Medicare, Medicaid and CHIP
Government programs ensure access to healthcare for vulnerable populations. Medicare covers people 65 and older and younger individuals with specific disabilities. Medicaid and the Children's Health Insurance Program (CHIP) are joint federal-state initiatives offering health coverage to low-income families, children, pregnant women, the elderly and people with disabilities.
Top Stories
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News
27 Oct 2025
Do MA Star Ratings incentivize consistent quality performance?
Data shows MA plans move in and out of MA Star Ratings thresholds for lucrative bonus payments, suggesting a potential flaw in the rating system. Continue Reading
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News
24 Oct 2025
CMS calls back furloughed employees to help with Medicare, ACA enrollment periods
Roughly 3,000 employees are coming back to work on Monday, funded by user fees as the shutdown drags into its fourth week. Continue Reading
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03 Jan 2024
2024 Employer Sponsored Health Plan Predictions: GLP-1s, Vendors, Data
In 2024, healthcare costs will drive decision-making in employer sponsored health plans as they reassess their point solutions and benefits. Continue Reading
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Answer
02 Jan 2024
2024 Payer Strategies: Population-Based Plans, MA Differentiation
In 2024, payer strategies will include improving health equity partnerships, differentiating their Medicare Advantage plans, and offering care navigation. Continue Reading
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News
27 Dec 2023
Humana Awards $169K in Health Equity Grants to Community-Based Orgs
The health equity grant recipients align with Humana’s goals to improve access to care and address social determinants of health. Continue Reading
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News
20 Dec 2023
Most Employers Offering Retiree Health Plans Use Medicare Advantage
For many retirees, a Medicare Advantage plan may be the only option they have for receiving retiree health benefits. Continue Reading
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News
15 Dec 2023
2022 National Healthcare Spending Growth Slowed to Pre-COVID Levels
National healthcare spending grew 4.1 percent in 2022 and Medicare and private payers experienced a slightly slower growth rate than the previous year. Continue Reading
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Answer
12 Dec 2023
How Healthcare Leaders Can Weigh Pros, Cons of Payer Megamergers
Payer megamergers can have mixed results and the overall impact largely hinges on the companies' commitment to value-based care principles. Continue Reading
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News
07 Dec 2023
Humana Foundation Grants $1M to Address Food Insecurity, Mental Health
The grants will help researchers analyze various interventions and their impacts on food security and mental health. Continue Reading
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News
06 Dec 2023
How Employers Can Promote Cardiovascular Care, Women’s Health
Employers can implement a number of strategies to raise awareness and promote access to cardiovascular care to support women’s health. Continue Reading
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Feature
05 Dec 2023
How Do Payers Cover Prenatal, Postpartum Care for Pregnant People?
Public and private payers cover essential prenatal care for pregnant people, but coverage levels and costs may vary by plan. Continue Reading
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News
04 Dec 2023
Payers Embrace Healthcare IT for Cost Optimization, Member Engagement
Payers expect to increase their spending on healthcare IT resources by 3 to 5 percent in the next two years. Continue Reading
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News
04 Dec 2023
Setting the Foundation for Member Engagement Across Populations
Health payers need a solid member engagement foundation in order to tailor their strategies to optimize outcomes and costs for specific populations. Continue Reading
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Answer
29 Nov 2023
Blue Cross Blue Shield of MA Eliminates More Prior Authorizations
The payer focused on prior authorizations that may slow down the transition from hospital care to home care. Continue Reading
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Feature
16 Nov 2023
How Can Payers Support Providers Through Workforce Challenges?
Payers can implement value-based payment models and invest in training programs to support providers through workforce challenges. Continue Reading
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News
15 Nov 2023
How Much Members Spend on Diabetes Chronic Disease Management
It is well known that diabetes is a costly disease, but even members with insurance may pay thousands of dollars per year for chronic disease management. Continue Reading
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News
13 Nov 2023
KLAS: Epic’s Payer Platform Generates High User Satisfaction
Epic’s payer platform helped improve cost savings around users’ clinical data acquisition efforts. Continue Reading
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News
09 Nov 2023
What Non-Medical Supplemental Benefits Will MA Plans Offer in 2024?
