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
03 Dec 2025
New value-based payment model aims to boost tech use
A new payment model from the CMS Innovation Center will use fixed, value-based payments to support technology-supported care for chronic disease management. Continue Reading
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02 Dec 2025
Home health agencies face 1.3% decrease in Medicare payments
CMS finalized the CY 2026 Medicare payment rates for home health agencies, issuing a significantly smaller cut to payments than the $1.135 billion proposed reduction. 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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News
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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News
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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News
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
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News
07 Apr 2023
How 2023 Medicare Advantage Enrollment Growth Has Shifted
Medicare Advantage enrollment growth in 2023 was associated with quality performance and was highest among for-profit health plans. Continue Reading
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News
05 Apr 2023
Out-of-Pocket Spending for Pediatric Hospitalizations Reached $3,000
Out-of-pocket spending for pediatric hospitalizations was higher for those covered by high-deductible health plans and exceeded $3,000 for one in seven hospitalizations. Continue Reading
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03 Apr 2023
Study Finds Racial Coverage Disparities Following Unemployment
Black and Hispanic adults likely faced racial coverage disparities following job losses due to structural and administrative barriers to Medicaid enrollment, according to the researchers. Continue Reading
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31 Mar 2023
Anthem Announces Virtual-First Health Plan in MO for Commercial Members
Commercial members will gain access to a symptom checker, routine wellness care, and behavioral health services through the virtual-first health plan. Continue Reading
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News
30 Mar 2023
CVS Health Finalizes $8B Acquisition of Signify Health
The merged CVS Health and Signify Health organization will focus on improving care delivery, lowering costs, and boosting member engagement. Continue Reading
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30 Mar 2023
How One Payer Redesigned Wellness Program Rewards Around Choice, Tech
UnitedHealthcare redesigned its rewards for wellness program participation to incorporate a wider range of options for members and more advanced technologies. Continue Reading
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News
29 Mar 2023
UPMC Partnership Facilitates Access to Healthcare Services, Coverage
UPMC’s Medicaid managed care plan members can receive assistance with accessing healthcare services and coverage at laundromats across Pennsylvania. Continue Reading
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27 Mar 2023
How Overall, Out-of-Pocket Costs of Obesity Escalated in 10 Years
Out-of-pocket costs grew 37 percent for individuals diagnosed with obesity between 2011 and 2021. Continue Reading
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27 Mar 2023
UnitedHealth Group Commits $2M to Improve Health Equity for LGBTQ+ Youth
The funding will go to Rainbow Health, a nonprofit organization that addresses health equity by facilitating care access for LGBTQ+ youth and people facing care disparities in Minnesota. Continue Reading
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21 Mar 2023
60% of Privately Insured Patients Utilized Some ACA Preventive Care
A recent study shows that ACA preventive care utilization is satisfactory in 2018, but the ongoing Braidwood Management v. Becerra case could jeopardize this access. Continue Reading
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20 Mar 2023
How Payers Can Promote Member Health and Well-being with Wearables
Providing wearable technology to members allows payers to engage with them in new ways. By providing users with real-time feedback and personalized recommendations Continue Reading
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20 Mar 2023
81% of Entries Are Inaccurate in Provider Directories of 5 Large Payers
Comparing provider directories from Aetna, Elevance, Cigna, Humana, and UnitedHealth with Medicare data, a research letter found that many entries contained inaccuracies. Continue Reading
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17 Mar 2023
National Alliance Playbook Guides Employers on Biosimilar Adoption
Biosimilar adoption is challenging but employers can follow several steps to improve their integration of biosimilars into formularies and plan designs. Continue Reading
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15 Mar 2023
BCBSRI Recognizes Healthcare Sites Providing LGBTQ-Inclusive Care
The latest round of BCBSRI’s Safe Zone certifications went to children’s hospitals, physical therapy locations, and hospital clinics that offer LGBTQ-inclusive care. Continue Reading
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14 Mar 2023
Humana Shares Data on Economic Contributions in Florida
The payer organization found that its presence in the state had contributed a total of $48 billion to the Florida economy throughout 2022. Continue Reading
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13 Mar 2023
