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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21 Nov 2025
Urban safety-net hospitals: The unseen victims of Medicaid cuts
A Harvard analysis shows urban safety-net hospitals facing the greatest financial distress as a result of Medicaid cuts under the One Big Beautiful Bill Act. Continue Reading
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18 Nov 2025
Epic and Humana launch digital health insurance card checks
Epic's Payer Platform will now store coverage information and digital insurance cards for more than 800,000 Humana Medicare Advantage Members. Continue Reading
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20 Apr 2021
Payer Community Health Partnerships to Address Food Insecurity
More than 2,000 Blue Cross NC members are enrolled in prevention programs that address social determinants of health such as food insecurity. Continue Reading
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19 Apr 2021
Addressing Social Determinants of Health Through Improved Digital Engagement
Social determinants of health play an important role in effective digital engagement by payers. Continue Reading
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19 Apr 2021
Health Plan Differentiation: The Big Disruptor in Senior Fitness
Health plan differentiation is key to improving member satisfaction and health outcomes, especially for Medicare Advantage. Continue Reading
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14 Apr 2021
Payer, Provider Launch Wellness-Focused Medicare Advantage Plan
The partners will be focusing on wellness as much as they focus on illness and emphasized that the health plan will be provider-led. Continue Reading
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12 Apr 2021
Identifying New Opportunities for Innovation in Supplemental Benefits
Supplemental benefits will play a vital role in future benefit design to deliver benefits that members are expecting and demanding. Continue Reading
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09 Apr 2021
Cigna + Oscar Extend Small Business Health Plan Footprint
The Cigna + Oscar brand’s small business health plan will be available to employers in California as businesses flounder due to the coronavirus pandemic. Continue Reading
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08 Apr 2021
Docs Say Payers Restored Prior Authorization in COVID Second Wave
Physicians reported that prior authorization programs delayed necessary care access and lead to poor patient outcomes during COVID-19’s peak. Continue Reading
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06 Apr 2021
Wellness Programs Are A Win-Win For Cost Saving, Member Outcomes
A payer received a two-fold return on investment after implementing a wellness program that significantly improved outcomes for members with obesity. Continue Reading
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05 Apr 2021
UnitedHealthcare Medicare Advantage Dominates MA Enrollment 2021
While the Medicare Advantage space saw a burst in overall enrollment in 2021, for-profit plans—particularly UnitedHealthcare Medicare Advantage plans—drove that increase. Continue Reading
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05 Apr 2021
How COVID-19 Proved the Value of Supplemental Benefits
The public health crisis has emphasized the ability of supplemental benefits to make access to affordable essentials a reality for vulnerable populations. Continue Reading
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02 Apr 2021
Payer Provides Homebound COVID-19 Vaccine Access, Best Practices
Massachusetts has called on a payer to enlist best practices in the statewide effort to provide COVID-19 vaccine access to the homebound population. Continue Reading
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01 Apr 2021
Payers Fund Community Health Centers to Aid Population Health
Payers are seizing opportunities to fund community health centers in order to support population health management. Continue Reading
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01 Apr 2021
Health Orgs Support MA Risk Adjustment For Audio-Only Telehealth
Several healthcare organizations have united in their call for audio-only telehealth strategies to count towards Medicare Advantage risk adjustment. Continue Reading
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31 Mar 2021
How Payers Are Involved in Boosting COVID-19 Vaccine Confidence
Payers are targeting coronavirus vaccine confidence through collaborations, marketing tools, and incentive programs. Continue Reading
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30 Mar 2021
Medicare Advantage Cost Burden Is Lower Than in FFS Medicare
For low-income beneficiaries, the Medicare Advantage cost burden proved to be nearly half as prevalent as the cost burden for traditional Medicare beneficiaries. Continue Reading
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29 Mar 2021
Payers Partner with Lyft to Expand Coronavirus Vaccine Access
The two payers are partnering with local health centers and nonprofits in order to coordinate ridesharing to expand coronavirus vaccine access. Continue Reading
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29 Mar 2021
Humana, Epic Tackle Electronic Prior Authorizations, Member Data
The payer and vendor are shifting their focus to implementing an electronic prior authorization solution to reduce delays in care delivery. Continue Reading
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29 Mar 2021
Why User-Centered Design Is Crucial to Member Engagement
Member-facing tools based on user-centered design are key to effective engagement during and beyond the pandemic. Continue Reading
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26 Mar 2021
Anthem Plans to Acquire myNEXUS, Expand Home Healthcare Services
Anthem’s move echoes the payer industry’s focus on improving access to and quality of home healthcare services for seniors. Continue Reading
