April 6, 2026
Medicare Advantage: CY27 Final Rates Provide Expected Relief, Longer-Term Risks Punted or Persist [HUM, ALHC, UNH, CVS, ELV, CNC, PRVA, ASTH, EVH]
The final CY27 Medicare Advantage (MA) rate announcement, reflecting a net 2.48% YoY benchmark increase, landed within our expectations and alleviates some of the near term-pressure on MA insurers [HUM, ALHC, UNH, CVS, ELV, CNC]…
March 16, 2026
Medicare Advantage: Final CY27 Rates Expectations of 1%-3% Increase [HUM, ALHC, UNH, CVS, ELV, CNC, PRVA, ASTH, EVH, DVA, FRE.DE]
We continue to expect CMS’s final CY27 rate announcement for Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC], affecting their contracted value-based care providers [PRVA, ASTH, EVH], to produce a low single-digit increase…
March 2, 2026
CMS’s ELV Sanction Warnings Sends MA Risk Adjustment Message, But Does It Up the Ante on a Broader Crackdown?
CMS’s warning letter against ELV of potential sanctions on new Medicare Advantage (MA) enrollment underscores another enforcement lever the agency can deploy to curb improper risk adjustment behaviors and overpayments. As the agency remains committed…
January 26, 2026
Medicare Advantage: CMS’s Negative Surprise of Flat Rates and Risk Adjustment Changes – What Now?
CMS’s negative surprise to Medicare Advantage (MA) insurers [HUM, UNH, ALHC, CVS, ELV, CNC] – which is also likely to spill over into weakness among insurers less or not exposed to this market [MOH, OSCR,…
November 26, 2025
Medicare Advantage Tech Changes Proposal: RFI Eases Risk Adjustment Concerns, Star Rating Changes Afoot [HUM, ALHC, UNH, CVS, ELV, PRVA, ASTH]
Our read of the proposed Contract Year 2027 Policy and Technical Changes regulation for Medicare Advantage (MA) and Part D (fact sheet here), confirms our expectations for a positive regulatory backdrop for 2027 for MA [HUM, ALHC,…
November 5, 2025
Medicare Advantage: Still Expecting Light Regulatory Touch for CY27 [HUM, ALHC, AGL, UNH, CVS, ELV, CNC, PRVA]
Listening to recent earnings calls held by various Medicare Advantage (MA) insurers and value-based care providers [HUM, ALHC, AGL, UNH, CVS, ELV] leaves us with the following thoughts on the MA regulatory policy environment for…
October 14, 2025
[HUM] Stars Rating Litigation Likely Brings Chapter to Close
We think this morning’s court ruling against Humana (HUM) in its Medicare Advantage (MA) Stars litigation is likely the end of the road in its efforts to secure a higher score for its 2026 payment…
September 29, 2025
Medicare Advantage: CMS’ Stable Message Eclipsed by Falling Enrollment Forecast, But A Wait and See Attitude Is Appropriate
While reports over the weekend about CMS’s Friday release of the Medicare Advantage (MA) and Part D Plan (PDP) premium, deductible and other information for the 2026 plan year focused on the 2.6% projected cut…
September 26, 2025
Medicare Advantage RADV Audits in Legal Limbo, But Don’t Discount Its Resurrection [HUM, UNH, CVS, CNC, ELV, ALHC]
Medicare Advantage (MA) insurers [HUM, UNH, CVS, CNC, ELV, ALHC] received some positive legal news that for now neutralizes the concern of widespread Medicare audits and potential concomitant recoupments. However, yesterday’s federal district court ruling…
July 2, 2025
Medicare Advantage RADV Update: Tons More PY19 Audits, UNH Has the Most For Now
CMS’s addition last week of 300+ Medicare Advantage (MA) [UNH, HUM, CNC, ELV, CVS, ALHC] contracts to be audited for risk adjustment data verification (RADV) during plan year (PY) 2019 raises the risk of larger…