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
-
News
09 Jun 2025
OIG audit finds $6.9M in MA overpayments made to Coventry
An OIG audit finds Coventry collected nearly $7 million in Medicare Advantage overpayments due to improper coding of high-risk diagnoses, although the payer denied the findings. Continue Reading
-
News
04 Jun 2025
CBO: Tax bill would strip health insurance from 11 million people
The Congressional Budget Office projected that nearly 11 million people would lose health insurance coverage under Trump's tax bill, which House Republicans narrowly passed in May. Continue Reading
-
News
17 Jan 2022
How Home Health Will Evolve in the Year Ahead
Changes in care delivery and strategic shifts to drive affordable, whole-person care will be important trends in home healthcare in 2022. Continue Reading
-
News
14 Jan 2022
At-Home COVID-19 Tests in Low Supply Before New CMS Requirements
An analysis of six online retailers and ten at-home COVID-19 test brands offered insight into the low supply of at-home COVID-19 tests available and reinforce payers’ concerns. Continue Reading
-
News
13 Jan 2022
Payers Lag On Acupuncture Coverage Despite Rising Utilization
Increased acupuncture utilization has been tied to expanded acupuncture coverage, but most of acupuncture spending is still out-of-pocket. Continue Reading
-
News
13 Jan 2022
UnitedHealthcare Offers Initiatives to Improve Vision, Eye Health
The payer will offer members discounts on laptops and screen filters that help reduce exposure to blue light and support vision and eye health. Continue Reading
-
News
12 Jan 2022
HRSA Expands Preventive Care Coverage Under ACA for Women, Children
The updated preventive care guidelines include coverage of double electric breast pumps without cost-sharing for mothers as well as suicide risk screenings for adolescents. Continue Reading
-
News
10 Jan 2022
Closing Gaps in Care with Advanced Interoperability Capabilities
Payers must improve their ability to access data by addressing interoperability capabilities within their health IT infrastructure. Continue Reading
-
News
07 Jan 2022
Centene Finalizes Acquisition of Behavioral Healthcare Platform
The acquisition of the behavioral healthcare platform will help the payer offer members integrated mental and physical healthcare services. Continue Reading
-
News
06 Jan 2022
Priority Health, Epic Partner to Improve Patient Data Exchange
Priority Health aims to use the payer platform to boost quality of care, lower costs, and to achieve real-time data. Continue Reading
-
News
04 Jan 2022
UHC Will Not Implement Emergency Care Coverage Changes
UnitedHealthcare previously announced that it would change how it assesses emergent care for coverage, but now the payer does not plan to make changes to emergency care coverage. Continue Reading
-
News
04 Jan 2022
Humana Expands Value-Based Care to Medicare Advantage Members in OR
Through a new partnership, Humana Medicare Advantage members will gain access to an integrated care team, physical and mental healthcare services, and regular wellness classes. Continue Reading
-
News
03 Jan 2022
Cancer Patients in High Deductible Health Plans Face Steep Costs
Patients who had cancer faced higher out-of-pocket costs compared to patients who did not have cancer, with patients in high deductible health plans experiencing the most expenses. Continue Reading
-
News
17 Dec 2021
Top 5 Insurers With The Highest Market Shares In The Most States
The payers with the highest national market shares are not the same as the payers with the highest market shares by state. Continue Reading
-
News
16 Dec 2021
Payer Funds Tech, Training To Support Rural Maternity Healthcare
Rural maternity healthcare services are challenging to initiate and maintain, but payers can support growth in these services with their funding. Continue Reading
-
News
14 Dec 2021
MA Plan Introduces Benefits to Address Chronic Disease Management
The new benefits from UVM Health Advantage prioritize chronic disease management, specifically supporting members with heart disease and diabetes. Continue Reading
-
News
13 Dec 2021
2021 Employer-Sponsored Health Plan Spending Growth Hit 6.3%
