The merger also needs the green light from 23 other states and ultimately the Department of Justice, which is also weighing the proposed $38.5 billion consolidation of Aetna and Humana.
Template includes coverage examples that demonstrate cost sharing amounts. Read more »
The Internal Revenue Service doesn't tell tax filers that their low and moderate incomes likely mean their households qualify for Medicaid or subsidies to buy coverage on the insurance exchanges.
Exchange websites that do not call attention to the quality of medical care in a plan are more likely to see consumers selecting the low-cost alternative, according to Health Affairs.
The federal and state marketplaces would do well to nudge consumers toward health plans that result in the best fit for the individual, according to a Health Affairs report. Read more »
The total 3.05 percent rate is less than the total 3.55 percent CMS proposed in February. Read more »
While healthcare provider directories have always been hard to maintain, new regulations can mean costly fines if insurers fail to keep accurate, up-to-date information on the physicians who are in their health plans. Read more »
UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive. Read more »
Once the transition to full Medi-Cal occurs, beneficiaries will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal.
The healthcare system in the United States is spending billions per year unnecessarily by continuing to use manual administrative processes, according to the 2015 CAQH Index that measures the shift to electronic HIPAA transactions between health plans and healthcare providers.
The rate of security incident disclosures in 2015 surpassed those of 2014, according to the second annual BakerHostetler Security Incident Response report. What's more, healthcare tops the list for frequency of data breaches. Read more »
The Centers for Medicare and Medicaid Services is aligning mental health and addiction payment requirements already in place for private health plans to states providing these services to low-income adults and children.
The interagency task force, which will be chaired by the White House's Domestic Policy Council, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law.
EmblemHealth and Northwell Health in New York have agreed to share risk in value-based contracts, EmblemHealth announced March 25. Read more »
The payer mix in a hospital system exerts enormous influence over its financial success and stability, or lack thereof, said the commission. For community hospitals, a large share of their patients are covered by government payers, and that means lower rates than for commercial patients.
After insurers dropped hundreds of providers in 2013, the Centers for Medicare and Medicaid Services issued rules giving people a "special enrollment period" to change plans or join regular Medicare if there was a "significant" change in their provider network.
For the program to work, it requires cooperation between providers and health plans, according to AHIP President and CEO Marilyn Tavenner.
Errors in insurance claims are costing the healthcare industry billions in wasteful spending, and both the payers and the providers are at fault, experts say.
The Maine Bureau of Insurance is closely monitoring Community Health Options, as the nation's only profitable co-op under the Affordable Care Act in 2014 posted a net loss of $74 million for 2015 and 2016 this month, according to information on the maine.gov website. Read more »
The Aetna Whole Health-Virtua plan will be introduced in South Jersey later this year and will use Virtua's community-based health system of hospitals, outpatient facilities, urgent care centers, and health and wellness centers. Read more »
Insurers are investing in programs that have moved beyond tobacco-free living sessions and gym membership benefits.
Insurers, which have long resisted efforts to let competitors or the public see the deals they make with doctors and hospitals, have aligned with providers against a plan by California's insurance exchange to cut hospitals from its networks for poor performance or high costs.
The Supreme Court has sided with Liberty Mutual Insurance and against the state of Vermont in a decision that could have implications for insurers nationwide.
The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs.