A tectonic shift is underway in the Medicare Supplemental (Med Supp) market and it’s coming from a source rarely discussed—the Medicare Access and CHIP Reauthorization Act (MACRA). Beginning in 2020, insurers will no longer be able to sell the most…

Employer Group Waiver Plans (EGWP) are often an untapped market within a comprehensive Medicare Advantage (MA) and Senior Market strategy for many regional health plans. Group retiree markets are changing due to pressure on retiree benefits. Refreshing your group retiree…

In a court decision last year in Swoben v. United Healthcare, the United States Court of Appeals for the Ninth Circuit held that an allegation—that a Medicare Advantage Plan performed a “biased” HCC-RAF retrospective medical review designed only to identify…

By now you are undoubtedly familiar with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The resulting Quality Payment Program (QPP) and its two participation pathways – Advanced Alternative Payment Models (APMs) and Merit-based Incentive Payment System (MIPS)…