In 2020, employer-sponsored health plan spending rose by 3.4 percent, but 2021 spending exceeded that, and 2022 is expected to perpetuate the trend. Continue Reading
-
News
08 Dec 2021
BMA Asks CMS to Enhance, Solidify Medicare Advantage Benefits
The letter supported policies that allow health plans to introduce Medicare Advantage benefits that address beneficiaries’ social determinants of health. Continue Reading
-
News
06 Dec 2021
How Health Plans Provide Effective Mental Health Support to Members
Demand for mental healthcare has increased during the pandemic and health plans have an opportunity to streamline access for members. Continue Reading
-
News
03 Dec 2021
Payer Funds Local Practices to Help Address Racial Care Disparities
The $25 million in grants will help local physicians and hospitals improve health equity strategies and address racial care disparities. Continue Reading
-
News
02 Dec 2021
CVS Health Contributes $9.2M to Address SDOH, Homelessness in DC
The payer’s contributions will go toward building a 41-unit housing development in DC that aims to reduce homelessness and increase access to affordable housing. Continue Reading
-
News
02 Dec 2021
UnitedHealthcare Launches Health Plan to Improve Customer Support
The payer has partnered with an accountable care organization to launch the health plan in two Arizona counties, aiming to streamline customer support. Continue Reading
-
News
01 Dec 2021
UnitedHealthcare Vision, Dental Plans Lead in Customer Satisfaction
Vision and dental plan customer satisfaction increased overall in 2021, with UnitedHealthcare receiving the highest scores. Continue Reading
-
News
23 Nov 2021
Humana Expands Medicare Advantage Value-Based Contract in MN
The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. Continue Reading
-
News
18 Nov 2021
An Overview of 2021 Prescription Drug Benefits: Tiers, Cost-Sharing
There was no singular right way for employers and payers to structure prescription drug benefits in 2021 as the nation continued to struggle with escalating drug prices. Continue Reading
-
News
15 Nov 2021
What Member Engagement Means to Today’s Healthcare Consumers
Health plans have improved their digital member engagement efforts, but they have more opportunities to tailor their activities to improve care management. Continue Reading
-
News
15 Nov 2021
The Status of High Deductible Health Plans with Savings Option
As deductibles continue to grow, large employers are leveraging high deductible health plans with savings option to manage cost-sharing. Continue Reading
-
News
12 Nov 2021
Americans Ready To Choose Coverage During 2022 Open Enrollment
As the coronavirus pandemic continues to influence members’ decision making, Americans are feeling more prepared to select a health plan during 2022 open enrollment. Continue Reading
-
News
11 Nov 2021
Teladoc, Trustmark Announce Virtual-First Health Plan
The partners stated that their virtual-first health plan will centralize around primary care services but would also include mental healthcare and chronic disease management capabilities. Continue Reading
-
News
11 Nov 2021
Humana Announces Changes To Veteran Population Health Management
Humana will add the veteran community to the payer’s Bold Goal initiative in order to improve veteran population health management. Continue Reading
-
News
10 Nov 2021
Payer Third Quarter Earnings Results Spotlight COVID-19 Impact
The impact of coronavirus remained clear across the payer third quarter earnings results for Humana, Anthem, and Aetna. Continue Reading
-
News
09 Nov 2021
Humana Type 2 Diabetes Reversal Program Leverages RPM, Nutrition
Humana’s Type 2 diabetes reversal program will leverage remote patient monitoring and personalized nutrition strategies to improve member outcomes. Continue Reading
-
News
08 Nov 2021
Step Therapy Protocols Vary By Health Plan, 55% Too Strict
Payers use step therapy protocols to lower costs, but some health plans implement step therapy protocols that go beyond clinical guidelines. Continue Reading
-
News
08 Nov 2021
United Behavioral Health Sued for Restrictive Bundled Payment Policy
United Behavioral Health is being sued for allegedly denying claims for medically necessary treatment under its bundled payment policy. Continue Reading
-
News
04 Nov 2021
