's revenue in 2026 due to reduced quality bonus payments from the Centers for Medicare & Medicaid Services (CMS). Despite the drop, Humana continues to focus on improving its performance and has appealed to CMS for a review of its ratings. In response to rising medical costs and lower reimbursements, Humana is also discontinuing Medicare Advantage plans in 13 counties, impacting 560,000 members. However, the company expects to retain about half of the affected members by offering alternative plan options. Humana remains committed to delivering quality care and addressing the issues that led to the decline in its star ratings. Stay updated with the latest payer industry news by following **DistilINFO HealthPlan** today!

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Payer Strategies Fuel Healthcare Progress and Breakthroughs

California Governor Gavin Newsom recently vetoed two key healthcare bills, sparking debate within the payer and provider sectors. One bill aimed to create a licensing and oversight structure for pharmacy benefit managers (PBMs) to improve drug pricing transparency, while the other sought to regulate private equity investments in healthcare. Meanwhile, Elevance Health faces a lawsuit for excluding anti-obesity medications from its health plans, a decision that plaintiffs argue violates the Affordable Care Act's (ACA) disability protections. In Minnesota, health systems like Essentia Health and Sanford Health are severing ties with Medicare Advantage plans from Humana and UnitedHealthcare, citing delays caused by prior authorization processes. These decisions may disrupt care for many Medicare Advantage beneficiaries. Additionally, other legislative updates, including Alaska's new PBM law and ongoing legal actions involving Aetna and Express Scripts, are shaping the U.S. healthcare landscape. Follow **DistilINFO HealthPlan** for the latest developments in healthcare legislation and payer news. Join our community today!

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CMS Innovation Lights the Path to Affordable Medications

The CMS Drug Price Negotiation Program, launched under the Inflation Reduction Act, is reshaping drug pricing to make essential medications more affordable for Medicare beneficiaries. The first round of negotiations, involving 10 high-cost drugs, is set to save Americans $1.5 billion in 2026. CMS will announce 15 additional drugs for the second round of negotiations in February 2025, with new prices effective in 2027. Key changes include the introduction of a Medicare Transaction Facilitator to streamline access and expanded stakeholder engagement, including patient roundtables. Although some pharmaceutical companies have challenged the program, courts have upheld the initiative. This program is a significant step in reducing healthcare costs and ensuring that patients can access life-saving medications at fair prices. Follow **DistilINFO HealthPlan** to stay updated on the latest payer industry developments. Join our community today!

Read more: https://distilinfo.com/healthplan/cms-innovation-ensures-bright-future/

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UnitedHealthcare Takes on CMS for Fair Star Ratings

UnitedHealthcare has filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) over a single phone call that could downgrade its Medicare Advantage star ratings, potentially affecting the company’s financial performance. The lawsuit, filed on September 30, 2024, challenges the inclusion of a CMS secret shopper test call that UnitedHealthcare claims did not meet CMS’s criteria for rating evaluation. With star ratings directly tied to bonus payments and beneficiary enrollment decisions, the stakes are high for UnitedHealthcare as the open enrollment period for 2025 Medicare Advantage plans begins soon. The outcome of this case could reshape how CMS evaluates star ratings and set a precedent for future disputes. Keep up with the latest updates by following **DistilINFO HealthPlan**—join our community for more payer industry insights.

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Medicaid Insurers Lead the Way for Better Maternal Care Nationwide

A new report from the HHS Office of Inspector General reveals significant gaps in Medicaid managed care organizations (MCOs) providing maternal health services. Despite Medicaid being the primary payer for 40% of all U.S. births, many states fail to require MCOs to cover essential maternal health providers like midwives, maternal-fetal medicine specialists, and doulas. This lack of coverage, particularly for marginalized populations like Black, American Indian, and Alaska Native women, may contribute to the U.S.’s high maternal mortality rate. The report urges states to expand coverage, improve network adequacy standards, and ensure all pregnant women receive necessary care. CMS has committed to addressing these disparities within six months. Learn more about how Medicaid can improve maternal healthcare by following **DistilINFO HealthPlan** for the latest updates.

