April 7, 2025
[HUM, ALHC, UNH, CNC, AGL, PRVA]: MA’s 5%+ Increase Met Our Expectations, But Longer-Term Coding and Part D Questions Remain
The final CY26 Medicare Advantage (MA) rate announcement met our previously-published optimistic expectations for a comfortable mid-single-digit YoY benchmark rate increase for MA insurers [HUM, ALHC, UNH, CVS, ELV, CNC] with CMS finalizing a 5.06% increase, largely…
April 6, 2025
[HUM, ALHC, UNH] Final Medicare Advantage Tech Changes Reg: Most Proposals Dropped Without Explanation, Await CY26 Rate Notice
CMS’s final CY26 technical changes rule for Medicare Advantage (MA) and Part D plans [HUM, ALHC, UNH, CVS, ELV, CNC] lived up to expectations of rolling back proposed restrictions in response to consumer complaints, but…
March 25, 2025
HUM, ALHC, UNH: Optimistic for Mid-Single Digit MA Rate Increase for CY26, Upcoding Remains a Longer-Term Issue
Anticipating CMS’s issuance of its final CY26 Medicare Advantage (MA) rate notice within the next two weeks (on or before Monday, April 7), we remain optimistic about near-term regulatory changes for MA insurers [HUM, ALHC,…
March 14, 2025
Oz Nomination: Moving towards Senate Confirmation, Medicare Advantage Comments Show Mixed View
Today’s Senate Finance Committee confirmation hearing of Dr. Mehmet Oz as Trump’s CMS Administrator provided limited new insights into his approach to Medicare, Medicaid, Obamacare, pharmacy benefit management reforms, health savings account adoption, and healthcare…
February 21, 2025
UNH: Thoughts on Reported DOJ Investigation
Today’s reaction to the WSJ report that UnitedHealth (UNH) is under civil investigation by the DOJ for Medicare False Claims Act violations strikes us as overwrought, with ultimate financial liabilities (still 1-2 years away) unlikely…
January 16, 2025
UNH: Though Confident, Public Policy Questions Remain
UnitedHealth’s (UNH) comments during its 4Q and full year 2024 earnings call about changes its it taking to head off certain public policy concerns (PBMs, prior authorization/claim denials) seem like the company is in catch-up…
January 11, 2025
[HUM, UNH, CVS, ELV, ALHC] CY26 Medicare Advantage Rates: Likely Upswing in the Final
CMS’s Friday release of the CY26 Advance Notice (AN) for Medicare Advantage (MA) insurers [HUM, UNH, CVS, ELV, ALHC, CLOV, CNC] came in better than our net YoY benchmark expectations with a proposed net increase…
January 8, 2025
Conference Policy Prep Pack: Healthcare Providers & Insurers
With a handful of healthcare provider and insurance companies headed to San Francisco next week for a key investor conference, below we provide a set of significant policy-related questions we would like to see management teams address…
December 6, 2024
[HUM, ALHC, UNH, CVS, ELV, AGL] Expectations for CY26 Medicare Advantage Advance Notice
KEY TAKEAWAYS: We expect the proposed YoY change in the CY26 benchmarks for Medicare Advantage (MA) plans is likely to be relatively flat, with a range between -1% and +1% that excludes coding trend, but…
November 20, 2024
[UNH, HUM, ALHC, AGL, PRVA, MD]: Trump’s Unorthodox CMS Pick Reinforces Already Anticipated Support for Medicare Advantage and Physicians
President Trump’s surprise and unorthodox nomination of Dr. Mehmet Oz to be CMS administrator, whom we presume will likely be confirmed, affords somewhat of a blank slate for others in the administration to fill in…