October 9, 2026
[HUM, CLOV, ALHC, UNH, CVS, ELV, CNC]: MA Star Ratings Raises Stake for Litigation Anew and Policy Debate
While last night’s widely telegraphed Star Ratings delivered clear winners [HUM, CLOV, Devoted Health (pvt)] and losers [ALHC] (and a mixed bag for UNH, CVS, ELV, CNC, and MOH), potentially underappreciated methodological choices by CMS…
October 6, 2026
[HUM, ALHC, UNH, CVS, ELV, CNC, CLOV] Appeals Court Seems Skeptical of CMS But RADV Overhang Not Going Away Completely
Following yesterday’s oral appellate arguments over HUM’s challenge to Medicare Advantage (MA) risk adjustment-related audit rules, we believe a majority of the three-judge panel is likely to side with the company and the lower court…
September 18, 2026
[PNTG, BTSG, AVAH, ADUS] Home Health Comment Review Reinforces Medicare Stable Outlook and Suggests Paths for Upside
Based on our review of stakeholder comments to CMS’s proposed CY27 Medicare home health (HH) payment rule, we continue to see an avenue for HH-specific upside in the final regulation due in late October/early November…
September 8, 2026
[CNC, OSCR, UNH, HUM, CVS, ELV, MOH, CI, HQY]: Mapping Payer Policy Risk / Upside by Congressional Control in November Elections
With the November elections less than two months away, we assess how different congressional outcomes could reshape the healthcare legislative agenda for health insurers, pharmacy benefit managers (PBMs), 340B contract pharmacies, and health savings account…
August 21, 2026
[HUM, ALHC, UNH, CVS, AGL, ASTH]: MA Tech Changes Rule Expectations: Stars Likely in Focus, Major Risk Adjustment Change Seem Less So
The pending Contract Year (CY) 2028 Technical and Policy Changes proposal for the Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC, CLOV, MOH] and MA-exposed providers [AGL, ASTH] could be relatively more consequential…
July 29, 2026
[CNC, CVS, UNH, HUM] CMS Raises Stakes for Standalone PDPs for CY27 Part D
Tuesday’s CMS release detailing the financial components of its CY27 standalone Medicare Part D program and its decision to sunset the related two-year Part D Premium Stabilization Demo suggest additional uncertainty for standalone Part D…
June 18, 2026
[HUM, UNH, CVS, ELV, CNC, ALHC, MOH, CLOV, CI]: CMS Recalculates 2026 Star Ratings in Light of CLOV Ruling, But Financial and Legal Questions Remain
CMS informed Medicare Advantage (MA) insurers [HUM, UNH, CVS, ELV, CNC, ALHC, MOH, CLOV] that it is voluntarily recalculating their CY26 Star Ratings, which determine CY27 Quality Bonus Payments (QBP). Under the agency’s approach, released…
June 1, 2026
CLOV Star Ratings Legal Win Creates System Uncertainty but Potentially Strengthens HUM Appeal
Last week’s federal court ruling in favor Clover Health (CLOV) against CMS injects fresh uncertainty into the Medicare Advantage (MA) Star Ratings and quality bonus payment framework [UNH, HUM, ELV, CVS, ALHC, CNC, MOH]. While…
May 7, 2026
Medicare Advantage: Policy Risk Panoply
With 1Q26 earnings now largely complete for the major Medicare Advantage (MA) insurers [UNH, HUM, ALHC, CVS, ELV, CNC, MOH], near-term MA policy risks remain less acute, though far from extinguished. Congressional cuts remain unlikely…
April 21, 2026
Being Coy on BALANCE – How Could CMS and Insurers Get to Yes [UNH, ELV, HUM, CVS, CNC, CI, MOH]
UnitedHealth’s (UNH) comments on its earnings call this morning, responding to a question about potential participation in CMS’s BALANCE obesity drug model, suggest that further design changes will be required for it – and likely…