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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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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11 Nov 2020
ProMedica Accused of Anti-Trust Actions, 50% Market Domination
ProMedica called lawsuit “frivolous” that alleged anti-trust activity resultant from McLaren’s acquisition of St. Luke’s. Continue Reading
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11 Nov 2020
Fewer MA Plans See High Medicare Advantage Star Ratings in 2021
If enrollment were to stay the same, fewer beneficiaries would end up in plans with higher Medicare Advantage Star Ratings compared to 2020. Continue Reading
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10 Nov 2020
Anthem Blue Cross Adds Providence to Value-Based Care Health Plan
First joint-venture between health system and health plan in the country set to enhance value-based care, streamline healthcare system experience. Continue Reading
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09 Nov 2020
BCBS of Louisiana Promotes Mental Health Services, Telehealth Appointments
Noting the unique stressors of 2020, BCBS of Louisiana fosters access to care using telehealth and virtual resources to support mental health. Continue Reading
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09 Nov 2020
Medicare Advantage Faces Sicker Population, Lower Payments in 2021
Medicare Advantage plans will need to brace themselves for anywhere from four to six percent lower payments and higher healthcare costs due to deferred care. Continue Reading
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09 Nov 2020
UnitedHealthcare Targets Children’s Eye Health, New Vision Benefits
As screen time increases with remote learning, UnitedHealthcare has expanded vision benefits for eligible dependents under the age of 19. Continue Reading
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06 Nov 2020
BCBSIL Pursues Health Equity With Pilot Program And Diversity Institute
The New Health Equity Hospital Quality Incentive Pilot Program will collectively provide $100 million in funding to participating hospitals. Continue Reading
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05 Nov 2020
BCBSA Settles Anti-Trust Litigation for $2.7B, Anthem Pays 22%
Blue Cross Blue Shield Association will distribute $2.7 billion to qualifying policyholders to end an anti-trust lawsuit. Continue Reading
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26 Oct 2020
Safeguarding Employees Through the Uncertainty of COVID-19
With workplaces welcoming back employees, employers and payers must ensure that work environments are safe and staff has timely and convenient access to care. Continue Reading
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23 Oct 2020
Top 5 Social Determinants of Health Domains for Payers to Address
To employ a comprehensive social determinants of health approach, payers can devise innovative solutions that tackle each of the five social determinants of health domains. Continue Reading
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21 Oct 2020
34% Medicare Advantage Plans Will Offer COVID-19 Benefits in 2021
Medicare Advantage plans are increasingly offering telehealth as a basic Medicare benefit, instead of a supplemental benefit, the study indicated. Continue Reading
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20 Oct 2020
Employer Sponsored 2020 Out-of-Pocket Costs Were Stable Pre-COVID
Premiums and deductibles for employer-sponsored health plans continued their upward trajectory in 2020, with average premiums for single and family coverage rising four percent each. Continue Reading
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19 Oct 2020
Surveys, Advanced Analytics Key for Member Experience, Star Ratings
Since Medicare Advantage Star Ratings are leaning more heavily on member experience in the coming years, payers will need to bolster their assessment tools. Continue Reading
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15 Oct 2020
Medicare Advantage Gross Margins Rise 41% Over 2019 Margins
Medicare Advantage average gross margins are the highest that they have ever been, increasing by on average $64 per member per month over June 2019 levels. Continue Reading
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15 Oct 2020
AMA: 56% Increase in Payer Market Consolidation In Past 5 Years
The American Medical Association found that payer market consolidation has been widespread across all markets and increasing. Continue Reading
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13 Oct 2020
Medicare Advantage HMOs Remain Popular in 2021 Open Enrollment
Medicare Advantage health maintenance organizations (HMOs) draw the largest percentage of Medicare enrollment, at 15.2 million enrollees. Continue Reading
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12 Oct 2020
21 Part D Plans Rank Tops in 2021 Medicare Advantage Star Ratings
The 2021 Medicare Advantage Star Ratings add to the positive narrative around the Medicare Advantage program as quality of care increases and accessibility continues to be strong. Continue Reading
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12 Oct 2020
Integrated Mental Health Strategies: A Right-Sized Approach to 2021
Promoting mental health strategies is a “win-win” proposition for members and a business’s bottom line, especially during a public health crisis. Continue Reading
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07 Oct 2020
Open Enrollment 2020 Marks Shift Toward Virtual Member Engagement
Due to social distancing restrictions, broker and member engagement during 2020 Medicare open enrollment will look very different than previous years. Continue Reading
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06 Oct 2020
Payer-Provider Partners Tap Telehealth for Behavioral Health Access