Coronavirus Pandemic’s Impact on Insurer, Consumer Trends in 2021
Insurers and enrollees shifted behavioral patterns in response to the coronavirus pandemic in 2020 and the repercussions continue to have an impact in 2021. Continue Reading
-
News
03 Nov 2021
COVID-19 May Push Americans To Change Plans For Open Enrollment
Apart from the pandemic, consumers found their own changing healthcare needs and healthcare costs to be compelling reasons for switching plans during open enrollment 2022. Continue Reading
-
Answer
01 Nov 2021
How Payers Help Tackle Substance Use Disorders, Other Conditions
Payers have several opportunities to improve their coverage options for members who have substance use disorders with co-occurring conditions. Continue Reading
-
News
01 Nov 2021
Aetna Will Offer Some Gene Therapies As Standard Medical Benefit
Aetna established a provider network for gene therapies which will be available to fully-insured and self-insured employers as a standard medical benefit in 2022. Continue Reading
-
News
01 Nov 2021
Leveraging Patient Access APIs to Optimize Risk Adjustment Efforts
The adoption of patient access APIs can enable claims data to move between payers and support improved risk adjustment. Continue Reading
-
News
01 Nov 2021
Addressing Senior Physical, Mental Health With Group Exercise
COVID-19 has taken a toll on seniors’ well-being. The right fitness programs can help lift seniors’ well-being post-pandemic. Continue Reading
-
News
29 Oct 2021
More Employers Turn to Employer-Sponsored Primary Care Clinics
Employer-sponsored primary care clinics can address a variety of employer goals including improving patient access to care, quality of care, and patient satisfaction. Continue Reading
-
News
26 Oct 2021
CVS Health to Offer Coverage for Moderna COVID-19 Booster Shot
Eligible individuals who have received a two-dose mRNA vaccine or a Johnson & Johnson vaccine can receive a Moderna COVID-19 booster shot at select CVS Health pharmacies at no cost. Continue Reading
-
News
25 Oct 2021
Members Find Private Payer Mental Healthcare Networks Inadequate
Even when payers integrate mental healthcare into primary care services, members said that mental healthcare networks paled in comparison to medical care networks. Continue Reading
-
News
25 Oct 2021
Most Payers Are Unfamiliar with Prescription Digital Therapeutics
Prescription digital therapeutics are still young, but payers are starting to consider whether covering these solutions could lower costs. Continue Reading
-
News
25 Oct 2021
Addressing Health Literacy to Improve Member Health, Outcomes
Health literacy is essential to empowering patients to take greater ownership over their healthcare experience and achieve improved outcomes. Continue Reading
-
News
22 Oct 2021
UnitedHealthcare Targets Prenatal Care, Maternal Health Outcomes
UnitedHealthcare will help launch group prenatal care models at OB-GYN clinics in North Carolina to improve maternal health outcomes. Continue Reading
-
News
21 Oct 2021
More Medicare Advantage Plans Offer SDOH Benefits With $0 Premium
In 2022, more beneficiaries will have access to Medicare Advantage plans with $0 premiums that offer supplemental benefits. Continue Reading
-
News
20 Oct 2021
UnitedHealth Group Kicks Off Integrated Virtual-First Health Plan
The new virtual-first health plan will be available in nine cities and will aim to integrate virtual and in-person care needs. Continue Reading
-
News
19 Oct 2021
Financially Burdened Seniors Struggle to Cover Healthcare Costs
In the past year, seniors reported having to delay treatment or postpone other expenses due to high healthcare costs. Continue Reading
-
News
19 Oct 2021
Continuous Marketplace Coverage Led to Increased Prenatal Care Use
Pregnant people who received continuous Marketplace coverage before and during pregnancy were more likely to have high prenatal care use. Continue Reading
-
News
18 Oct 2021
Walmart Increases Self-Funded Employer Access to Cost-Effective Care
Self-funded employer health plans will have access to Walmart’s collection of healthcare services following a partnership between the retail giant and a digital healthcare platform. Continue Reading
-
News
18 Oct 2021
Humana Expands Medicare Advantage Plans, Benefits in Tennessee