Health Insurance Impacts Racial Inequities in Cervical Cancer Diagnoses
Being uninsured or receiving health insurance through Medicaid accounted for more than half of racial inequities in advanced-stage cervical cancer diagnoses, researchers found. Continue Reading
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10 Mar 2023
CareOregon Initiative Boosts Access to Housing for Community Members
The recently purchased Red Lion Inn & Suites will be converted into housing units for community members with behavioral health needs and local healthcare workers, boosting access to housing. Continue Reading
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News
09 Mar 2023
Women Face High Out-of-Pocket Costs for Breast Cancer Treatment
Women with high deductible health plans or consumer driven health plans experienced higher out-of-pocket costs for breast cancer treatment than those with PPO or EPO plans. Continue Reading
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09 Mar 2023
CareFirst, Aledade Partnership to Help PCPs with Value-Based Care
The player plans to leverage tools and resources provided by Aledade to enhance the quality of care while reducing healthcare costs, supporting value-based care goals. Continue Reading
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07 Mar 2023
Humana Collab Expands Value-Based Care for Medicare Advantage Members
Through the 10-year agreement, Humana Medicare Advantage members will be able to receive value-based primary care from in-network physicians affiliated with Aledade, a public benefit corporation. Continue Reading
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06 Mar 2023
Blue Shield of CA Expands Access to Mental Healthcare Resources
Blue Shield of California members have gained access to mental healthcare resources, including assessments and topic centers, via an online platform. Continue Reading
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06 Mar 2023
BCBSM Funds Community-Based Orgs to Improve Senior Wellbeing
The $670,000 grant will support four community-based organizations that offer social and educational programs to improve the wellbeing of senior populations. Continue Reading
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03 Mar 2023
NCQA Recognizes WI UnitedHealthcare Plan for Health Equity Efforts
UnitedHealthcare Community Plan of Wisconsin has helped improve health equity by collaborating with community-based organizations across the state that support underserved populations. Continue Reading
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03 Mar 2023
Top Threats, Priorities in Employer-Sponsored Health Plan Benefits
Employers shared interventions that strengthen employer-sponsored health plan benefits in response to threats such as high-cost claims and medical inflation. Continue Reading
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01 Mar 2023
CareSource, Walmart Partner to Address Racial Health Disparities
The partnership aims to address maternal and racial health disparities, providing CareSource members access to social needs assessments, community resources, and health literacy education. Continue Reading
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28 Feb 2023
Blue Cross MN Partnership Expands Value-Based Care for Rural Members
Blue Cross Medicare Advantage members in 24 rural Minnesota counties will receive care under a full-risk value-based arrangement. Continue Reading
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27 Feb 2023
Humana Will Leave Employer Group Insurance Business to Focus on Public Plans
After exiting the employer group insurance business, Humana will prioritize the long-term growth of its Medicare Advantage, Medicare, and Medicaid health plans. Continue Reading
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24 Feb 2023
Why Employers Prefer Employer-Sponsored Health Plans Over Exchanges
Employers voiced a preference for employer-sponsored health plans over exchange coverage and expressed the conviction that, ultimately, employees share that view. Continue Reading
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22 Feb 2023
2022 Key Enrollment Trends For High Deductible Health Plans
Pre-deductible chronic disease prevention coverage was a big factor in high deductible health plan enrollees’ decision-making, along with factors like prescription drug coverage. Continue Reading
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21 Feb 2023
BCBST Report Reveals Racial Care Disparities Among TN Residents
Black Tennesseans were two and half times more likely to have a pregnancy-related death and two times as likely to die from diabetes than White women, highlighting racial care disparities in multiple areas. Continue Reading
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17 Feb 2023
Best Vendors for Healthcare Payer Services, Software Needs
Healthcare payers seeking a vendor for care management, risk adjustment, and other complex processes may find a high-performing partner in the Best in KLAS report results. Continue Reading
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17 Feb 2023
Indiana Payer Partners with Provider Org to Boost Primary Care Access
In addition to receiving exclusive primary care access, fully insured members of Physicians Health Plan of Northern Indiana will have access to an integrated care team, chronic condition management, and provider-dispensed medication. Continue Reading
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15 Feb 2023
Employer-Sponsored Health Plans Pay More for Drugs than Medicare
