For SNF operators, the dual trend of MA contraction and selective expansion creates an uneven payer landscape – facilities in markets where HCSC is newly entering should seek contract negotiations.
CMS Expects Medicare Advantage Enrollment to Dip in 2026
Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program should remain relatively stable next year, CMS said in a Sept. 26 news release. But MA enrollment is projected to decrease 900,000 in 2026.
— Becker’s Payer Issues Oct. 23, 2025,
Aetna is scaling up a program to provide more support to Medicare Advantage beneficiaries who are transitioning from the hospital into skilled nursing facilities or to their homes.
The Aetna Clinical Collaboration (ACC) program involves Aetna nurses who coordinate with hospital staff to provide more patient support during care transitions, with reduced hospital readmissions being one key goal, according to a Sept. 22 press release.
— Skilled Nursing News, Sept. 23, 2025
HCSC to Offer MA Plans in 30 States
As a wave of insurers exit Medicare Advantage plans, Health Care Service Corporation is jumping in, launching plans in 948 counties across 30 states and the District of Columbia, according to a Sept. 10 news release.
HCSC’s MA plans will span markets in Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Kansas, Kentucky, Maryland, Missouri, Mississippi, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia and Washington.
— Becker’s Payer Issues | Payer News, Sept. 12, 2025
The great Medicare Advantage contraction appears set to continue
Shakespeare famously wrote in The Tempest, “What’s past is prologue,” to express how events of the past set the stage for developments in the present.
That sentiment was clear for health insurers in the second quarter, in which companies that slashed Medicare benefits and cut loose unprofitable members last year enjoyed apparent immunity from the tidal wave of medical costs burying their peers.
Humana and CVS were the only insurers to raise their annual profit expectations following the second quarter, bucking a broader downturn. Four other major payers – UnitedHealth, Elevance, Centene and Molina – either lowered their profit expectations or established new floors well below previous targets.
— Healthcare Dive. August 6, 2025
Elevance loses lawsuit over Medicare Advantage quality ratings
A federal judge in Texas struck down Elevance Health’s lawsuit that argued the government unfairly lowered its Medicare Advantage quality ratings — a decision that could cost Elevance $375 million in bonus revenue.
U.S. District Judge Mark T. Pittman, appointed by President Trump in 2019, chastised Elevance’s legal arguments as “perplexing” and said the health insurance company was ignoring basic math. He said the Centers for Medicare and Medicaid Services, the federal agency that regulates Medicare Advantage plans and assigns star ratings to every plan, correctly followed the law.
The decision marks yet another loss for the Medicare Advantage industry, which has aggressively sued the government over its ratings calculations in a bid to recapture billions of dollars in potentially lost revenue.
Elevance loses lawsuit over Medicare Advantage quality ratings
— STAT. August 19, 2025Elevance Health loses Medicare Advantage star ratings suit to CMS
— Fierce Healthcare. August 20, 2025Elevance loses Medicare Advantage star ratings suit
— Healthcare Dive. August 20, 2025
Humana must face class action suit over use of AI in denying post-acute care
Humana must face a class action lawsuit alleging that its use of artificial intelligence to deny post-acute care to Medicaid Advantage beneficiaries became fraud when those automated decisions replaced the interpretation of clinicians.
Judge Rebecca Grady Jennings of the US District Court for the Western District of Kentucky on Friday ruled that the plaintiffs did not have to exhaust Medicare administrative appeals before filing their complaint in late 2023.
— McKnight’s Long-Term Care News. August 19, 2025
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