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25 Mar 2021
Electronic Prior Authorizations Impact Quality, Provider Burden
In order to soothe the controversies around prior authorizations, payers and providers may turn to electronic prior authorizations for faster care delivery and lower burden for providers. Continue Reading
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24 Mar 2021
How Payers Can Prepare for the Payer Price Transparency Rule
The fate of the payer price transparency rule has yet to be determined, but payers should begin preparations for compliance nonetheless. Continue Reading
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23 Mar 2021
Shared Financial Risk of Dialysis May Lead to Medicare Cost Saving
Adults on dialysis with employer-sponsored plans who switched to Medicare prematurely cost CMS $3 billion, signaling the need for shared risk. Continue Reading
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22 Mar 2021
13 Areas of Low-Value Care Spending in Medicare Advantage Plans
Although the Medicare Advantage model is frequently touted as an example for pursuing value-based care, there are multiple areas in which these plans support low-value care spending. Continue Reading
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22 Mar 2021
Achieving Holistic Care Through Effective Digital Health
Effective digital health views a person's health as much more than a doctor’s visit. Continue Reading
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19 Mar 2021
Payer Announces Virtual Care Option for Hearing Care Access
To provide greater hearing care access to members and lower out-of-pocket costs, UnitedHealthcare Hearing has introduced a virtual care capability. Continue Reading
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18 Mar 2021
Blue Cross NC Initiates Medicaid Managed Care Enrollment Period
The Medicaid managed care plan will provide beneficiaries with access to a broad provider network and social determinants of health support. Continue Reading
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17 Mar 2021
Employer-Sponsored Health Plans See Strong Member Satisfaction
Despite the coronavirus pandemic’s blow to employer-sponsored health plans, members appreciated their health plans' care coordination and prescription drug refills. Continue Reading
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16 Mar 2021
Humana Will Begin Transitioning Senior Services Into New Brand
The payer’s new brand, CenterWell, will incorporate multiple payer-agnostic services, but Humana will start by phasing-in its senior services. Continue Reading
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15 Mar 2021
Payer Eyes Health Equity With COVID-19 Vaccine Access Network
Blue Shield of California has expanded its network to cover over 1,200 COVID-19 vaccination sites, boosting vaccine access for at-risk populations. Continue Reading
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15 Mar 2021
How OTC Medicines, Supplemental Benefits Improve Care, Cost
Over-the-counter (OTC) medicines play an essential role in keeping individuals and populations healthy while, at the same, time driving down healthcare spending. Continue Reading
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12 Mar 2021
Creating Strategies to Expand Transgender Healthcare Coverage
Data collection and stakeholder communication are key, but ultimately transgender healthcare coverage is a matter of listening and acting. Continue Reading
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11 Mar 2021
NCQA Calls for Digital Quality Measures in Value-Based Care Plans
CMS should employ the use of a digital quality measure system to ensure consistent, efficient quality reporting within value-based care plans. Continue Reading
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11 Mar 2021
BCBSMA Invests in Electronic Registry for End-Of-Life Care Quality
A BCBS investment will fund the development of a Massachusetts statewide electronic registry to ensure providers deliver quality end-of-life care. Continue Reading
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10 Mar 2021
An Overview of Disruptive Payers That Filed for an IPO in 2021
Both Oscar Health and Alignment Healthcare have been disruptive payers in the health insurance world for their use of technology. Continue Reading
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09 Mar 2021
How Payers Can Take Action Against Racial Care Disparities
Racial care disparities occur throughout the healthcare system, but payers have a unique opportunity to effect change. Continue Reading
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08 Mar 2021
Rural Medicare Advantage Members Hit Care Access Snags, Switch Plans
About 10% of rural members enrolled in Medicare Advantage plans reported care access dissatisfaction in comparison to just 4.6% of nonrural beneficiaries. Continue Reading
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08 Mar 2021
Improving Member Experience with a Unified Data Platform
Data and department silos are preventing actionable intelligence into the right hands to achieve quality improvement. Continue Reading
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04 Mar 2021
AHIP, BCBSA Pilot Supports Equitable COVID-19 Vaccine Delivery
The payer organizations will enable equitable COVID-19 vaccine delivery by targeting the two million most vulnerable seniors in the US and leaning on various partnerships. Continue Reading
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02 Mar 2021
Payer Partners with CBOs to Reduce Maternal Care Disparities
BCBSIL’s approach underscores the critical role that payer partnerships with community-based organizations can play in reducing maternal care disparities. Continue Reading
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01 Mar 2021
Three Common Characteristics Among Virtual-First Health Plans