Five of the most used physician-administered drugs cost over 200 percent higher for employer-sponsored health plans than for Medicare. Continue Reading
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14 Feb 2023
New Humana Community Partnerships to Strengthen Health Equity
The payer has announced a new health equity strategy that centers around forming community partnerships to tackle healthcare barriers and social determinants of health, such as food insecurity. Continue Reading
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13 Feb 2023
Out-of-pocket Costs for Opioid Use Disorder Treatment Varied by Payer
In 2020, the mean out-of-pocket cost for opioid use disorder medication paid for by self-pay patients was $8.44 compared to $0.10 for prescriptions paid for by Medicaid. Continue Reading
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10 Feb 2023
Centene Managed Care Plans Will Pay Medi-Cal $215M for Overcharges
Centene saved its managed care plans $2.70 per prescription drug claim through its pharmacy benefit manager contracts, but did not pass on these discounts to Medi-Cal, according to the settlement. Continue Reading
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09 Feb 2023
High Deductible Health Plan Enrollment Hit Record High in 2021
High deductible health plan (HDHP) enrollment reached record levels in 2021, with some states seeing over 60 percent of their private-sector workers covered through an HDHP. Continue Reading
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09 Feb 2023
Humana Maintains Primary Care Access for Medicare Advantage Members
Humana Medicare Advantage members will continue to have access to ChenMed’s medical center brands, which provide primary care at more than 120 locations across 50 states. Continue Reading
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08 Feb 2023
Most Employers Will Enhance Services to Improve Employee Wellbeing
Most employers plan to enhance their current employee wellbeing programs by adding more services, while almost a quarter are considering switching to a new vendor partner. Continue Reading
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08 Feb 2023
Employers Emphasize Quality of Care When Assessing Health Plans
Employers remained dissatisfied with their health plans in 2022, but those who had higher health plan satisfaction indicated that their payer’s quality of care emphasis was a key driver. Continue Reading
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07 Feb 2023
ACHP Addresses Proposed Rule on Substance Use Disorder Patient Data
The CARES Act’s substance use disorder patient data requirements should be more aligned with HIPAA standards, ACHP and its co-signees argued. Continue Reading
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06 Feb 2023
How a Growing, Changing Medicare Population Will Impact Payers
As Medicare takes on an aging, sicker population, payers need to ensure they are meeting evolving member expectations and using data to drive their strategy for member satisfaction. Continue Reading
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03 Feb 2023
Health Savings Account Balances, Contributions Grew in 2021
The average health savings account balance and total contribution were higher for those that received funds from employers in 2021. Continue Reading
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02 Feb 2023
Aetna Funding Improves Healthcare Access for Domestic Violence Survivors
The funding will help domestic violence survivors and their children enroll in healthcare coverage through Medicaid, CHIP, or other health plans while maintaining confidentiality. Continue Reading
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30 Jan 2023
Cigna’s Integrated Health Plan Reduced Care Costs for Employers
When individuals with a diabetes diagnosis were enrolled in the integrated health plan, employers saved $2,500 per member per year. Continue Reading
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25 Jan 2023
Employer-Sponsored Health Plans Face High Costs for SUD Treatment
Alcohol- and opioid-related use disorders were the most prevalent substance use disorders and posed some of the highest per-enrollee costs for employer-sponsored health plans. Continue Reading
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25 Jan 2023
Elevance Health Will Acquire BCBSLA, Improve Care Access in LA
In addition to improving care access, the proposed acquisition will create a foundation that aims to support local communities, address complex care needs, and reduce health inequities. Continue Reading
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23 Jan 2023
Medicare Pays Medicare Advantage Plans 6% More Than FFS Medicare
Medicare Advantage plans have seen growing enrollment in recent years, but they have also seen persistent coding intensity problems that lead to excess payments. Continue Reading
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19 Jan 2023
Tufts Health Plan, Harvard Pilgrim Collab Boosts Access to LGBTQ+ Care
Fully insured commercial members will have access to integrated LGBTQ+ care, including gender-affirming physical and mental healthcare, behavioral health services, and social support groups. Continue Reading
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19 Jan 2023
Private Payers Reimbursed Telehealth, In-Person Care Equally in 2020
Private health plan claims show that the average telehealth claims were generally within ten percent above or below the in-person care cost at the beginning of the pandemic. Continue Reading
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17 Jan 2023
BCBSRI Grants $740K to Improve Health Equity, Access to Stable Housing