The need for behavioral health services skyrocketed since the start of the COVID-19 pandemic. Payer-provider partnerships will be critical to maintaining these services throughout the pandemic and after. Continue Reading
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01 Oct 2020
MA Payers Focus on Cutting Out-of-Pocket Costs, Home Health in 2021
Three major Medicare Advantage payers emphasized lower out-of-pocket costs for home healthcare telehealth benefits, premiums, and prescriptions. Continue Reading
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22 Sep 2020
Employer-Sponsored Healthcare Coverage Fell by 3.3 M, 2M Uninsured
The report’s findings corroborate previous findings about the impact of Medicaid expansion and how employer-sponsored healthcare coverage losses are deepening racial disparities. Continue Reading
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21 Sep 2020
Payers Begin To Pay Individual, Small Group Rebates Amid COVID-19
BlueCross BlueShield of Tennessee and Cigna will pay out individual and small group rebates to 143,000 members. Continue Reading
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16 Sep 2020
MA Plan Uses Home Healthcare to Manage Multiple Chronic Diseases
Aetna’s program aims to help Medicare Advantage members with multiple chronic diseases through preventive care and at-home services. Continue Reading
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15 Sep 2020
Two Blues Partner with Providers to Launch New Health Plans
In New Jersey and Wisconsin, Blues are partnering with local providers on new health insurance ventures. Continue Reading
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14 Sep 2020
Humana Launches Two More Value-Based Program for Specialty Care
Models focused on heart and shoulder surgery join four other value-based programs for specialty care. Continue Reading
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14 Sep 2020
How an Innovative User Experience Streamlines Care Access, Cost
Effective virtual care technology is able to streamline access to high-quality care at a lower cost by focusing on user experience. Continue Reading
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02 Sep 2020
Payer Seeks to Democratize Social Determinants of Health Data
Blue Shield of California’s new partnership aims to make regional social determinants of health data available to all in order to assist healthcare reforms. Continue Reading
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01 Sep 2020
Neither Anthem, Cigna to Receive Damages in Merger Disputes
Anthem and Cigna’s merger dispute ends with the court deciding that neither of the major payers should receive any form of payment from the other for all their troubles. Continue Reading
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01 Sep 2020
New Aetna Health Plan Leverages CVS HealthHUBs, Narrow Networks
The narrow network health plan will incorporate lower cost sites of care and will offer premiums that Aetna projects will be 20 percent lower than its PPO competitors. Continue Reading
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27 Aug 2020
Verily Launches Tech-Focused Payer for Self-Funded Employers
The life sciences and healthcare company will join forces with a Switzerland-based insurer to launch the new product for self-funded employers. Continue Reading
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26 Aug 2020
Aetna Fined $500,000 for Denying Emergency Room Claims in CA
The payer denied 93 percent of the emergency room claims that California investigated, underscoring that surprise billing remains a relevant issue during the coronavirus pandemic. Continue Reading
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25 Aug 2020
Hits to Employer-Sponsored Insurance May Affect Healthcare Jobs
In an industry that relies heavily on employer-sponsored insurance to cover its income, unemployment and loss of insurance could become a serious economic feedback loop. Continue Reading
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24 Aug 2020
Dispelling the Most Common Myths About Virtual Care
Virtual care is changing patient access to care, but choosing the right modality goes a long way toward increasing utilization and satisfaction Continue Reading
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13 Aug 2020
Sentara Healthcare, Cone Health Announce Value-Based Care Merger
The integrated health systems’ value-based care merger continues a trend of slow but continued mergers and acquisitions in the first half of 2020 despite the pandemic. Continue Reading
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12 Aug 2020
AHIP Responds to Lawmaker Questions on Payer COVID-19 Profits
The House Committee on Energy and Commerce will conduct an investigation into coronavirus testing coverage as well as how payer COVID-19 profits are being returned to the consumer. Continue Reading
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11 Aug 2020
Dawn of the Virtual Medicare Advantage Plan from Alignment Health
The virtual Medicare Advantage plan incentivizes employing virtual care combined with personal interaction from concierge care and service. Continue Reading
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04 Aug 2020
WellCare Offers SDOH Support for Seniors Through End of 2020
WellCare’s new partnership highlights both the continued need for social determinants of health support and the varied timelines of payer coronavirus-related programs. Continue Reading
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04 Aug 2020
Oscar Health Product Gives Members Free Virtual Care, Telehealth
The free virtual care and telehealth services—among other services—aim to lower healthcare spending for Oscar Health members. Continue Reading
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03 Aug 2020
Humana Tackles CKD Through Home Healthcare, Care Coordination
