Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to tighten prior authorization rules, boost transparency and curb practices that delay care.

The post Bipartisan Bill Seeks to Strengthen Oversight of Medicare Advantage appeared first on MedCity News.

Ed Park is sincere and passionate about his calling as the CEO of Devoted Health, which provides Medicare Advantage plans to seniors in 29 states. But it remains to be seen if he can do more or the same with less.

The post CEO of For-Profit MA Plan Tells CMS “Pay Us Less” appeared first on MedCity News.

A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny.

The post Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage appeared first on MedCity News.

New research from the Elevance Health Public Policy Institute finds that higher enrollment in Medicare Advantage may be linked to lower overall Medicare spending.

The post Report: Growth in MA Is Associated With Lower Total Medicare Spending appeared first on MedCity News.

Jefferson Health in Philadelphia is suing Aetna over a new Medicare Advantage payment policy that hospitals say unfairly reduces reimbursements for legitimate inpatient stays. The case highlights a broader clash between providers and Medicare Advantage plans over “downcoding” short hospital stays and controlling costs.

The post Jefferson Health Sues Aetna As Providers’ Frustration with MA Grows appeared first on MedCity News.

Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more transparent way to control spending.

The post Do Healthcare CEOs Agree on Whether VBC and MA Actually Save Money? appeared first on MedCity News.

The settlement demonstrates that enforcement risk is real and substantial, but it also highlights an opportunity. Medicare Advantage oversight does not require years of new rulemaking or experimental pilots because the technical capability to validate documentation at scale already exists and can be deployed today.

The post The Kaiser Settlement Should End the Guesswork in Medicare Advantage Oversight appeared first on MedCity News.

Further change in the Star Ratings program is inevitable, but one thing won’t change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher overall rating.

The post 2026 Star Ratings Shift: 4 Strategies for MA Plans appeared first on MedCity News.

At the end of the day, it doesn’t matter what your patient mix looks like; your notes can and will be pulled into audits. Waiting until CMS is at your doorstep isn’t a strategy — it’s a risk. Now is the moment to get ahead of it.

The post Why Providers Can’t Ignore CMS Audits appeared first on MedCity News.

The challenge for policymakers is balance: encouraging rigor without unintentionally weakening a program that now serves the majority of Medicare beneficiaries. Thoughtful rate calibration can determine whether this transition strengthens the program or strains it unnecessarily.

The post Medicare Advantage’s Discipline Era — and Why the Final Rate Notice Matters More Than It Appears appeared first on MedCity News.

Five Kaiser Permanente affiliates agreed to pay $556 million to settle allegations from the Department of Justice that they improperly inflated Medicare Advantage payments through inaccurate diagnosis coding. The case is one of the largest risk-adjustment settlements to date — and it signals continued federal scrutiny of the program.

The post Kaiser Permanente to Pay $556M to Settle Medicare Advantage Fraud Allegations appeared first on MedCity News.

Rising healthcare costs and flaws in the Medicare Advantage program are likely to dominate healthcare reform discussions in 2026, according to one PitchBook analyst. Potential policy changes could focus on improving affordability in the ACA market and fixing distorted incentives in Medicare Advantage.

The post Rising Costs & Medicare Advantage Flaws to Drive Healthcare Reform Talks in 2026 appeared first on MedCity News.

CMS is proposing major changes to Medicare Advantage Star Ratings, drawing mixed reactions from healthcare leaders.

The post What Do Healthcare Leaders Think About CMS’ Proposed Star Ratings Overhaul? appeared first on MedCity News.

Thirteen House Democrats introduced eight bills to rein in Medicare Advantage and bolster traditional Medicare.

The post Lawmakers Introduce Multiple Bills Aimed at Medicare Advantage Reform appeared first on MedCity News.

The pathway for health plans to achieve better Star ratings performance in their MA business depends on creating an ecosystem where providers are supported with the right tools and resources, incentives are properly aligned, and the member experience remains central to all initiatives.

The post What’s Missing from Your Tool Chest? How Health Plans Can Improve Star Ratings in Medicare Advantage appeared first on MedCity News.

Overall customer satisfaction in Medicare Advantage plans is 623 points on a 1,000-point scale, a 29-point drop from last year, according to a new report from J.D. Power.

The post Report: Member Satisfaction in MA Insurers Is Dropping Due to Lack of Trust appeared first on MedCity News.