Humana intends to introduce new Medicare Advantage plans for Tennesseans in 2022 that address dual-eligible benefits, veteran coverage, and food insecurity. Continue Reading
-
News
18 Oct 2021
A Phased Approach to Next-Generation Member Engagement
A two-phased approach allows health plans to identify and target specific populations and then deploy and measure the effectiveness of their member engagement efforts. Continue Reading
-
News
14 Oct 2021
UnitedHealthcare Shares Growth, COVID-19 Impacts, 2022 Forecast
The third quarter earnings report and call for UnitedHealthcare revealed the impact of the coronavirus pandemic, but ended on a hopeful note for 2022. Continue Reading
-
News
12 Oct 2021
Employer Health Benefits Spending Will Normalize in 2022
After two unpredictable years of healthcare spending, employer health benefits spending will return to prepandemic levels in 2022, employers predicted. Continue Reading
-
News
11 Oct 2021
51% of Employees Satisfied with Employer-Sponsored Health Benefits
Overall, employees reported being satisfied with their employer-sponsored health benefits, but they still expressed the need for more mental health benefits and lower costs. Continue Reading
-
News
07 Oct 2021
Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS
Medicare Advantage coronavirus hospitalizations and mortality rates were lower than the rates in fee-for-service Medicare during most of 2020. Continue Reading
-
News
04 Oct 2021
How Payers Use Chronic Disease Management Flexibilities in HSAs
The flexibilities for covering chronic disease management in health plans with health savings accounts have enabled payers to reduce cost-sharing for members. Continue Reading
-
News
01 Oct 2021
Blue Cross NC Reduces Lab Service Costs, Unnecessary Testing
Lab service costs can be an expensive category of healthcare spending, but Blue Cross NC aimed to change that with its latest partnership. Continue Reading
-
News
29 Sep 2021
Top 5 Largest Health Insurers in the US by National Market Share
UnitedHealth Group, Anthem, Aetna, and Cigna returned to the list of the top five largest health insurers and one newcomer joined the list. Continue Reading
-
News
29 Sep 2021
Health Insurance Industry Consolidation Grew from 2014 to 2020
At the national level, UnitedHealth Group, Anthem, Aetna, and Cigna maintained their rankings as holding the highest market shares while health insurance industry consolidation grew. Continue Reading
-
News
29 Sep 2021
How Data Aggregation, Sharing Improves Specialty Patient Outcomes
With data supplementation, specialty pharmacies can piece together a complete digital picture of the patient that improves medication adherence and patient outcomes. Continue Reading
-
News
28 Sep 2021
4 Employer Health Benefit Strategies That Lower Healthcare Costs
Advanced primary care, episode-based benefits, integrated health benefits, and association health plans are employer health benefit strategies that can help employers manage costs. Continue Reading
-
News
27 Sep 2021
How Change Management Leads to Successful Member Engagement
Health plans implementing a digital platform for member engagement must consider the importance of effective change management. Continue Reading
-
News
24 Sep 2021
UPMC Partners with Meal Delivery Service, Improves Health Outcomes
The pilot program utilized a meal delivery service that helped members tackle food insecurity and manage chronic conditions. Continue Reading
-
News
20 Sep 2021
How Specialty Pharmacies Connect the Dots for Patient-Centered Care
Specialty pharmacists are able to coordinate services and address social determinants of health, leading to improved medication adherence and health outcomes. Continue Reading
-
News
17 Sep 2021
NCQA Releases Health Plan Performance Ratings with COVID-19 Data
NCQA found that health plan performance for most eligible plans hovered around 3.5 stars overall on measures covering quality of care, patient experience, and health quality processes. Continue Reading
-
News
15 Sep 2021
How Payers Can Cultivate Consumer-Centered Digital Innovation
Consumer-centered digital innovation is increasingly important for payer success, but what digital solutions do members want and how should payers implement them? Continue Reading
