Elevance Health is suing CMS over its 2026 Medicare Advantage star ratings, arguing the agency gave competitor Clover Health a favorable recalculation after losing a court case to the insurer in May.

Longevity Health has earned a 5-star Medicare Advantage rating for its New Jersey Institutional Special Needs Plan, giving the payer its third 5-star contract following CMS’s recalculation of 2026 ...

Nine insurers have announced they will stop offering ACA marketplace plans, either nationally or in specific states, after the 2026 plan year. The withdrawals come amid declining enrollment nationwide ...

The ground is shifting beneath the healthcare industry, and payers know it. With federal Medicaid funding under scrutiny, enhanced ACA subsidies expired, value-based care models continuing to evolve, ...

CareFirst BlueCross BlueShield has filed a federal racketeering lawsuit against a Maryland insurance broker and his brother, alleging the pair fraudulently enrolled overseas clients in health plans ...

Commercial health plans are facing the steepest single-year cost increase in 17 years, with the group market trend projected to reach 9% in 2027, according to PwC’s annual medical cost trend report ...

Regence (Cambia Health Solutions): The four Regence plans reported results by net margin rather than dollar net income, so they are not directly comparable to the dollar figures above. Regence Blue ...

Federal enforcement around Medicare Advantage risk adjustment and billing has ramped up over the past two years, producing multimillion-dollar settlements with insurers, provider groups, and the ...

In fiscal year 2024, Medicare Advantage patients remained in the hospital 11.2% longer on average than those in traditional Medicare, according to a June 15 report from the Medicare Payment Advisory ...

CMS elevated Clover Health’s Medicare Advantage star rating from 3.5 to 4.5 for its largest contract, according to a June 9 regulatory filing. Clover’s PPO covers 97% of its members, and the ...

The Fourth Circuit Court of Appeals ruled that skilled nursing facility operators facing civil monetary penalties from CMS have no constitutional right to a jury trial. Here is what to know. 1. The ...

MultiPlan, now rebranded as Claritev, has been at the center of multiple sprawling legal challenges regarding its repricing tools. While some battles have been ongoing, others are just gaining steam.