The Centers for Medicare & Medicaid Services (CMS) recently released the Final Rate Announcement for Calendar Year (CY) 2025. The announcement finalized a payment increase of 3.7% over CY 2024, which (as we previously reported) represents no significant change from…

THE PRESSURE IS ON TO PROTECT EXISTING ENROLLMENT WHILE DEMONSTRATING BETTER VALUE FOR BENEFICIARIES IN MEDICARE ADVANTAGE PLANS. The Centers for Medicare & Medicaid Services (CMS) released the 2025 Advance Notice on January 31, 2024, prompting Medicare Advantage organizations (MAOs)…

Reprinted with AIS Health permission from the Oct. 19 issue of Radar on Medicare Advantage Leading up to the Oct. 15 start of the Medicare Annual Election Period (AEP), news reports across the U.S. have depicted down-to-the-wire disputes between Medicare…

Introduction The recent publication of 2024 Medicare Advantage (MA) Star ratings confirmed that the regulatory and operating environment for this program will challenge health plans (especially compared to past years) as the Centers for Medicare and Medicaid Services (CMS) shifts…

As Medicare Advantage Organizations (MAOs) get ready for the upcoming Annual Enrollment Period (AEP), they should proactively prepare for one of the most competitive marketing seasons to date. The cumulative impact from changes in payment rates; regulatory pressure on Third…

Summary At one point, the Affordable Care Act (ACA) market was the “new kid on the block” and every health plan wanted in. Shortly after its debut, plans faced financial and competitive challenges. The uncertainty of this market rapidly became evident…

This brief builds upon last year’s analysis of Medicare’s Annual Enrollment Period (AEP) and highlights results from the most recent enrollment data available1 from the Centers for Medicare and Medicaid Services (CMS) that accounts for 2023 AEP. Where helpful, we’ll compare…

The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently introduced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model as a redesign of the Global Professional Direct Contracting Model (GPDC). The move represents the…

In late February 2022, HealthScape published an initial review of Annual Enrollment Period (AEP) results, noting material changes to Medicare Advantage (MA) membership from December 2021 to January 2022 (when AEP enrollments went into effect) across nearly 300 carriers, including…

The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently provided long- awaited clarification on the status of the Direct Contracting program. CMS has formally canceled the Geographic Direct Contracting Model (Geo) and is phasing out the Global and…