The payer has further expanded its chronic kidney disease management program to extend home healthcare and care coordination to Medicare Advantage members. Continue Reading
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27 Jul 2020
High Deductible Health Plan Enrollees Need Better HSA Education
With so many high deductible health plan enrollees not using their health savings accounts, employers and health plans can do a better job of member education. Continue Reading
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27 Jul 2020
COVID-19 May Impact Employer-Sponsored Plans Less Than Expected
Researchers found that the negative effects to employer-sponsored plans may be lower than expected and predicted the churn within and between markets in the health payer industry. Continue Reading
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23 Jul 2020
Payers Turn to In-Home Screening Kits for Chronic Preventive Care
Since some chronic preventive care services can only be done physically and not via telehealth, payers are designing kits for members to test themselves. Continue Reading
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23 Jul 2020
Payers Split on Factoring COVID-19 into 2021 Premium Rates
The 63 filings that have been made public shed some light on payers’ justifications for whether to consider coronavirus when setting 2021 premium rates. Continue Reading
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22 Jul 2020
Payer Helps Employers Recognize, Address Workforce Mental Health
Independent Health’s partnership aims to help employers identify workforce mental health conditions and navigate subsequent, sensitive conversations. Continue Reading
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22 Jul 2020
Molina Healthcare to Acquire Passport Health Plan Medicaid Plans
The acquisition is taking place in the aftermath of a heated Medicaid managed care contract dispute in which Passport Health Plan lost its managed care contract. Continue Reading
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16 Jul 2020
UnitedHealth Group’s Q2 Report Reveals Payer Progress, Priorities
The report starts providing answers to some of the questions payers faced at the end of the first quarter and outlines payer progress and priorities going forward through COVID-19. Continue Reading
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15 Jul 2020
Payer Fuses Value-Based Care, Support Payments for Small Practices
Blue Cross Blue Shield of Massachusetts is launching a new payment model for small practices that combines value-based care and support payments. Continue Reading
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14 Jul 2020
Walmart Forays Into Medicare with Walmart Insurance Services LLC
The retailer has been tight-lipped about the move but may be interested in selling Medicare plans through its new insurance arm, Walmart Insurance Services LLC. Continue Reading
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13 Jul 2020
Private Payer COVID-19 Reimbursement Rates Are Twice Medicare Rates
Even with the 20 percent boost in Medicare payments from the CARES Act, payers pay 1.8 to 2.1 times the Medicare rate for services related to coronavirus treatment. Continue Reading
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03 Jul 2020
Humana Ups COVID-19 Testing With At-Home, Drive-Thru Testing
The health payer will provide at-home or drive-thru COVID-19 testing for members who are displaying symptoms of or at-risk for the disease. Continue Reading
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02 Jul 2020
Vision Care Plans Generate High Member Satisfaction, Low Costs
Overall, 72 percent of patients reported that they were satisfied with their vision care plans, citing discounts and savings. Continue Reading
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29 Jun 2020
Tufts Health Plan Expands Substance Abuse Care Coverage
The partnership will expand coverage for substance abuse care at a time when mental and behavioral healthcare programs are in high demand. Continue Reading
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29 Jun 2020
Anthem Skill Uses AI, Alexa For Medication Adherence, Engagement
The artificial intelligence virtual assistant helps improve medication adherence and member engagement through 24/7, personalized service. Continue Reading
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25 Jun 2020
4 Health Benefits That Are Valuable to Small Businesses
Small businesses indicated four types of health benefits that they value, including nontraditional benefits. Continue Reading
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25 Jun 2020
Medicare Advantage, Part D ERSD Rules Could Boost Costs
With the 2021 Medicare Advantage and Part D rule finalized, payers may need to prepare for higher Medicare Advantage spending due to new ESRD enrollees. Continue Reading
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24 Jun 2020
CVS Health Gives Employers Access to COVID-19 Testing Solutions
The COVID-19 testing solutions embrace both on-site and off-site testing and leverage data analytics and integrated technology. Continue Reading
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24 Jun 2020
Telehealth May Help Payers Control Uncertain Healthcare Spending
Many factors driving healthcare spending, including mental healthcare utilization and specialty drug spending, are wild cards, but there are some factors that payers can control. Continue Reading
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23 Jun 2020
AMA: Payers Did Not Fix Prior Authorization, Cut Provider Burden
The American Medical Association called for federal action in response to the payer failure to fix prior authorization. Continue Reading
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23 Jun 2020
How Payers Can Improve Member Engagement by Partnering with Members
Strong partnership with members is key to member engagement and member satisfaction, a recent JD survey found. Continue Reading