Many insurers seem to be retreating from Medicare Advantage by exiting unprofitable markets and reducing benefits. This could be extremely disruptive to patients, experts warn.

The post Insurers are Pulling Back on MA. How Does this Affect Patients? appeared first on MedCity News.

As CMS ramps up its RADV initiatives in the months ahead, plans should ensure their risk adjustment programs meet the highest standards of accuracy and compliance. Prospective and retrospective analytics enhanced by AI can help plans work with providers to optimize documentation at the point of care and identify coding errors during audit preparation.

The post Employing AI in Coding and Risk Adjustment: 4 Key Recommendations appeared first on MedCity News.

The Trump administration’s Make America Healthy Again nutrition policies and Medicare Advantage plan ethics were prominent themes on the latest episode of the Debunked Podcast with MedCity News Editor-in-Chief Arundhati Parmar and guest co-host Paul Markovich, CEO of Blue Shield of California parent company Ascendiun.

The post Debunked Episode 18: Unpacking MAHA, Nutrition on a Regional and Global Scale appeared first on MedCity News.

Two U.S. representatives have introduced the Prompt and Fair Pay Act, a bipartisan bill that would require Medicare Advantage plans to reimburse providers at least the same rates as traditional Medicare, as well as pay claims more promptly. Providers and industry groups have welcomed the proposal, citing mounting financial strain and growing concerns over care delays and denials.

The post Bipartisan Bill Seeks to Establish Parity Between MA & Traditional Medicare Payments appeared first on MedCity News.

A recent KFF report showed that in 2024, 79% of counties in the U.S. were highly concentrated for Medicare Advantage, and 18% were very highly concentrated. 

The post Report: Majority of Medicare Advantage Markets Lack Competition appeared first on MedCity News.

To remain resilient amid the volatility, skilled nursing facilities need to stay on top of what’s impacting operations and consider strategic opportunities. Here are important trends to watch. 

The post Industry Pressures and Possibilities: What’s Ahead for Skilled Nursing Facilities appeared first on MedCity News.

The 2026 Medicare Advantage Rate Announcement is more than just funds allocation — it signals a policy shift. It’s the next phase of value-based care and encourages every stakeholder in the MA ecosystem to rise to the occasion.

The post The AI Advantage: Navigating the 2026 Medicare Advantage Rate Bump appeared first on MedCity News.

DUOS recently won the health tech consumer/employer track of MedCity News’ INVEST Pitch Perfect contest. The company supports older adults and their caregivers by addressing health-related social needs and connecting patients to care.

The post INVEST Pitch Perfect Spotlight: How DUOS Is Leveraging Tech To Support Older Adults appeared first on MedCity News.

Earlier this month Sachin Jain, CEO of SCAN Health Plan, a nonprofit Medicare Advantage company, provided some refreshing straight talk on what is wrong with MA while stressing that it is far better than traditional Medicare for seniors.

The post Medicare Advantage CEO: My Baby is Ugly…(video) appeared first on MedCity News.

SCAN Group is partnering with Sutter Health to develop new Medicare Advantage products and eventually launch a joint venture Medicare Advantage plan.

The post What SCAN and Sutter Health Hope to Achieve with Their MA Partnership appeared first on MedCity News.

The goal of the Two-Midnight Rule, originally introduced under traditional Medicare Part A, was to reduce hospital admissions and to ensure the appropriate use of inpatient versus outpatient observation status. Here are some challenges and best practices.

The post Navigating Medicare Advantage Compliance One Year After the Two-Midnight Rule appeared first on MedCity News.

CMS recently announced that payments to Medicare Advantage plans will increase by 5.06%, drawing support from payer advocates.

The post Payer Advocates Applaud 5% MA Payment Increase appeared first on MedCity News.

The distinction between value-based care and value-based payment isn’t merely semantic — it represents a crucial fork in the road for healthcare delivery. As AI and other technologies become more prevalent in healthcare, we must ensure they’re deployed in service of improving patient care rather than merely optimizing revenue.

The post The Dark Side of AI in Medicare Advantage: When Value-Based Payment Eclipses Value-Based Care appeared first on MedCity News.

Medicare Advantage plans can more effectively position themselves for success under an evolving measurement system. Here are three strategic actions health plan leaders should prioritize to enhance 2026 bids to secure stronger Star Rating performance. 

The post The New Game Plan for Star Ratings Must Start with Member Incentives appeared first on MedCity News.