UNH (US)


June 23, 2025

Home Health: Potential Substance of Upcoming CY26 Medicare Rate Proposal [AMED, PNTG, BTSG, ADUS, AVAH]

By Beth Steindecker

In the upcoming CY26 Medicare payment proposal for home health (HH) agencies [AMED, PNTG, BTSG, ADUS, AVAH, UNH], which we expect within the next two weeks based on historical patterns, we think it is more…

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June 16, 2025

Medicare Advantage: Filling in RADV Blanks; HUM Has Most Contracts Targeted [HUM, UNH, CVS, ELV, CNC, ALHC]

By Beth Steindecker

Late Friday, CMS announced the latest list of Medicare Advantage (MA) contracts to be targeted for risk adjustment data verification (RADV) audits – this time for payment year (PY) 2019 – and its associated processes…

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June 13, 2025

PBMs: State Legislative Risks Persist Through Session Ends [CI, CVS, UNH, HUM, ELV, Navitus]

By Beth Steindecker

With many 2025 state legislative sessions having concluded, pharmacy benefit managers (PBMs) have – for the moment – successfully avoided various bills seeking to aggressively curb industry practices, except for a few new laws in…

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May 21, 2025

Medicare Advantage: Ramping Up RADV Audits Clearly a Threat, But Does It Head Off Other Risks? [HUM, UNH, CVS, ELV, ALHC]

By Beth Steindecker

CMS’s announcement late Wednesday to turn the dial up on its risk-adjustment data verification (RADV) audits of Medicare Advantage (MA) contracts with an eye toward the entire landscape raises legitimate fears of recouping sizable past…

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May 19, 2025

Expected Federal Report on Fertility Benefits: Regulatory Recommendations Likely Incremental [PGNY]

By Beth Steindecker

Since we are at the 90-day mark after February 18 release of the White House’s Executive Order (EO) supportive of in-vitro fertilization (IVF), there is a hope that the Trump administration’s anticipated report of potential…

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May 13, 2025

[ELV, CNC, MOH, UNH, CVS] CMS Managed Care Provider Tax Proposal

By Beth Steindecker

Yesterday’s CMS proposal confirms our suspicion that the agency would seek to tighten state provider taxes – primarily those on managed care [ELV, UNH, CNC, MOH, CVS, CI, OSCR]– used to secure sizable federal Medicaid…

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May 7, 2025

PBMs: Death by a Thousand Cuts? [CI, CVS, UNH, ELV, GDRX]

By Beth Steindecker

The list of potential state and federal legislative threats to pharmacy benefit managers (PBMs) [CI, CVS, UNH, ELV, GDRX] seems to be growing, even though there has not been widespread enactment of these bills. Putting…

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April 10, 2025

[CVS, CI, UNH]: Senate Confirmation of 3rd FTC Commissioner Allows for Future Resumption of PBM Litigation

By Beth Steindecker

Today’s successful Senate confirmation of Mark Meador to join the FTC as a commissioner paves the way for the FTC to officially resume its antitrust litigation against the pharmacy benefit managers (PBMs) [CVS, CI, UNH,…

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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

By Beth Steindecker

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…

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April 6, 2025

[HUM, ALHC, UNH] Final Medicare Advantage Tech Changes Reg: Most Proposals Dropped Without Explanation, Await CY26 Rate Notice

By Beth Steindecker

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…

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