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…
November 3, 2025
Physicians: Final Rule Favors Independent Doctors / Freestanding Centers but Cost Growth and Rate Pressures on Facility-Based Doctors Remain [RDNT, USPH, SEM, PRVA, ASTH, RadPar, Envision]
CMS’s final CY26 Medicare Physician Fee Schedule (PFS), released late Friday, offered a split-screen picture for physicians, largely depending on whether they provide care in the office / freestanding center (positive) or in a facility…
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 15, 2025
Physician Fee Schedule: Despite 3+% Increase YoY, CMS Proposes Some Squeezes [RDNT, USPH, PRVA, RadPar, Envision]
While Monday night’s proposed CY26 Medicare Physician Fee Schedule (PFS) provides an annual rate increase for physicians of 3.3%+ compared to cuts during prior years, closer examination of the proposal reveals some potential reimbursement headwinds…
June 6, 2025
Thoughts on Medicare Savings Ideas in Reconciliation
Yesterday’s news reports that Senate Republicans are considering and discussing Medicare savings policies to add to the reconciliation bill for lowering the overall deficit and/or filling any potential hole from softening some of the House’s…
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…
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,…
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…