Insurance

In 2021, UnitedHealth Group received 42% of the $33 billion in additional Medicare Advantage payments from differential coding.

This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.

Prior authorizations create substantial administrative and financial burdens on physicians and patients and can disrupt the continuity of care.

Best practices can help MA plans improve their Star Ratings performance while allow for strategies for medication adherence to grow.

The researchers emphasized the need for ongoing research and advocacy to further address drug affordability.

Tenacious efforts at every level, from the individual clinician to the hospital to the state to Congress, will be needed to make sure patients can access life-saving gene therapies for neuromuscular diseases.

Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.

Michael Chernew, PhD, professor of health care policy and director of the Healthcare Markets and Regulation Lab, Harvard Medical School, shares how cost-sharing policies shape access to critical health care services and influence value-based insurance design.

The second Trump administration is expected to bring changes to Medicaid, Medicare Advantage, and the health insurance exchanges, as well as highlight the Make America Healthy Again (MAHA) movement, speakers at the Value-Based Insurance Design Summit said.

Flood exposure was more strongly associated with increased health care use and cost during the summer months and among Medicare beneficiaries aged 85 or older.

A new report shows most Americans believe the government is too involved in health care regulation and want to see a ban on pharmaceutical company advertisements in the US.

Older, generic medications, including ones for cyclosporine, nicotinamide, and dapsone, can effectively treat patients with various dermatological conditions while helping to reduce insurance and cost barriers.

Thy N. Huynh, MD, FAAD, Bruce A. Brod, MHCI, MD, FAAD, and Melissa Piliang, MD, FAAD, discussed expanding access to pediatric dermatology, dermatology data aggregation, and advocacy for Medicare physician payment reform, respectively.

Information on health equity was removed by the federal government for both the Children’s Health Insurance Program and Medicaid.

Enhanced premium tax credits (PTCs) have made marketplace health insurance more affordable, and eliminating them could have sweeping impacts on consumers and the health care industry, according to a new report.

In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.

Expanding coverage and access to glucagon-like peptide-1 (GLP-1) medication can be beneficial for all with the cooperation of multiple parties in health care.

The Health Insurance Disparities Index allows stakeholders to assess progress in addressing health care disparities using publicly available, validated, reported health plan quality metrics results.

Medicare Advantage (MA) plans, with fixed payments based on medical complexity, incentivize aggressive coding of comorbidities, potentially inflating costs for the federal government, according to Andrew S. Oseran, MD, MBA, MSc, of Beth Israel Deaconess Medical Center.

Delays in receiving coverage for essential medications like insulin and albuterol can worsen symptoms, increase costs, and add stress for patients.

Building trust with patients who are dually eligible for Medicaid and Medicare can help to improve their lives as they navigate receiving care to address their clinical and behavioral health needs.

Of the surveyed physicians, 93% reported that prior authorization delays patient care, and 89% said it contributes to burnout.

These findings support the claim that Medicare Advantage (MA) payments may be driven more by diagnosis and coding practices rather than differences in disease burden between MA and fee-for-service (FFS) Medicare beneficiaries.

Higher telemedicine adoption among Medicare beneficiaries was associated with a slight increase in total visits but a reduction in certain low-value tests and related spending.

The rising frequency of natural disasters due to climate change could make health plans more susceptible to significant negative effects, according to Maria DeYoreo, PhD, of RAND Corporation.

The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.

The study found no evidence that geographically limited disasters significantly reduced annual quality performance scores, highlighting the resilience of these programs.

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.

The House budget includes cutting $880 billion from programs under the House Energy and Commerce Committee's jurisdiction, which include Medicaid.