Although payers are still exploring how to best use virtual care and telehealth technologies, virtual-first health plans have started to develop a couple of consistencies. Continue Reading
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26 Feb 2021
Lower Spending Drives Senior Satisfaction with Medigap Policies
Although seniors still have concerns around affordability related to their Medigap policies, they appreciate lower out-of-pocket costs on hospital and physician services. Continue Reading
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22 Feb 2021
Top 5 Common Conditions Driving Employer Healthcare Spending
Five common conditions, most of which are chronic, fuel employer healthcare spending and can—by extension—impact payer’s spending. Continue Reading
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22 Feb 2021
Adopting a Member-Centered Approach to Digital Health Management
Payers have a real opportunity to play a meaningful role in the future of healthcare as an advocate for patients. Continue Reading
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19 Feb 2021
Humana Announces MA Chronic Disease Management, SDOH Model
Through this model, Humana seeks to improve chronic disease management for seniors with complex conditions and the payer plans to expand the program in 2021. Continue Reading
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18 Feb 2021
Payer Seeks to Lower Behavioral Health Hospital Readmissions
The payer’s new program seeks to reduce behavioral health hospital readmissions by five percent through counseling, medication management support, and case management. Continue Reading
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17 Feb 2021
Aetna to Re-Enter ACA Individual Health Insurance Marketplace
The payer has yet to finalize which markets it will join, but executives committed to re-enter the individual health insurance marketplace on January 1, 2022. Continue Reading
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16 Feb 2021
Humana, IBM Partner To Streamline Member Engagement With AI
The payer and technology company will focus on improving and personalizing member engagement, particularly engagement related to healthcare spending and benefits information. Continue Reading
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15 Feb 2021
Payer Extends COVID-19 Treatment, Telehealth Benefits Through 2021
Blue Cross and Blue Shield of Minnesota has extended COVID-19 treatment and telehealth benefits past the HHS’ public health emergency period. Continue Reading
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12 Feb 2021
How Payer Forecasting Is Shifting Towards Real-Time Data Analytics
A real-time data analytics approach demands that payers pursue full interoperability and requires a different mindset than the traditional approach has required. Continue Reading
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11 Feb 2021
Payer Aids Federally Qualified Health Centers in COVID-19 Efforts
By funneling funding towards federally qualified health centers, the payer supports local vaccination, outreach, and access to care efforts. Continue Reading
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10 Feb 2021
Payers Expect Enrollment to Offset Normalized Healthcare Spending
Payers anticipate that increased membership, lower utilization, potentially a higher federal medical assistance percentage, and other factors could offset healthcare spending as it returns to normal levels. Continue Reading
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09 Feb 2021
Payers Prepare For Costs in 2021 After COVID-19 Deferred Care
After COVID-19 drastically cut costs, payers are preparing for the coming benefit year’s costs to account for a year’s worth of deferred care. Continue Reading
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08 Feb 2021
More MA Plans Offering Benefits for Members with Chronic Diseases
More Medicare Advantage members with chronic diseases have access to food-related benefits from their health plan in 2021 than in 2020. Continue Reading
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04 Feb 2021
BCBS Introduces Value-Based, Patient-Centered Kidney Care Model
Blue Cross NC has launched a value-based care model set to improve health outcomes and member experience using patient-centered kidney care. Continue Reading
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02 Feb 2021
Consolidated Medicare Advantage Plans See Quality Improvement
Payers that consolidate Medicare Advantage plans with lower star ratings into plans with higher star ratings deliver higher quality of care for enrollees who were previously in low-rated plans. Continue Reading
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01 Feb 2021
Aetna Updates Policies to Cover Transgender Feminizing Surgeries
The payer updated its policies in response to four transgender members who came forward and demanded better access to care after their feminizing surgery claims were denied. Continue Reading
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29 Jan 2021
Experts Call For Updated Medicare Advantage Star Ratings Survey
The Medicare Advantage consumer survey requires modernization to accurately gauge member experience and promote value-based care. Continue Reading
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28 Jan 2021
Anthem Earnings Call Projects COVID-19 Vaccine Impact, ACA Growth
Anthem executives plan to focus on modernization in 2021, with an emphasis on artificial intelligence, automation, and telehealth. Continue Reading
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28 Jan 2021
Patient Navigators Call For Funding To Promote Marketplace Care Access
After marketplace cuts under the Trump administration, patient navigators are asking for funding to promote care access during a COVID-19 enrollment period. Continue Reading
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27 Jan 2021
Medicaid Expansion Helped Detect Undiagnosed HIV Infections
