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Medicare Advantage

All articles tagged with #medicare advantage

politics28 days ago

Trump’s 2027 Medicare Advantage bump signals austerity for private plans

The Trump administration proposes a 2027 pay increase for Medicare Advantage of less than 1% (about $700 million), a smaller boost than insurers hoped and aimed at stabilizing payments while curbing upcoding. Insurers warn the modest increase could force benefit cuts or higher seniors’ premiums, while CMS argues the measure is a right-sizing effort to reduce waste; a final rate decision in spring will trigger renewed lobbying from industry and policymakers.

via Politico|
#cms#medicare-advantage#medicare-payments
UNH: Margin Pressure Now, AI-Driven Efficiency to Drive Long-Term Upside
business29 days ago

UNH: Margin Pressure Now, AI-Driven Efficiency to Drive Long-Term Upside

UnitedHealth Group remains a contrarian buy after a selloff driven by Medicare Advantage margin concerns; 2026 revenue is expected to fall about 2% while operating income tops $24 billion due to cost controls and AI-led efficiency gains. Near-term EPS growth is about 8.6%, but management targets a long-term adjusted EPS CAGR of 13–16%, suggesting meaningful upside if multiple expands to a forward P/E around 15.8. With strong cash flow funding dividends, buybacks, and roughly $1.5 billion a year in tech/AI investments, the key risks are medical cost volatility and ongoing Medicare funding pressures.

via Seeking Alpha|
#ai-cost-controls#business#earnings-guidance
Medicare Rate Surprise Triggers Selloff in Major Health-Insurers
business29 days ago

Medicare Rate Surprise Triggers Selloff in Major Health-Insurers

The CMS proposed only a 0.09% average 2027 increase for Medicare Advantage rates, far below analysts’ expectations, sending shares of UnitedHealth, Humana, CVS Health and peers down sharply (as much as about 20% for UNH) on concerns about margins and future revenue. The notice also highlighted a plan to exclude diagnosis information from certain risk-score calculations, which could further affect payments. Analysts noted the flat-rate stance would blunt the sector’s margin turnaround despite past rate hikes, contributing to a broad market pullback in health-insurer stocks.

via Barron's|
#business#earnings#health-insurance
UnitedHealth Struggles With Earnings Miss And Margin Headwinds
business29 days ago

UnitedHealth Struggles With Earnings Miss And Margin Headwinds

UnitedHealth reported a Q4 revenue and EPS miss with its medical care ratio at 89.1%, signaling ongoing margin pressure. Medicare Advantage reimbursement increases are expected to be modest, adding near-term headwinds and tempering the earnings outlook. Management suggests 2026 will be a transition year, offering potential long-term upside for patient investors while the near term remains challenging.

via Seeking Alpha|
#business#earnings-miss#margin-pressure
Markets Hold Steady Ahead of Fed Decision as Earnings Week Kicks Into Gear
business1 month ago

Markets Hold Steady Ahead of Fed Decision as Earnings Week Kicks Into Gear

Futures for the S&P 500 were largely unchanged as traders await the Fed’s rate decision this week; after Monday’s gains led by tech, health insurers fell in after-hours trading on CMS’s near-flat Medicare Advantage payment proposal for 2027, while President Trump signaled higher tariffs on South Korean autos, pharmaceuticals and lumber, adding risk to an earnings-heavy week.

via CNBC|
#business#earnings#fed
Bernstein names UnitedHealth as 2026's top healthcare pick
markets1 month ago

Bernstein names UnitedHealth as 2026's top healthcare pick

Bernstein analyst Lance Wilkes designates UnitedHealth Group (UNH) as his top healthcare stock for 2026, keeping an Outperform rating with a $444 target as margins in Medicare Advantage/Medicaid are expected to recover. He expects earnings growth to resume as UNH exits unprofitable businesses and weighs the potential separation of UnitedHealthcare and Optum, with Optum viewed as a long‑term growth driver. Bernstein sees roughly 33% upside from current levels, while the broader market consensus remains bullish with a target near $398 (~19% upside).

via TipRanks|
#bernstein#markets#medicare-advantage
Kaiser Permanente to pay $556 million to settle Medicare Advantage fraud allegations
business1 month ago

Kaiser Permanente to pay $556 million to settle Medicare Advantage fraud allegations

The Justice Department announced a $556 million settlement with Kaiser Permanente over allegations that it inflated Medicare Advantage payments by adding improper diagnoses to patient charts after visits, a practice the government says diverted about $1 billion from taxpayers between 2009 and 2018; Kaiser says the settlement resolves the matter without admitting wrongdoing and notes it concerns risk-adjustment practices rather than care quality.

via statnews.com|
#business#doj-settlement#healthcare-fraud
Grassley accuses UnitedHealth of turning Medicare Advantage risk scoring into a profit engine
politics1 month ago

Grassley accuses UnitedHealth of turning Medicare Advantage risk scoring into a profit engine

A Senate majority staff report based on more than 50,000 pages alleges UnitedHealth Group uses aggressive diagnosis capture, in-home health risk assessments, and coding guidance to inflate Medicare Advantage risk scores and in turn receive higher CMS payments. The findings describe a specialized workforce and data capabilities that adapt to CMS crackdowns, with examples like diagnoses for opioid dependence, alcohol use disorders, and dementia, and warn that the company sells its criteria to other MAOs, potentially impacting taxpayers and the integrity of the MA program. The report follows Grassley’s long history of MA oversight and calls for continued scrutiny of risk-adjustment practices.

via Grassley.senate.gov|
#cms#grassley#medicare-advantage
Medicare Open Enrollment: Key Updates for Federal Employees and State Residents
healthcare3 months ago

Medicare Open Enrollment: Key Updates for Federal Employees and State Residents

Dave Ramsey emphasizes that the Medicare Annual Enrollment Period (AEP) is for current beneficiaries to modify their coverage, not for first-time enrollees, who should sign up at age 65. He explains the differences between Original Medicare and Medicare Advantage, and highlights upcoming changes in 2026, including a cap on out-of-pocket drug costs at $2,100.

via TheStreet|
#2026-drug-costs#aep#healthcare
Medicare Advantage 2026 Ratings: Winners, Losers, and Industry Insights
healthcare4 months ago

Medicare Advantage 2026 Ratings: Winners, Losers, and Industry Insights

The 2026 Medicare Advantage star ratings remained stable overall, with some insurers like Elevance and Centene improving, while others like Humana and Aetna saw declines. Clover Health experienced a significant drop below 4 stars, potentially impacting its earnings. The ratings influence insurer revenues and strategies, with some plans adjusting their offerings to maintain or improve their scores amid regulatory and market pressures.

via Healthcare Dive|
#2026#healthcare#healthcare-quality