The funding will help improve access to stable housing for Rhode Islanders by supporting organizations that focus on building and renovating homes and increasing homebuyer education. Continue Reading
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11 Jan 2023
Deductibles, Copayments, OOP Max Trends Indicate Cost-Sharing Growth
Between 2013 and 2020, employees experienced higher cost-sharing for many medical services, although some shifts depended on plan type and union employment. Continue Reading
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10 Jan 2023
Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM
BCBSM’s full-risk value-based care contracts aim to improve members’ healthcare experience by boosting care quality and reducing costs. Continue Reading
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04 Jan 2023
Women with Employer Sponsored Health Insurance Face Affordability Issues
Nearly 4 percent of women with employer-sponsored health insurance reported unaffordability for medical care compared to 2.7 percent of men. Continue Reading
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30 Dec 2022
CA, AZ Payers Boost Care Access for Active-Duty Service Members
Active-duty service members will have access to Blue Shield of California’s and Blue Cross Blue Shield of Arizona’s provider networks during their service and after transitioning to Veterans Affairs eligibility. Continue Reading
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28 Dec 2022
Court Says BCBSIL Cannot Exclude Coverage of Gender-Affirming Care
BCBSIL is a third-party administrator for an employer-sponsored health plan that denied coverage of gender-affirming care for an employee’s transgender son. Continue Reading
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28 Dec 2022
How Payer, Provider Alignment Enables Simplified Medical Billing Format
After years of working toward this goal, the payer and provider partners introduced a simplified medical billing format, in part made possible due to their joint venture model. Continue Reading
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22 Dec 2022
Harvard Pilgrim, Tufts Health Plan Increase Caregiver Support for Members
Commercial members will have access to caregiver support tools starting in January 2023, including care coordinators and an online peer network. Continue Reading
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21 Dec 2022
Blue Cross MN Value-Based Contract Reduced Cancer Care Costs
The value-based contract, which focuses on utilizing care coordination to prevent unnecessary hospital visits, reduced cancer care costs by more than ten percent for patients with Blue Cross employer group coverage. Continue Reading
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20 Dec 2022
How Coverage and Costs Vary Within Different Types of Health Plans
Different types of health plans, such as health maintenance organizations and preferred provider organizations, can lead to varying out-of-pocket expenses, monthly premiums, and annual deductibles for members. Continue Reading
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19 Dec 2022
93% of Employees Satisfied with Employer Sponsored Health Insurance
Employees described their employer-sponsored health insurance as affordable, high-quality, and comprehensive. Continue Reading
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15 Dec 2022
Nonprofit Sues GA for Refusing to Cover Transgender-Related Healthcare
The lawsuit aims to prevent the Georgia State Health Benefit Plan, which provides health insurance coverage for over half a million Georgians, from excluding coverage for transgender-related healthcare. Continue Reading
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15 Dec 2022
SCAN Group, CareOregon Plan to Combine, Form HealthRight Group
The new combined company that SCAN Group and CareOregon form would continue to serve Medicare and Medicaid beneficiaries. Continue Reading
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14 Dec 2022
ACAP Health Plans Will Identify Birthing-Friendly Hospitals in Directories
Including the birthing-friendly hospital designation in provider directories will help ACAP health plan members identify facilities that deliver quality maternal healthcare. Continue Reading
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13 Dec 2022
Payer Announces Partnership to Offer In-Home Care with Flexible Hours
The partnership allows members to access in-home care after normal primary care office hours any day of the week. Continue Reading
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12 Dec 2022
Aetna Grants $9.3M to Support Behavioral Health for Youth in Foster Care
The funding supports Aetna’s goal of helping children in foster care transition to home- or community-based settings and receive behavioral health services. Continue Reading
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12 Dec 2022
Heat-Related Illness Diagnoses Among Private Payer Members Are Increasing
Payers should be aware that heat-related illness diagnoses are increasingly prevalent among males and older privately-insured populations. Continue Reading
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09 Dec 2022
High Deductibles Create Barriers to Screening Mammograms, Follow-Up Tests
More than 20 percent of women said they would skip follow-up tests for a screening mammogram if they knew they would face a high deductible. Continue Reading
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08 Dec 2022
Elevance Health ACO Generated Cost Savings Among Fully Insured Members