Improved care access led to increased detection of undiagnosed HIV infections and use of HIV prevention services in Medicaid expansion states. Continue Reading
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25 Jan 2021
How Top Payers Are Providing COVID-19 Vaccine Coverage, Support
While certain rules govern coronavirus vaccine coverage during the public health emergency, some payers are looking beyond the crisis. Continue Reading
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25 Jan 2021
Health Payer Unveils Virtual Care Plan, Telehealth Care Access
The first virtual care plan on the Texas Exchange utilizes telehealth technology to promote care access to primary and preventative services. Continue Reading
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22 Jan 2021
2021 Payer Strategies Build on Telehealth, Gene Therapy Lessons
Payers will hone their telehealth and gene therapy strategies in 2021 and will also refine their forecasting capabilities. Continue Reading
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21 Jan 2021
MA Plans See 99% Member Satisfaction Among Non-White Members
While Medicare Advantage plans saw high member satisfaction, health plans can improve member education on enrollment processes and different types of Medicare coverage. Continue Reading
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21 Jan 2021
WI Submits Medicaid Demonstration Waiver, Health Savings Account Program
The Medicaid demonstration waiver, submitted to CMS in late December, seeks to leverage health savings accounts for childless Medicaid enrollees. Continue Reading
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20 Jan 2021
UnitedHealthcare Q4 Earnings Report Shows Leveling Care Activity
The coronavirus pandemic did impact UnitedHealthcare in the fourth quarter of 2020, particularly in regards to employer-sponsored health plan membership and outpatient activity. Continue Reading
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19 Jan 2021
Payer Diversity Program Contributes $375M to Economy, Creates Jobs
Along with the supplier diversity program, Independence Health Group uses other strategies to increase workforce diversity, healthcare access, and healthcare equity. Continue Reading
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18 Jan 2021
4 Positive Trends That Continue to Define Medicare Advantage Plans
Medicare Advantage plans have diverse member populations, low member spending, high quality of care, and high enrollment growth. Continue Reading
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15 Jan 2021
UnitedHealthcare Expands Virtual Care Policy to Boost Primary Care
The payer will expand its existing virtual care service as an alternative to in-person care, extending the policy into new states in 2021. Continue Reading
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13 Jan 2021
AHIP Blasts Pharmaceutical Industry as Drug Prices Increase
The payer organization called on the incoming administration to prioritize shielding Americans from drug price increases. Continue Reading
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08 Jan 2021
Payer Expands Member Engagement Program, Digital Outreach to ACA Members
The ACA member rewards program will feature digital outreach to promote member engagement and allow the payer to ensure members have access to care. Continue Reading
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07 Jan 2021
ACHP: Access to CDC COVID-19 Vaccine Data Key to Member Engagement
The payer organization argued that claims and billing data is slow and incomplete, hindering effective member engagement for vaccine distribution. Continue Reading
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06 Jan 2021
UnitedHealth Group Plans to Acquire Change Healthcare in 2021
UnitedHealth Group’s diversified health services company, Optum, and Change Healthcare will combine to simplify healthcare data exchange, lower spending, and streamline payment. Continue Reading
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05 Jan 2021
How 3 Major Payers Extended Temporary COVID-19 Benefits into 2021
While many elements are consistent, some major payers differ on how many COVID-19 benefits they are extending and for how long. Continue Reading
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04 Jan 2021
Joint Venture To Lower Employee Healthcare Costs, Haven, Disbands
The partnership between Amazon, JPMorgan Chase, and Berkshire Hathaway to address rising employee sponsored healthcare costs is shutting down. Continue Reading
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04 Jan 2021
Centene Plans to Acquire Major Behavioral Healthcare Platform
Centene executives say that the acquisition of Magellan Health would help the payer integrate its behavioral healthcare and physical healthcare services, among other potential benefits. Continue Reading
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30 Dec 2020
Drug Wholesale Prices Impact Payer Spending, Out-of-pocket Costs
A report in JAMA shows drug wholesale list prices doubled from 2010-2016, which led to increases in payer spending and out-of-pocket costs for patients. Continue Reading
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23 Dec 2020
How Non-Profit Medicare Advantage Plans Can Improve Growth
As for-profit Medicare Advantage health plans pull ahead in enrollment growth, non-profit Medicare Advantage health plans can improve their competitiveness. Continue Reading
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17 Dec 2020
Private Payer Spending Hits $1.2T in 2019 As Spending Growth Slows
Healthcare spending in the US reached $3.8 trillion overall in the year before the coronavirus pandemic gripped the nation. Continue Reading
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17 Dec 2020
Payer Gross Margins, Medical Loss Ratios Point to a Profitable 2020
Gross margins and medical loss ratios indicated that payers continued to make a profit through the third quarter of 2020. Continue Reading
