Medicare Advantage

Medicine to Feds: Back Off Prior Authorization Requirements - 08/09/2024

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.

New Medicare Advantage Rules Aim to Improve Access, Equity - 05/15/2024

Medicare Advantage enrollees soon may benefit from expanded access to outpatient behavioral health care and more equitable prior authorization policies.

CMS Finalizes 2025 Medicare Advantage Payment Rates - 04/16/2024

Despite a 0.16% reduction in base pay rate, Medicare Advantage plans are projected to see a 3.7% growth in revenue in 2025 thanks to a rising average patient risk score.

Medicare Advantage – and Disadvantage: Program Enrollment Grows Amid Physician Concerns - 04/03/2024

Despite its growing popularity among Medicare patients, Medicare Advantage is divisive among physicians.

Medicare Advantage Plans Wrongly Denied Prior Auth, Payment Requests, Fed Report Shows - 05/06/2022

About 13% of prior authorization denials in Medicare Advantage likely prevented or delayed necessary care, according to an analysis by the U.S. Department of Health and Human Services Office of the Inspector General. The report also found that nearly one-fifth of the time Medicare Advantage plans denied payment requests when the request met Medicare coverage rules and should have earned approval.

Medicare Advantage Plans - 11/17/2020

More than ten million Medicare beneficiaries currently receive their Medicare coverage through Medicare Advantage (MA); a program in which Medicare contracts with and pays private health plans to provide coverage for Medicare benefits.