Food and produce, transportation, and social needs services top the list of non-medical supplemental benefits from Medicare Advantage plans in 2024. Continue Reading
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Feature
02 Nov 2023
How Public, Private Payers Cover Care for the LGBTQ+ Population
Healthcare coverage for the LGBTQ+ population differs depending on a member’s state, health plan, and service needed. Continue Reading
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News
31 Oct 2023
Study Finds Geographic Variation in Payer Prices for Office Visits
The county-level price for patient office visits from Humana ranged from $69 to $144 nationwide. Continue Reading
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Feature
30 Oct 2023
Top Payer Concerns, Opportunities Around Generative AI Integration
Payers should create a unified approach to AI overall, thoroughly document generative AI integration, and ensure the explainability of their generative AI tools. Continue Reading
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News
27 Oct 2023
Finances, Mental Health Concerns Impact Adults’ Wellbeing, Cigna Finds
Almost a third of adults who reported needing mental health counseling did not receive care, primarily due to high costs. Continue Reading
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Feature
26 Oct 2023
4 Key Strategies to Promote Effective Payer, Provider Alignment
Data-sharing, value-based contracts, and standardized quality measures are critical to improving payer-provider alignment. Continue Reading
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Answer
25 Oct 2023
3 Steps One Medicaid MCO Took to Boost Its Patient Experience Score
Patient experience is a key measure in the NCQA health plan rating system, but two components—ease and speed of access to care—can be hard to achieve. Continue Reading
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News
23 Oct 2023
Humana Ranks High for Experience, Affordability Among MA Plans
Humana earned 3.9 stars for member experience and an overall rating of 4.3 stars. Continue Reading
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Feature
20 Oct 2023
Demystifying Medicaid Managed Care, Its Role in the Future of VBC
Medicaid managed care plans have gained traction as the dominant form of coverage in the Medicaid space with millions of beneficiaries in managed care organizations. Continue Reading
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News
19 Oct 2023
Employer Sponsored Health Insurance Premiums Grew by 7% in 2023
The average annual premium for employer-sponsored health insurance is $8,435 for single coverage and $23,968 for family coverage. Continue Reading
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Feature
18 Oct 2023
3 Ways That Large Employers Influence Health Insurance Costs, Coverage
Large employers can impact health benefit design, access to chronic disease management programs, and affordability of care. Continue Reading
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News
10 Oct 2023
What Are Major Payers Offering Medicare Advantage Members in 2024?
UnitedHealthcare, Humana, Cigna, and Aetna are aiming to keep premiums and prescription drug costs low for Medicare Advantage beneficiaries in 2024. Continue Reading
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News
09 Oct 2023
UHC Commercial Plan Focuses on Price Transparency, Preventive Care
The payer’s emphasis on preventive care may have contributed to its and strong re-enrollment rate. Continue Reading
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News
05 Oct 2023
Mortality Rates Among Women and Children Are Rising, UHG Report Finds
Between 2018 and 2021, the maternal mortality rate increased by 29 percent, from 17.3 to 22.4 deaths per 100,000 live births. Continue Reading
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News
03 Oct 2023
Alignment Health to Offer Medicare Advantage Plans That Address SDOH
The Medicare Advantage plans will address food insecurity by offering benefits like quarterly grocery allowances. Continue Reading
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News
02 Oct 2023
How API Marketplaces and Strategic Partnerships Drive Payer Innovation
API marketplaces are pivotal for enhancing innovation by streamlining operations, improving member experiences, and strengthening provider relationships. Continue Reading
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News
28 Sep 2023
AMA: Commercial Coverage of Digital Medicine Services is Inconsistent
Transparency on commercial coverage policies for digital medicine services was also lacking, with some plans having no coverage information publicly available. Continue Reading
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News
26 Sep 2023
Cigna Healthcare Invests $1M to Reduce Food Insecurity for Seniors
The funding will support programs that address food insecurity, such as food pantries, mobile food deliveries, and nutritional meal boxes. Continue Reading
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News
25 Sep 2023
Anthem Blue Cross Grants CA Orgs $1.2M to Address Mental Health
The grants are a part of Elevance Health Foundation’s $30 million commitment to improve equity for people with mental health disorders. Continue Reading
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News
25 Sep 2023
How APIs Transform Payer Approaches to Member, Provider Experience
APIs are reshaping healthcare by improving member and provider interactions, driving digital maturity in health plans, and offering real-time information access, cost transparency, and streamlined processes Continue Reading
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News
22 Sep 2023
Employers Expect Highest Health Plan Benefits Cost Growth in 10 Years
Employees are expected to cover 22 percent of total premiums in 2024, a factor of health plan benefits costs that has not changed since 2022. Continue Reading
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News
20 Sep 2023
How Payers Unlock Healthcare Efficiency Through the Power of APIs