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16 Dec 2020
Payers Will Improve Virtual Care, Forecasting, Growth in 2021
After the coronavirus pandemic decimated the healthcare system in 2020, payers have the chance to rebuild and rethink their strategies around virtual care in 2021. Continue Reading
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15 Dec 2020
CareFirst Announces COVID-19 Vaccine Coverage for All Members
Shortly after the FDA approved its first emergency use authorization for a coronavirus vaccine, the payer stated it would offer coronavirus vaccine coverage. Continue Reading
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15 Dec 2020
Experts Share 5 Pivotal Payer Industry Trends To Watch in 2021
Emerging from a tumultuous year, leaders from across the industry named these five payer industry trends that payers should focus on in 2021. Continue Reading
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14 Dec 2020
Humana Announces Value-Based Primary Care Services MA Model
Humana is the only payer to expand this value-based primary care services model to all 48 contiguous states and Washington, DC. Continue Reading
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14 Dec 2020
How COVID-19 Has Renewed Focus on Health Equity and Social Determinants of Health
While social determinants of health are by no means a new concept, the pandemic continues to highlight their impact on the ability of individuals to avoid infection Continue Reading
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10 Dec 2020
Highmark Expands Partnership to Personalize Substance Abuse Care
The health plan is expanding on an existing partnership to bolster its approach to substance abuse care. Continue Reading
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10 Dec 2020
Medicare Advantage Quality of Care Surpasses Traditional Medicare
While Medicare Advantage quality of care was excellent for high-need, high-cost individuals, the plans were not as strong in cost and utilization for certain beneficiary populations. Continue Reading
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09 Dec 2020
Prescription Coverage Draws Beneficiaries to Medicare Advantage
Nearly 30 percent of respondents cited prescription coverage as their reason for selecting a Medicare Advantage plan for 2021. Continue Reading
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09 Dec 2020
How Payers Use Clinics to Boost Vision Benefits, Access to Care
Aetna sponsored a three-day vision clinic in partnership with an international vision care nonprofit to expand access to care for Atlanta residents. Continue Reading
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08 Dec 2020
BCBS Payers Support Preventative Care, Access to Vaccinations
Across the country, BCBS payers are promoting vaccinations and immunizations by improving access to preventative care with a focus on at-risk communities. Continue Reading
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08 Dec 2020
How Medicaid Managed Care Organizations Can Improve Long-Term Care
A new AHIP report shows how Managed Care Organizations can streamline care and improve quality monitoring of Medicaid enrollees, including those in long-term care. Continue Reading
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07 Dec 2020
BCBSIL Grant Promotes Preventative Care, Immunization Access
As part of an immunization initiative, BCBSIL has granted 12 organizations across Illinois up to $50,000 each to promote preventative care measures and immunization access. Continue Reading
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07 Dec 2020
How Health IT Promotes Medicare Member Caregiver Wellbeing
Regence health plans announced a health IT partnership that promotes independent living by providing home healthcare for Medicare members and support for caregiver wellbeing. Continue Reading
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04 Dec 2020
3 Payers Rank Among the Top 25 Employers for COVID-19 Response
The companies were ranked based on policies such as sick leave adaptations and community relief donations to determine their coronavirus response. Continue Reading
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02 Dec 2020
How COVID-19 May Impact MA Risk Scores, Payments in 2022, 2023
Medicare Advantage risk scores might not see the effects of coronavirus-related deferred care until contract year 2023. Continue Reading
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30 Nov 2020
Payer Minimizes Member Healthcare Spending With Health Rewards
Ambetter has minimized healthcare spending for hundreds of thousands of members through a program that incentivizes member engagement with rewards. Continue Reading
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30 Nov 2020
Employer-Sponsored Health Costs Rise, Call For ACA Expansion
Continued increases to premium contributions and deductibles for employer-sponsored health plans could further burden struggling families. Continue Reading
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27 Nov 2020
How Copayment, Coinsurance Impact Member Healthcare Spending
As employers search for new ways to control and reduce healthcare spending, copayments and coinsurance may be useful tools for particular healthcare services. Continue Reading
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24 Nov 2020
ACA Marketplaces Gain Payers in 2021, Rural Areas Still Struggle
Although the Affordable Care Act marketplaces are increasing payer participants overall, rural counties still face challenges in drawing more payer competition. Continue Reading
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23 Nov 2020
ACHP: Solidify Telehealth Flexibilities, COVID-19 Test Funding
The Alliance of Community Health Plans urged Congress to consider making telehealth flexibilities more concrete and increasing federal burden for coronavirus testing coverage. Continue Reading