Under Elevance Health’s ACO model, cost savings ranged from -$25.42 per member per month in 2016 to -$44.08 per member per month in 2020 for fully insured members. Continue Reading
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06 Dec 2022
Behavioral Health Treatment was Associated with Lower Healthcare Costs
The mean per member per month healthcare cost for individuals who received outpatient behavioral health treatment was $571 compared to $686 for those who did not receive treatment. Continue Reading
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05 Dec 2022
CareFirst Funds Community-Based Orgs to Boost Behavioral Healthcare Access
The community-based organizations are working to improve behavioral healthcare access for youth and strengthen the provider workforce in low-income and rural areas. Continue Reading
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02 Dec 2022
Payer Sees Significant Mental Healthcare Utilization, Network Size Growth
Blue Cross Blue Shield of Massachusetts shared data on mental healthcare utilization and network size shifts that reflected the payer’s mental healthcare expansions. Continue Reading
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01 Dec 2022
Health Insurance Price Growth Rises to 20%, Outpacing Other Medical Care
Experts anticipated high health insurance prices, but it remains unclear whether high prices in the rest of the nation’s goods and services will push health insurance prices even higher. Continue Reading
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30 Nov 2022
Gold Carding Has Mixed Effects on Streamlining Prior Authorization Processes
Gold carding is a relatively new approach to streamlining prior authorization processes that appealed to many health plans but may not consistently deliver on its promises. Continue Reading
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29 Nov 2022
Health Insurance Coverage Disruptions Tied to Higher Mortality Risks
The link between health insurance coverage disruptions and high mortality risks highlights the importance of including coverage disruption assessments in social risk screenings. Continue Reading
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28 Nov 2022
SCAN Health Plan Expands Dual Eligible Special Needs Plan in CA
The payer’s Fully Integrated Dual Eligible Special Needs Plan includes zero-dollar copays for prescription drugs, free access to virtual behavioral health services, and dental coverage, among other benefits. Continue Reading
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23 Nov 2022
35% More MA Plans Offering Home-Based Supplemental Benefits in 2023
The number of Medicare Advantage plans to offer primarily health-related supplemental benefits increased from 824 in 2022 to 1,111 in 2023. Continue Reading
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22 Nov 2022
Health Insurance Is Expensive, But Americans Intend to Keep Their Plans in 2023
Seven out of ten Americans plan to stay in their current health plan in 2023 even as healthcare costs escalate, but many also have a threshold for how much more they are willing to pay. Continue Reading
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22 Nov 2022
Medicare Advantage Premiums Rise, Zero-Dollar Premium Plan Uptake Declines
Data from the first half of the 2023 open enrollment season is revealing departures from the last three years’ open enrollment trends. Continue Reading
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17 Nov 2022
Top 5 States with the Highest Levels of Healthcare Spending
Healthcare spending was highest in South Dakota, Louisiana, West Virginia, Florida, and Wyoming. Continue Reading
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17 Nov 2022
CareSource Addresses LGBTQA+ Housing Social Determinants of Health Barriers
The payer will help pay for the construction of an inclusive housing setting for LGBTQA+ seniors who often face discrimination and social determinants of health barriers when seeking housing. Continue Reading
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16 Nov 2022
ERIC: Allow Employer Sponsored Health Plans to Electronically Deliver AEOB
If employer sponsored health plans could deliver advanced explanation of benefits materials electronically, it could improve costs and members’ healthcare literacy. Continue Reading
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15 Nov 2022
50% of Coronavirus Hospitalizations Covered by ESI Cost Over $25K
Coronavirus hospitalizations could cost between $10,000 and more than $38,000 in employer-sponsored health plans, depending largely on whether the hospitalization included an ICU stay. Continue Reading
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10 Nov 2022
How Massachusetts’ Benchmark Impacted Healthcare Cost Growth
Accountability mechanisms that accompanied the state’s benchmark legislation, including Cost Trends Hearings and Performance Improvement Plans, did little to constrain healthcare cost growth, stakeholders noted. Continue Reading
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09 Nov 2022
Community Health Plans Lowered Consumer Healthcare Spending in 2022
Community health plans improved healthcare spending in a variety of ways, but largely through their drug pricing advocacy and premium adjustments. Continue Reading
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09 Nov 2022
Elevance Health Will Acquire Specialty Pharmacy To Treat Chronic Diseases
The payer has already shared plans to improve the specialty pharmacy’s speed and expand its services to encompass a wider scope of chronic diseases. Continue Reading