Healthcare payers are harnessing the power of APIs to create seamless member experiences, streamline operations, and stay competitive in the digital healthcare landscape. Continue Reading
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News
18 Sep 2023
Blue Shield of CA Technology Partnership Improves Care Management
Through a new care management platform, care managers can access members’ health data in one location. Continue Reading
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Feature
13 Sep 2023
How the Top 4 Disruptive Insurtechs Have Evolved Since Their IPOs
In a health insurance landscape that is consolidating into a few major players, four insurtechs sought to change the system. Continue Reading
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Feature
07 Sep 2023
Exploring the History of the Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association boasts 34 independent companies that provide healthcare coverage to people across the United States. Continue Reading
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News
28 Aug 2023
Cigna Removes Prior Authorization for 25% of Medical Services
The payer has removed prior authorization requirements for over 1,100 medical services since 2020. Continue Reading
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Feature
28 Aug 2023
Top 5 Largest Health Insurance Payers in the United States
These top five health insurance payers hold the largest net revenue and members. Continue Reading
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Answer
16 Aug 2023
Payer Turns to PBM Coupon Program to Lower Prescription Drug Spending
In the first quarter of 2023, the program resulted in $4.5 million in reduced prescription drug spending for participating employer groups. Continue Reading
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News
15 Aug 2023
How Payers Are Reducing Prior Authorizations, Limiting Care Disruptions
To limit patient care disruptions, payers have reduced prior authorization requirements for genetic testing, cataract surgeries, and physical therapy. Continue Reading
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Answer
14 Aug 2023
Key Strategies for Transitioning a Health Plan into Cloud Computing
Cloud computing technology adoption is on the rise worldwide, but how can health plans shift their complex processes into this new platform? Continue Reading
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News
11 Aug 2023
Blue Cross of Idaho Invests in Digital Platform, Improving Senior Care
Blue Cross of Idaho’s investment will help Endear Health expand its digital platform and facilitate access to healthcare programs for seniors. Continue Reading
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Feature
10 Aug 2023
Unpacking What Price Transparency Looks Like for Health Plans
Health plans must sort through heaps of data to publish useful, accurate price transparency information for consumers. Continue Reading
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Feature
04 Aug 2023
Top Member Education Strategies for High Performance Network Benefits
Member education strategies might vary based on whether the network is narrow or tiered, but clear communication is always necessary. Continue Reading
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Answer
26 Jul 2023
First Impressions Count: How Onboarding Affects Member Engagement
From the first point of contact to tracking the results on welcome package touchpoints, onboarding strategies are key to forming a strong payer-member relationship. Continue Reading
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News
24 Jul 2023
Consumers Blame Payers, Utilization Management for Delays in Care
Utilization management barriers were particularly high for individuals with neurological disorders and mental healthcare needs. Continue Reading
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News
21 Jul 2023
Humira Price for Commercial Plans Remained Steep Despite High Rebates
The net price of Humira for commercial health plans in 2020 was $1,812, significantly higher than its initial launch price of $522. Continue Reading
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News
19 Jul 2023
How Mental and Behavioral Health Disparities Impact Adults, Youth
American Indian/Alaska Native adults faced higher rates of substance use disorder and drug deaths, highlighting mental and behavioral health disparities. Continue Reading
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News
17 Jul 2023
Real-Time Data: Enhancing Payer Contracts in Post-Acute Care Settings
Real-time data and interventional analytics are improving payer contracts and outcomes in post-acute care. Continue Reading
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News
14 Jul 2023
UHC Reports 13% Revenue Growth in Q2 2023 Due to Rising Enrollment
UnitedHealth Group executives highlighted key hurdles for payers in 2023 including provider shortages and drug costs. Continue Reading
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News
13 Jul 2023
Cigna Healthcare Boosts Treatment Access with New Biosimilar Coverage
By covering the Humira biosimilars, Cigna Healthcare aims to promote competition that will generate lower prescription drug costs. Continue Reading
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Feature
12 Jul 2023
How Payers Can Identify Providers for High-Performing Networks
Prioritizing data collection, technology, and provider engagement can help payers identify providers to include in high-performing networks. Continue Reading
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News
10 Jul 2023
Humana Foundation Supports Initiative to End Veteran Suicide
The initiative will direct philanthropic grants to nonprofit organizations working to end veteran suicide, including $6 million from the Humana Foundation. Continue Reading
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Feature
29 Jun 2023
How Plans Can Improve Race and Ethnicity Data Collection for HEDIS
Empowering payer staff and prioritizing self-reported data are critical to race and ethnicity data collection. Continue Reading
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News
26 Jun 2023
