The enrollment shift toward regional and nonprofit MA plans may open opportunities for SNF operators to renegotiate contracts and establish preferred provider relationships with plans built around stability and quality rather than short-term margin management.
Judge Orders UnitedHealth to Hand Over Documents in AI Coverage Denial Case
“The plaintiffs allege the tool overrode physicians’ decisions and led to premature denials of medically necessary skilled nursing facility care… a 2024 Senate investigation found that UnitedHealth’s denial rate for post-acute care claims more than doubled after it began using naviHealth and nH Predict.”
— Becker’s Payer Issues, March 11, 2026
Aetna to Pay $118M to Resolve Medicare Advantage Upcoding Allegations
“The settlement comes amid a wave of federal scrutiny over risk-adjustment practices across the MA industry this year alone, following a record $556 million settlement with Kaiser Permanente in January and an ongoing enrollment sanction threat against Elevance Health.”
— Becker’s Payer Issues, March 11, 2026
CMS to Suspend Enrollment into Elevance’s Medicare Advantage Plans
“CMS said the intermediate sanctions stem from ‘substantial and persistent noncompliance with Medicare Advantage risk adjustment data submission requirements.’ The sanctions will apply until Elevance resolves the issues.”
— Becker’s Payer Issues, March 2, 2026
“One in 10 MA enrollees are being forced to switch plans in 2026 due to insurer market exits, a tenfold increase from historical averages. … ‘I think this year, enrollees voted and said, we’re going to go with the plan that’s been consistent and that’s not moving their benefits around every year.'”
— Becker’s Payer Issues, March 2, 2026
Medicare Advantage Margins Outpace Other Lines of Business: KFF
“Gross margins per enrollee — how much greater the total premium income is than total claims costs — reached $1,655 in the MA market by the end of 2024… Notably, these margins do not suggest all insurers are thriving within MA. Amid concerns over financial sustainability, several insurers exited MA in 2025.”
— Becker’s Payer Issues, February 25, 2026
Health Insurer Financial Performance in 2024
“Through the end of 2024, gross margins in the Medicare Advantage market averaged $1,655 per enrollee, which is 17% lower than in 2023 ($1,986), consistent with reports by the largest Medicare Advantage insurers of increased utilization beginning in late 2023 that extended through 2024.”
— KFF, February 23, 2026
Kaiser Permanente to Pay $556M to Settle Medicare Advantage Whistleblower Lawsuit
“Multiple Kaiser Permanente affiliates improperly increased risk-adjusted MA payments by pressuring physicians to add diagnoses to patient medical records after visits had occurred — even when those diagnoses were not evaluated or treated during the visit.”
— Becker’s Hospital Review, January 15, 2026
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