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Medicare Advantage Plans Offer Bundled Coverage and Additional Benefits for 2027

Medicare Advantage Plans Offer Bundled Coverage and Additional Benefits for 2027

Medicare Advantage, also known as Medicare Part C, provides an alternative to Original Medicare by bundling hospital, medical, and often prescription drug coverage into a single plan offered by private insurers. These plans are required to cover all services included in Original Medicare (Parts A and B) and frequently add extra benefits such as dental cleanings, vision exams, and hearing aids. Unlike Original Medicare, Medicare Advantage plans include an annual out-of-pocket maximum, capping the amount beneficiaries pay for covered medical care each year. While beneficiaries continue to pay their standard Part B premium, some Advantage plans may offer a partial rebate. Plans vary by insurer and ZIP code regarding benefits, costs, and provider networks. Most plans operate with specific networks of doctors and hospitals, and some may require referrals for specialists or prior authorization for certain services. The Centers for Medicare & Medicaid Services (CMS) sets federal limits for these plans, including ...
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Humana Rebounds in Medicare Advantage Star Ratings, Potentially Unlocking $4.8 Billion in Bonuses

Humana Rebounds in Medicare Advantage Star Ratings, Potentially Unlocking $4.8 Billion in Bonuses

Humana Rebounds in Medicare Advantage Star Ratings, Potentially Unlocking $4.8 Billion in Bonuses
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Boise Cascade to Acquire Two Taiga Distribution Centers in California

Boise Cascade to Acquire Two Taiga Distribution Centers in California

Boise Cascade to Acquire Two Taiga Distribution Centers in California
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Independence Blue Cross Offers Discounts on Connected Fitness Equipment

Independence Blue Cross Offers Discounts on Connected Fitness Equipment

Independence Blue Cross Offers Discounts on Connected Fitness Equipment
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Medicare Does Not Cover Long-Term Custodial Care, Highlighting Planning Gap for Beneficiaries

Medicare Does Not Cover Long-Term Custodial Care, Highlighting Planning Gap for Beneficiaries

Medicare generally does not cover long-term custodial care, which includes assistance with daily activities such as bathing, dressing, eating, or using the bathroom, when this is the primary type of care needed. While Medicare Part A may cover a limited stay in a skilled nursing facility for up to 100 days per benefit period, this is only under specific conditions, such as following a qualifying hospital stay of at least three days, and for medically necessary services like physical therapy or skilled nursing. This coverage is intended for short-term recovery and rehabilitation, not for ongoing custodial care. Many people mistakenly assume Medicare will cover extended nursing home stays, leading to significant financial surprises. Medicare Advantage plans may offer limited supplemental benefits for in-home support, but these are typically not equivalent to comprehensive long-term care coverage.
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Nebraska Total Care Updates Medicaid Claims Adjudication for Applied Behavior Analysis Services

Nebraska Total Care Updates Medicaid Claims Adjudication for Applied Behavior Analysis Services

Effective February 1, 2027, Nebraska Total Care will implement updates to its claims adjudication processes for Applied Behavior Analysis (ABA) services under Heritage Health (Medicaid). This change aims to align claims processing more closely with the Medicaid ABA Service Definition for procedure codes 97153, 97154, and 97158. The update ensures that authorized units for ABA services will be matched to weekly utilization service definition guidelines. Claims submitted with units exceeding the authorized weekly amount will be denied for the excess units. However, cases approved for medical necessity that require service units beyond standard guidelines will be adjudicated in accordance with those specific authorizations. This enhancement does not alter the existing medical necessity determination or authorization requirements but rather refines how approved authorizations are applied during claims processing to ensure accuracy and consistency with issued approvals.
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Humana lifts annual profit forecast as medical costs ease

Humana lifts annual profit forecast as medical costs ease

By Sneha S K and Christy Santhosh Nov 6 (Reuters) - Humana raised its full-year profit forecast on Friday after reporting lower-than-expected medical costs as the health insurer positions itself for a return to improved profit margins by 2028, sending its shares up 3.2% in morning trading.
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Attorney General Jeff Jackson Announces $40 Million Multistate Settlement with Ahold Delhaize Over Prescription Drug Pricing

Attorney General Jeff Jackson Announces $40 Million Multistate Settlement with Ahold Delhaize Over Prescription Drug Pricing

Attorney General Jeff Jackson announced that North Carolina will receive $503,460 as part of a $40 million multistate settlement with Ahold Delhaize. The settlement resolves allegations that the company's supermarkets, including Food Lion, Giant, Hannaford, and Stop and Shop, reported inflated prescription drug prices to Medicare Part D, Medicaid, and TRICARE. According to the North Carolina Department of Justice, these alleged actions caused the insurance companies to pay more than they should have. The supermarkets reportedly offered discounted prices to these programs but allegedly failed to report those prices as their usual and customary prices when submitting claims. This settlement follows a whistleblower lawsuit filed in federal court in Pennsylvania, with the North Carolina Department of Justice collaborating with other state and federal agencies to investigate the case and negotiate the resolution.
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Humana Exceeds Q3 Earnings and Revenue Forecasts, Boosts Full-Year Guidance

Humana Exceeds Q3 Earnings and Revenue Forecasts, Boosts Full-Year Guidance

Humana Exceeds Q3 Earnings and Revenue Forecasts, Boosts Full-Year Guidance
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States Urged to Expand Substance Use Disorder Treatment for Pregnant Individuals

States Urged to Expand Substance Use Disorder Treatment for Pregnant Individuals

A new report emphasizes the critical need for states to expand and integrate substance use disorder (SUD) treatment with obstetrics and gynecologic care for pregnant individuals. Untreated SUD during pregnancy can lead to severe health consequences for both the parent and infant, including premature birth, low birth weight, stillbirth, fetal alcohol spectrum disorders, and neonatal opioid withdrawal syndrome (NOWS). Unintentional overdose is also cited as the leading cause of maternal death. The report highlights successful integrated care models in Indiana and Oregon, such as the Indiana Pregnancy Promise Program and Project Nurture, which combine SUD treatment with maternity care, offering services like medication for opioid use disorder (MOUD) and contingency management. These programs have shown positive outcomes, including increased postpartum care engagement and reduced foster care placements for infants. The report also advocates for strengthening community-based support through health workers, peer...
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APRIL International Addresses Rising Healthcare Costs to Maintain Access to Quality Care

APRIL International Addresses Rising Healthcare Costs to Maintain Access to Quality Care

APRIL International Addresses Rising Healthcare Costs to Maintain Access to Quality Care
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Humana Raises 2026 Earnings Forecast Amid Strong Medicare Advantage Enrollment and Favorable Costs

Humana Raises 2026 Earnings Forecast Amid Strong Medicare Advantage Enrollment and Favorable Costs

Humana Raises 2026 Earnings Forecast Amid Strong Medicare Advantage Enrollment and Favorable Costs