Members with Anxiety, Depression Face Higher Out-of-Pocket Spending
Out-of-pocket spending is almost twice as high for individuals with anxiety, depression or both. Continue Reading
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26 Jun 2023
BCBSA Will Invest $10M to Address Youth Mental Health Crisis
The funding will support Boys & Girls Clubs of America as they offer trauma-informed training and virtual therapy to address the youth mental health crisis. Continue Reading
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22 Jun 2023
Blue Cross MN Commercial Plans Will Cover Peer Support Specialists
Peer support specialists use their own lived experiences with mental health challenges to support people in similar situations. Continue Reading
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Feature
21 Jun 2023
How to Personalize Chronic Disease Management through Concierge Care
Elevance Health changed its approach to chronic disease management with a digital-first concierge program. Continue Reading
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News
19 Jun 2023
KFF: Over Half of Insured Adults Face Problems with Health Insurance
Adults who reported having poor or fair mental health experienced more problems with health insurance. Continue Reading
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News
09 Jun 2023
SCAN, CareOregon Grants Help Eliminate $110M in Medical Debt
The grants will help abolish medical debt for almost 70,000 people across Arizona, California, Nevada, Oregon, and Texas. Continue Reading
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News
08 Jun 2023
BCBSTX Provider Network Expansion Improves Behavioral Healthcare Access
The expanded provider network will facilitate behavioral healthcare access for fully insured BCBSTX group plan members in Texas and Illinois. Continue Reading
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08 Jun 2023
5 Chronic Diseases Plague High Spending Group Health Plan Members
The five common chronic diseases include heart disease, respiratory conditions, musculoskeletal conditions, and more. Continue Reading
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07 Jun 2023
Coverage Rates Equalize For LGBT Community, But Disparities Remain
Coverage rates for the LGBT community have improved, but LGBT individuals are still more likely to forego care due to cost. Continue Reading
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07 Jun 2023
Blue Cross MA Expands Mental Health Resources, Provider Network
Blue Cross has added more mental healthcare groups to its provider network, improving member access to mental health resources. Continue Reading
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06 Jun 2023
NY Health Plan Helps Members Navigate Health Insurance Renewals
Healthfirst members can receive personalized outreach via email, text, and phone about health insurance renewals. Continue Reading
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06 Jun 2023
Medicare Advantage Risk Adjustment Model Accuracy May Vary By Race
The Medicare Advantage risk adjustment model consistently underestimated American Indian/Alaska Native beneficiaries’ costs. Continue Reading
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02 Jun 2023
Type 2 Diabetes Patients Benefit from Capital Blue Cross Program
New research showed that type 2 diabetes patients experienced weight loss and lower A1c levels resulting from Capital Blue Cross assistance. Continue Reading
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01 Jun 2023
AHIP: Most Consumers Are Satisfied with Employer-Provided Coverage
A survey from AHIP found that 63 percent of consumers felt satisfied with their current employer-provided coverage. Continue Reading
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31 May 2023
Loss of ACA Preventive Care Mandate Could Impact 10M Enrollees
The long-term impacts may be higher as the US Preventive Services Task Force updates preventive care recommendations. Continue Reading
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30 May 2023
Aetna Awards $250K in Social Determinants of Health Grants in MI
The Aetna grants will provide support to 10 community-based organizations in Michigan, enabling them to fund social determinants of health and health equity initiatives for low-income patients. Continue Reading
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25 May 2023
Healthcare Organizations Oppose UHC’s GI Prior Authorization Program
The payer’s GI endoscopy prior authorization program will exacerbate care disparities and increase provider burden, the organizations wrote. Continue Reading
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22 May 2023
Aetna Injects $7.3M into Virginia FQHCs for Improved Cancer Outcomes
The value-based care incentive payments will go toward 22 FQHCs to fund methods promoting better cancer outcomes, such as greater preventive screening access. Continue Reading
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18 May 2023
KFF: Payers Will Issue $1.1B in Medical Loss Ratio Rebates in 2023
Payers in the individual market are expected to issue the highest medical loss ratio rebates of $500 million in 2023. Continue Reading
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16 May 2023
Blue Cross MA Expands Primary Care Network Amid Provider Shortages
The expanded primary care network will allow Blue Cross members to access virtual and in-person care, including mental health services and care navigation support. Continue Reading
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15 May 2023
CareSource Enters Value-Based Agreement to Improve Pediatric Health Outcomes
The value-based agreement with The Children’s Care Network will provide physicians with data and analytics to help them boost pediatric health outcomes in Georgia. Continue Reading
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News
15 May 2023
Humana Collabs with DME Companies to Advance Value-Based Home Healthcare
The collaboration aims to improve home healthcare quality for Medicare Advantage members and simplify the process of ordering and receiving durable medical equipment for providers. Continue Reading