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22 Jun 2020
Cigna, Priority Health Form Strategic Alliance For Employer Plans
The strategic alliance will focus on offering broader access to care and streamlining previous areas of partnership. Continue Reading
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22 Jun 2020
How Payers Scale Social Determinants of Health Goals
Humana’s Bold Goal program highlights ways that payers can scale their social determinants of health strategies across lines of business and demographics. Continue Reading
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19 Jun 2020
Blues Plans Highmark, HealthNow New York Announce New Affiliation
The non-profit Blues plans announced an “affiliation agreement” that will make Highmark Health the primary licensee of some of HealthNow’s services areas in New York. Continue Reading
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18 Jun 2020
4 Ways Payers Can Invest In Mental and Behavioral Healthcare
As payers try to meet the demand for mental and behavioral healthcare services, some put their support behind existing provider and public trainings, call centers, and hotlines. Continue Reading
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18 Jun 2020
Private Payers Face More Medicaid Competition on ACA Marketplaces
Contrary to expectations, Medicaid competition is surging on the marketplaces as differences between private payer and Medicaid payer plans diminish. Continue Reading
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17 Jun 2020
How To Scale A Telehealth Strategy: Pilots, Providers, and Payment
Blue Shield of California’s Health Reimagined initiative models a new way for payers to scale a telehealth strategy. Continue Reading
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17 Jun 2020
COVID-19 Spotlights 3 Payer Telehealth Expansion Challenges
Payer telehealth strategies face the challenges of determining coverage for new and different sites of care and technologies as well as state and federal regulatory boundaries. Continue Reading
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16 Jun 2020
High Deductible Health Plans Create Cost-Related Barriers to Care
Among other things, providers said that high deductible health plans cost patients and providers hours of rearranging schedules and delayed care. Continue Reading
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16 Jun 2020
Payers Support Dental Partners With Stipends, Boost Teledental Care
As dental partners struggle to make ends meet due to coronavirus, payers are offering direct support through stipends and exploring teledental coverage. Continue Reading
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12 Jun 2020
BCBS Deal Collaborates to Gather Population Health Data
BCBSRI and its behavioral healthcare provider partner are working together to collect and leverage population health data in Rhode Island. Continue Reading
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11 Jun 2020
4 Payer Data Points That Demonstrate Behavioral, Mental Care Parity
Experts are calling on health plans to be more transparent about behavioral and mental care parity by self-reporting these four data points. Continue Reading
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10 Jun 2020
Payer COVID-19 Healthcare Spending for 2020, 2021 May Hit $546.6B
Although the payer COVID-19 healthcare spending estimates are still uncertain, experts projected that delayed care might decrease costs. Continue Reading
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05 Jun 2020
Beyond COVID-19: Telehealth, Partnerships, Member Engagement
Payers have been on the frontline of COVID-19 response efforts, but now plan leaders are grappling with how to handle telehealth, partnership, and member engagement in a post-pandemic world. Continue Reading
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05 Jun 2020
Inaccurate Provider Directories May Spark Surprise Medical Bills
Patients seeking mental healthcare support may find themselves hit with surprise bills due to inaccurate directory information. Continue Reading
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04 Jun 2020
MA Risk Adjustment Should Include Audio-Only Telehealth Diagnoses
As COVID-19 motivates more audio-only telehelath utilization, audio-only telehelath diagnoses should count toward Medicare Advantage risk adjustment. Continue Reading
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03 Jun 2020
Out-of-Pocket Insulin Costs Stagnant for Commercial Members
Out-of-pocket insulin costs remained steady for commercial members while the overall price soared and other plan types experienced higher costs. Continue Reading
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03 Jun 2020
BCBS Companies Hold Almost 50% of Market Share on ACA Marketplaces
The main competitor for Blue Cross Blue Shield companies is typically not national or regional payers, but rather Medicaid managed care health plans. Continue Reading
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02 Jun 2020
COVID-19 Healthcare Spending Hinges On Hospitalization Rates
While mortality has virtually no impact on COVID-19 healthcare spending, halving hospitalizations could nearly halve the overall healthcare cost of the pandemic. Continue Reading
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02 Jun 2020
Subsidizing COBRA Could Boost Enrollment, Cut Uninsurance
Without subsidizing COBRA, the health insurance option is not in high demand due to costs and enrollment procedures, although enrollees enjoy broader provider networks. Continue Reading
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01 Jun 2020
Cigna Care Card Lets Employers Support Members During COVID-19
The Cigna Care Card gives tax-free funds to members for qualifying purposes related to the coronavirus pandemic. Continue Reading
