UNH (US)

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…

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…

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…

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…

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…

Through 2028, Obamacare enrollment faces two statutory headwinds after the large, still unfolding 2026 reset: The 2027 narrowing of ACA subsidy eligibility for certain non-citizens. The 2028 installation of pre-enrollment subsidy eligibility verification. For exchange…

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…

Home health (HH) agencies [PNTG, BTSG, AVAH, UNH, ADUS, Elara] received a favorable surprise in CMS’s proposed CY27 Medicare HH reimbursement rule, released Wednesday. The regulation includes: A temporary 3% recoupment adjustment, matching the final…

Senate HELP Chairman Bill Cassidy’s (R-LA) recently introduced 340B Drug Pricing Integrity and Affordability for Patients Act raises threats to 340B contract pharmacies (both brick-and-mortar and mail-order) [CVS and private Walgreens, and to a much…

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…