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11 May 2023
Anthem Blue Cross Grants $400K to Boost Maternal Health Outcomes
The funding will support a program that provides prenatal care and mental health services to improve maternal health outcomes for pregnant people impacted by domestic violence. Continue Reading
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11 May 2023
Payer Invests in Helping Young Adults Find Work After Foster Care
Finding work after foster care can be a critical step for young adults who have aged out of the foster care system and Blue Cross NC’s partnership seeks to connect them with opportunities. Continue Reading
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10 May 2023
22% of Employers Waver on Adhering to ACA Preventive Care Rules
As the Affordable Care Act’s preventive care services regulations come under scrutiny, nearly a quarter of employers are unsure whether they would uphold the rules if eliminated. Continue Reading
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09 May 2023
CA Health Plans Commit $114M to Address Homelessness, Health Equity
The funding will address health equity by securing housing units for unhoused individuals with rental vouchers and supporting those who require assistance with daily living activities. Continue Reading
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09 May 2023
Humana Seeks to Improve Medicare Advantage Specialty Needs Benefits
Medicare Advantage members in skilled nursing facilities and senior living homes have complex needs and Humana and Longevity Health Plan’s partnership seeks to address those needs. Continue Reading
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08 May 2023
UHC Grants $275K to Address Social Determinants of Health for Foster Kids
Local organizations will use the funding to advance social determinants of health initiatives for foster children, including kinship placements and support groups. Continue Reading
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04 May 2023
UnitedHealthcare Pays $91.2M After Underpaying Envision for Medical Care
The financial award compensates the medical group for UnitedHealthcare’s breach of contract after the payer reduced reimbursement to Envision clinicians in 2017 and 2018. Continue Reading
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02 May 2023
Higher Market Share Helps Payers in Negotiations, Premium Impact Unclear
Numerous factors impact payer-hospital price negotiations including market share, but the actual impact on premiums remains uncertain. Continue Reading
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28 Apr 2023
Payers Fall Short of Employer Expectations on Behavioral Healthcare
Employers seeking a strong commitment to behavioral healthcare access and quality of care from their payer partners expressed disappointment in a National Alliance survey. Continue Reading
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Feature
25 Apr 2023
3 Ways Payers Can Employ Machine Learning, Advanced Analytics
Machine learning and advanced analytics have various uses in the health insurance industry, including condensing medical records, hypertargeting, and supporting risk adjustment. Continue Reading
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News
24 Apr 2023
Anthem, Valley Health Resolve Lawsuit Over Past-Due Payments
Valley Health dropped its lawsuit against Anthem Blue Cross and Blue Shield, which claimed the payer owed the health system $11.4 million in past-due payments. Continue Reading
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21 Apr 2023
Humana Funds UNF Program Expansion to Address Food Insecurity
Food insecurity is a major social determinant of health barrier for many seniors, but a couple of colleges are seeking to address this issue. Continue Reading
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19 Apr 2023
Importance of Increased Activity to Lower Rates of Chronic Conditions
Importance of Increased Activity to Lower Rates of Chronic Conditions Continue Reading
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19 Apr 2023
Why Addressing Stress is the Foundation for Improved Health Outcomes
Why Addressing Stress is the Foundation for Improved Health Outcomes Continue Reading
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18 Apr 2023
83% of Consumers Are Interested in Health Savings Accounts for Non-HDHPs
Health savings accounts have helped consumers manage escalating healthcare costs, but if these accounts were acceptable through non-HDHP plans the uptake might be even higher. Continue Reading
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17 Apr 2023
Coverage Gaps, Uninsurance Tied to Unmet Vision Care Needs
Almost half of adults with year-round uninsurance and 27 percent of those who experienced coverage gaps reported unmet needs for vision care. Continue Reading
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14 Apr 2023
Humana Continues to Address Housing Stability with $40M Investment
The funding will address housing stability by acknowledging the limited number of low-cost rental units and creating affordable housing capacity in underserved communities. Continue Reading
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13 Apr 2023
Employees Turn to Health Savings Accounts to Manage Healthcare Costs
Gen-Zers are particularly receptive to health savings accounts, but many employees are seeing the value as healthcare costs continue to escalate. Continue Reading
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10 Apr 2023
Aetna Offers Virtual Care Tool for Gastrointestinal Chronic Diseases
The payer’s partner will enable members in certain plans to access gastrointestinal treatment and management support through its virtual care tool. Continue Reading
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10 Apr 2023
How Interventional Analytics Will Improve Nursing Care for MA Members
Interventional analytics has emerged as an essential technology to assist payers and nursing homes in making care decisions to improve outcomes for aging members. Continue Reading