-
News
14 Sep 2021
Digital Member Experience Services May Boost Plan Satisfaction
Payers may see increased enrollment and higher member satisfaction levels if they employ omnichannel digital member experience services. Continue Reading
-
News
13 Sep 2021
Payer Extends Medicare Advantage Footprint to Reach 5M Seniors
SCAN Health Plan will offer its senior-first Medicare Advantage Plans in 17 markets across three states starting in 2022. Continue Reading
-
News
13 Sep 2021
6 Reasons to Invest in Next-Generation Member Engagement
Health plans must meet the changing expectations of consumers to deliver a meaningful member experience through targeted member engagement. Continue Reading
-
News
09 Sep 2021
Anthem Offers Virtual Care Platform To Facilitate Second Opinions
The virtual care platform will be provided in conjunction with The Clinic by Cleveland Clinic in order to connect members with high-quality care and secondary health assessments. Continue Reading
-
News
08 Sep 2021
How COVID-19 Impacted Employer-Sponsored Health Plan Coverage
Employer-sponsored health plan coverage did not return to pre-pandemic levels even as the employment levels recovered in 2020. Continue Reading
-
News
07 Sep 2021
Centene Will Group Medicare Offerings Under Wellcare Brand
In addition to consolidating its Medicare offerings, the payer will streamline its Wellcare branding in order to improve member engagement and experience. Continue Reading
-
News
02 Sep 2021
New BCBSA Plan Product Prioritizes Labor Union Health Insurance
CareFirst and Highmark are introducing a health insurance product to the 2022 market that will focus on improving labor union health insurance. Continue Reading
-
News
02 Sep 2021
6 Policies To Reduce Prescription Drug Prices, Boost Competition
As prescription drug spending climbs, ACHP is calling on policymakers to reduce high prescription drug prices and enhance market competition. Continue Reading
-
News
30 Aug 2021
Cigna Expands Individual Health Insurance Market Participation
After the surge in 2021 marketplace enrollment due to the special enrollment period, payers are announcing plans to expand their reach in the individual health insurance market in 2022. Continue Reading
-
News
30 Aug 2021
How Personalized Messaging Leads to Effective Member Engagement
Tailoring messaging to the unique and specific needs of individuals is essential for health plans to improve member engagement. Continue Reading
-
News
25 Aug 2021
ACHP: Health Equity Success Requires Holistic, Integrated Approach
ACHP outlined a holistic approach for payers to achieve health equity by addressing care disparities on multiple interconnected levels including individual, community, and systemic. Continue Reading
-
News
24 Aug 2021
Private Payers Renew Cost-Sharing For COVID-19 Hospitalizations
Nearly three out of four private payers are no longer waiving cost-sharing for COVID-19 hospitalizations and treatment. Continue Reading
-
Answer
23 Aug 2021
How Payers Can Launch a Virtual-First Health Plan
Virtual-first health plans appear to be the natural next step in the evolution of virtual care, remote care, and telehealth technology. How can payers launch a successful plan? Continue Reading
-
News
23 Aug 2021
How Specialty Pharmacies Address Social Determinants of Health
Specialty pharmacies are uniquely positioned to identify social determinants of health that could impact medication adherence and health outcomes. Continue Reading
-
News
20 Aug 2021
MO Medicaid Home Healthcare Program Received Improper Payments
The state claimed more than it should have in federal Medicaid reimbursement for its Medicaid home healthcare program and did not keep adequate documentation. Continue Reading
-
News
19 Aug 2021
Payer Virtual Care Management Platform Prioritizes Holistic Care
The payer’s virtual care management platform will improve patient-provider communication and offer members a convenient and holistic approach to care management. Continue Reading
-
News
18 Aug 2021
Medicare Advantage Healthcare Spending Exceeds Original Medicare
Policymakers may soon have to address inequities between Medicare Advantage healthcare spending and Medicare spending. Continue Reading
-
News
18 Aug 2021