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28 May 2020
15 Payers File on WA Individual Health Insurance Marketplace
The fifteen payers filed over 180 plans on the individual health insurance marketplace as unemployment drives more consumers to the ACA exchange. Continue Reading
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27 May 2020
Claims May Rise in 2 to 3 Months As Patients Seek Deferred Care
The awaited rise in non-urgent and elective deferred care may occur in the next couple of months as patients emerge from quarantine. Continue Reading
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26 May 2020
Payers Assist States in Contact Tracing, Despite Consumer Distrust
As states accept payer support in managing the contact tracing workload, consumers express distrust in payers’ ability to preserve their anonymity in app-based contact tracing. Continue Reading
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22 May 2020
Mental Health Visits Take Majority of 1M Payer Telehealth Claims
Blue Cross Blue Shield of Massachusetts shared some of its telehealth claims data from the past nine weeks and found a strong demand for remote mental healthcare. Continue Reading
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21 May 2020
Centene Emphasizes MA Wellness Care, Waives Healthcare Costs
Payer efforts to support Medicare Advantage members getting back on their feet emphasize primary care, behavioral healthcare, telehealth, and social determinants of health. Continue Reading
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19 May 2020
How Payers Make Wellness Programming Available Despite COVID-19
Blue Cross and Blue Shield of Rhode Island and other payers are relying more heavily on digital solutions for wellness programming during COVID-19. Continue Reading
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19 May 2020
UnitedHealth Group Offers Remote, Low Cost Access to Eyewear
The announcement comes as eyewear purchases and other vision care benefits take a hit due to social distancing restrictions. Continue Reading
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14 May 2020
Healthcare Spending Boost to Come for Private Insurance Members
While many privately insured members expect to increase their healthcare spending due to coronavirus, almost an equal amount say they will skip their annual exam. Continue Reading
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14 May 2020
Payers Offer Premium Credits for Cash-Strapped Members, Employers
Priority Health offers premium credits to members and employers as many struggle financially during the coronavirus pandemic. Continue Reading
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12 May 2020
How Payer SDOH Investments Balance COVID-19 Relief Versus Recovery
Humana’s $50 million COVID-19 relief and recovery funding provides insight on the challenges of supporting community partners during the uncertainties of pandemic. Continue Reading
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11 May 2020
How Medicaid Managed Care Plans Address SDOH, Expand Care Access
Medicaid managed care plans are creating innovative solutions in telehealth, social determinants of health, and access to care, says AHIP. Continue Reading
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11 May 2020
BCBSM, Humana Waive Medicare Advantage Costs as States Reopen
Payers focus on covering primary care visits, mental and behavioral healthcare, and enabling Medicare Advantage members to adapt to the post-pandemic world. Continue Reading
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05 May 2020
$820M Payer Acquisition Boosts Medicaid Portfolios Amid COVID-19
Molina is using the deal to expand its Medicaid and Medicare portfolios as coronavirus drives Medicaid enrollment higher. Continue Reading
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04 May 2020
The Building Blocks of an Effective Coronavirus Response Strategy
The coronavirus pandemic has forced payers to leverage strategies for engaging members, providers, employees, and the community to fight COVID-19. Continue Reading
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30 Apr 2020
AHIP Releases COVID-19 Priorities as States Consider Re-Opening
The priorities outline health plan commitments to providers, patients, and the general public as the coronavirus pandemic continues and some states are re-opening. Continue Reading
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30 Apr 2020
BMA: CMS Should Lessen Medicare Advantage 2021 Bid Uncertainty
Better Medicare Alliance called on CMS to exclude vaccine costs, use 2019 data, and reduce normalization factors for Medicare Advantage plans. Continue Reading
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29 Apr 2020
BCBS MA Deploys Employees for Contact Tracing, Staffing Support
Blue Cross Blue Shield of Massachusetts has committed over 100 employees to coronavirus-related efforts, including contact tracing and supplementing healthcare staff. Continue Reading
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28 Apr 2020
Payers Slated to Pay $2.7B in Medical Loss Ratio Rebates in 2020
Private payers are on track to pay more than double last year’s record high of medical loss ratio rebates to beneficiaries, Kaiser Family Foundation reports. Continue Reading
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27 Apr 2020
How Population Health Tactics Fortify COVID-19 Member Engagement
Population health management is key to identifying, segmenting, and reaching members with effective member engagement during coronavirus. Continue Reading
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26 Apr 2020
Key Fixes to NY Commercial Payer Exchange to Ease New Enrollment
UHF outlines key changes for the New York off-exchange marketplace that will help consumers who have lost their jobs shop for commercial coverage directly from payers. Continue Reading