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Premera Blue Cross Introduces Fresh Medicare Coverage Options

Premera Blue Cross is exiting the Medicare Advantage (MA) market by 2025 due to rising medical costs and regulatory challenges, affecting 32,000 MA members in Washington. This decision highlights growing financial pressures within the healthcare industry, making it unsustainable for insurers to maintain MA programs. While Premera will continue offering Medicare supplement plans, this exit follows a trend seen with other insurers like Blue Cross Blue Shield of Kansas City, who are also grappling with similar challenges. As insurers rethink their long-term strategies, the future of Medicare Advantage remains uncertain, pushing policymakers to address these issues. Follow **DistilINFO HealthPlan** to stay informed on the latest payer industry updates.

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CVS Health Shines | Strategic Review Sparks Positive Changes

CVS Health is undergoing a strategic review as it faces financial challenges, particularly in its Aetna insurance division, due to rising costs in Medicare Advantage. While rumors of a potential company breakup have circulated, Glenview Capital, a key stakeholder, clarified that it is not advocating for such a move. Instead, the hedge fund is focused on improving CVS’s governance, culture, and operational performance. CVS has already announced layoffs affecting 2,900 corporate positions as part of its cost-cutting measures aimed at saving $2 billion. The company’s leadership is exploring various options to stabilize its operations and improve profitability in both its retail and insurance sectors. The strategic review underscores CVS’s commitment to adapting and thriving in the evolving healthcare landscape. Stay updated with the latest payer news by following **DistilINFO HealthPlan** and join our community to stay ahead!

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Blue Shield of California Cuts Costs with a Bold New Partnership

Blue Shield of California is revolutionizing the pharmaceutical industry with its innovative Pharmacy Care Reimagined model, moving away from traditional pharmacy benefit management (PBM) practices. In collaboration with Fresenius Kabi and Evio Pharmacy Solutions, Blue Shield offers a biosimilar for Humira at a dramatically reduced price of $525 per monthly dose, compared to Humira's $2,100. This game-changing partnership not only lowers prescription costs but also improves medication adherence by reducing out-of-pocket expenses for members. With a modular approach involving partners like Amazon Pharmacy and Mark Cuban Cost Plus Drug Company, Blue Shield is promoting transparency and flexibility in drug pricing. Learn more about their groundbreaking initiatives on Distilinfo Healthplan.

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Mastering Value-Based Care with Tried-and-True Strategies

Value-based care (VBC) is reshaping healthcare by focusing on quality over quantity, but its success hinges on provider commitment and strategic investments. According to Mike Jasperson of Priority Health, successful VBC initiatives require more than just participation—they demand deep investment in infrastructure, such as analytics and electronic medical records. Priority Health’s partnership with Corewell Health exemplifies this, achieving $45 million in savings and improving patient outcomes through a fully integrated, full-risk contract. However, challenges like capital shortages and provider education remain significant barriers. Priority Health's strategic approach to risk assessment and selective partnerships has been key to its success. As the healthcare industry continues to navigate the complexities of VBC, these factors will be crucial for organizations aiming to thrive. For more insights on value-based care, visit DistilINFO Healthplan.

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Navigating Health Trends | Aon Predicts a 9% Increase in Costs

Aon’s latest report forecasts a substantial 9% surge in employer-sponsored health plan costs for 2025, up from a 6.4% rise in 2024. This significant increase is driven by elevated medical claims, rising prescription drug prices, and growing demand for specialty medications like GLP-1 receptor agonists used in treating diabetes and obesity. The average cost per employee is projected to exceed $16,000 in 2025, compared to $14,823 in 2024. As costs rise, employees are also expected to shoulder a heavier financial burden, with average out-of-pocket expenses continuing to climb. Employers may consider strategies such as high-deductible health plans to mitigate costs, but these options could shift more expenses onto employees. This trend highlights the ongoing challenges in managing healthcare expenses for both employers and their workforce. For more insights and updates, visit DistilINFO Healthplan.