Pros, Cons of Small Employers Joining Association Health Plans
Association health plans attract small businesses and self-employed individuals who want lower costs and more leverage in the marketplace, but are the benefits worth the detracting factors? Continue Reading
-
News
17 Aug 2021
2021 Healthcare Spending, Hospital Admissions Lower Than Expected
Lower 2021 healthcare spending may be a result of patients forgoing treatment, instead of simply rescheduling services that the pandemic delayed in 2020. Continue Reading
-
News
16 Aug 2021
UHC Will Pay Penalty on Mental, Behavioral Reimbursement Parity
UnitedHealthcare will pay $15.6 million in penalties and payments to beneficiaries and it will correct its policies that restricted mental and behavioral reimbursement parity. Continue Reading
-
News
12 Aug 2021
Aetna Increases Member Primary Care Access With New Virtual Plan
CVS Health and Aetna have expanded their virtual care options with the launch of the new virtual primary care program which seeks to improve primary care access for members. Continue Reading
-
News
11 Aug 2021
Payer Expands Value-Based Care Footprint for Clinical Procedures
Regence BlueShield is expanding its value-based care program by adding more covered services and welcoming Washington state’s largest healthcare purchaser. Continue Reading
-
News
10 Aug 2021
The Fundamentals of Medicare Advantage Star Rating Methodology
The Medicare Advantage Star Rating methodology involves various components in order to measure Medicare Advantage health plan performance. Continue Reading
-
News
10 Aug 2021
Centene Promotes Employee COVID-19 Vaccination, Remote Work
The Delta variant not only stalled the return to the workplace, but also caused the payer to redouble its efforts support employee coronavirus vaccination. Continue Reading
-
News
09 Aug 2021
SCAN Health Plan Reports Decline in COVID-19 Vaccine Disparities
The payer stated that various efforts at building trust with members led to a decrease in coronavirus vaccine disparities, including both racial and economic disparities. Continue Reading
-
News
05 Aug 2021
Tracking Social Determinants of Health Data in Medicare Advantage
Medicare Advantage plans have to draw social determinants of health data from a number of sources, both internal and external. Continue Reading
-
News
04 Aug 2021
Top Trends In Small Business Health Insurance During COVID-19
Instead of dropping coverage due to economic pressures, small business health insurance remained stable during the pandemic. Continue Reading
-
News
03 Aug 2021
Payer Financially Supports Diversity in Mental Healthcare Workforce
Blue Shield of California is financially supporting an internship program that encourages underrepresented young adults to join the mental healthcare workforce. Continue Reading
-
News
03 Aug 2021
DOJ Intervenes in Whistleblower Cases Alleging Medicare Fraud
Six cases in Colorado and California alleged that Kaiser Permanente committed Medicare fraud in its Medicare Advantage risk adjustment processes. Continue Reading
-
News
30 Jul 2021
2022 Marketplace Rate Filings Show Few Pandemic-Related Increases
A collection of marketplace rate filings for 2022 showed that most payers do not expect the coronavirus pandemic to have an upward impact on premiums. Continue Reading
-
News
29 Jul 2021
What Employees Want in Their Employer-Sponsored Health Benefits
Employers and employees agree that healthcare costs are out of control, but they differ on the role of employer-sponsored health benefits. Continue Reading
-
News
29 Jul 2021
UHC Funds Community-Based Social Determinants of Health Efforts
The payer is awarding more than $11 million to community-based organizations across 18 states to improve access to care and address social determinants of health barriers. Continue Reading
-
News
28 Jul 2021
Cigna + Oscar Extends Virtual Primary Care Plan 2022 Footprint
The payer has announced the expansion of Oscar Virtual Primary Care into two additional states for members of select Cigna + Oscar health plans. Continue Reading
-
News
28 Jul 2021
How Health Plans Successfully Implement a Digital Strategy
Effectively putting into place a digital strategy allows health plans to rethink outreach, engagement, and care management. Continue Reading