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Experience Premier Primary Care at Mosaic Health

Elevance Health has partnered with private equity firm Clayton, Dubilier & Rice (CD&R) to launch Mosaic Health, a groundbreaking $4 billion primary care venture aimed at transforming healthcare in the U.S. This initiative brings together Elevance Health's resources and CD&R's expertise, integrating advanced digital platforms like Apree Health with the established provider network of Millennium Physician Group. Mosaic Health, led by seasoned healthcare executives Clay Richards and Tony Hughes, is set to serve 1 million members across 19 states, offering innovative and patient-centered primary care services. With a projected annual revenue of $4 billion, Mosaic Health is positioned to become a significant player in the healthcare industry, driving forward a new standard in primary care. Learn more about this transformative venture at DistilInfo.

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Stay Informed: Essential Updates on Prior Authorization

Prior authorization (PA) is a crucial yet often controversial aspect of healthcare, determining whether insurance will cover certain treatments and services. Recently, significant updates have emerged that are reshaping the PA landscape. Centene, for instance, has shown a high rate of overturning PA denials upon appeal, while L.A. Care Health Plan has reduced 24% of its PA requirements to ease administrative burdens. Meanwhile, Medicare Advantage insurers denied 7.4% of PA requests in 2022, highlighting ongoing challenges. UnitedHealthcare is launching a national gold-card program to streamline PA for compliant providers, and Illinois has passed legislation to ban PA for psychiatric services by 2026. Additionally, AI is increasingly being used to assist in PA appeals, and Humana supports federal reforms to improve the process. These developments reflect a growing focus on reducing delays and enhancing patient care. Stay updated on these changes at DistilInfo.

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UnitedHealthcare & HealthONE: Deal Approaching Key Deadline

The ongoing contract negotiations between UnitedHealthcare and HealthONE could have significant implications for healthcare access in the Denver metro area, especially as the September 1 deadline looms. UnitedHealthcare, one of the largest insurers in the U.S., and HealthONE, a key healthcare provider in Denver, are at a critical juncture in their discussions. If they fail to reach an agreement, UnitedHealthcare members—particularly those on Medicare Advantage plans—could lose in-network access to HealthONE's facilities, leading to higher out-of-pocket costs and potential disruptions in care. UnitedHealthcare has criticized HealthONE for demanding what it considers an unreasonable price hike, while HealthONE argues that UnitedHealthcare's proposed rates are below market value. As both parties work towards a resolution, the outcome will not only affect Denver-area patients but could also set a precedent for future negotiations between insurers and healthcare providers. For more insights, visit DistilInfo.

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Centene's Future Shines with Bold New Board Leadership

Centene has strengthened its leadership by appointing Thomas Greco, a seasoned executive with over 30 years of experience in consumer goods and retail, to its board of directors. Greco’s impressive career includes leadership roles at PepsiCo, where he served as CEO of Frito-Lay, and at Advance Auto Parts, where he was CEO until 2023. His strategic insights, honed through successful stints in driving growth, innovation, and operational excellence, align with Centene’s goals of expanding its market reach and enhancing healthcare services. This move reflects a broader trend in the healthcare industry of bringing in leaders from diverse sectors to offer fresh perspectives. Greco’s experience in consumer behavior and supply chain management is expected to contribute significantly to Centene’s efforts to improve healthcare delivery and patient outcomes. Bookmark DistilInfo for more insights into Centene's strategic developments.

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Cutting Healthcare Costs: Top Employer Strategies for 2025

As healthcare costs continue to surge, U.S. employers are preparing for a significant rise in the expense of providing employee healthcare coverage in 2025. A recent report by Aon Plc projects a 9% increase in the average cost of employer-sponsored healthcare, marking one of the most substantial year-over-year jumps in recent history. The report, which analyzed data from 950 U.S. employers covering 6.7 million employees, predicts that healthcare costs per employee will surpass $16,000 in 2025, up from $14,823 in 2024. Key drivers of this increase include rising employment levels, inflation, and the growing use of advanced medical treatments and costly prescription drugs like GLP-1. As employers face these challenges, innovative strategies such as value-based care and employee wellness programs may be essential to managing the financial burden of rising healthcare costs. Visit DistilInfo for more insights on managing healthcare expenses.

Read more: https://distilinfo.com/healthplan/healthcare-costs-with-2025/

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