HFMA Archives | PayerIndex™

MA Winter Roundup for SNFs: small gains and continued pressure

March 28, 2026

Our Take: Skilled nursing operators are seeing gains from proactive Medicare Advantage contract renegotiation; CMS is expands oversight of MA prior authorization and mandates the elimination of fax workflows by…

Read this article

Payer Roundup – March 2026

March 28, 2026

Our Take: KFF data confirms MA remains the highest-margin insurance segment, and regional plans are capturing enrollment gains as national insurers retreat. Federal enforcement of Medicare Advantage risk-adjustment fraud is…

Read this article

Contract Year 2027 Medicare Advantage and Part D Proposed Rule

March 14, 2026

Our Take: CMS’s CY2027 Medicare Advantage proposed rule streamlines Star Ratings and raises a red flag about dual-eligible enrollment in I-SNPs. The rule proposes that these nursing-home-focused plans may need…

Read this article

March 2026 Report to the Congress: Medicare Payment Policy

March 12, 2026

Our Take: MedPAC’s March 2026 report estimates Medicare is overspending by 14% on MA enrollees compared to FFS. This estimated $76 billion in higher costs is driven by favorable selection…

Read this article

First-Time Medicare Advantage Enrollees Demonstrate Increasing Demographic and Clinical Diversity

March 10, 2026

Our Take: First-time Medicare Advantage enrollees grew 85% between 2012 and 2022, and the population is now markedly more diverse, with dual-eligibles nearly doubling and Black beneficiaries rising from 13%…

Read this article

MA recipients, dual eligibles less likely to be discharged to highly rated post acute rehab

February 24, 2026

Our Take: A JAMA study of more than 44,000 stroke patients finds that MA and dual-eligible beneficiaries are significantly less likely to be discharged to highly rated SNFs than traditional…

Read this article

Study Finds Significant Medicare Advantage Disenrollment as Market Adjustments Continue

February 18, 2026

Our Take: A JAMA research letter finds that forced MA disenrollments jumped from under 1% historically to an estimated 10% in 2026, affecting approximately 2.9 million enrollees. Enrollees are losing…

Read this article

Medicare Advantage Enrollment Grew by About 1 Million People, Mainly Due to Special Needs Plans

February 15, 2026

Our Take: Medicare Advantage reached 35 million enrollees in 2026, but overall growth slowed to just 3%, with special needs plans accounting for 83% of all new enrollment as the…

Read this article

Study of Discharge Appeals in a Skilled Nursing Facility

February 1, 2026

JAMDA

Our Take: About 1 in 10 post-acute SNF patients filed a discharge appeal at a single California facility, with 77% ultimately losing. The patients who lost faced a 27.8% 30-day…

Read this article

MA Denial Proof Mounts as CMS Moves Toward Mandatory Reporting

January 30, 2026

Our Take: Provider surveys and research document the scale of the Medicare Advantage denial burden in skilled nursing. CMS is advancing mandatory denial reporting and prior authorization pilots, while legislative…

Read this article

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

January 28, 2026

Our Take: Medicare Advantage insurers made 53 million prior authorization requests in 2024, a 6% year-over-year increase. 7.7% of requests were denied, even as insurers publicly pledged to reduce administrative…

Read this article

CMS Proposes Nearly Flat Medicare Advantage Payment Rates for 2027

January 26, 2026

Our Take: CMS has proposed a 0.09% net average payment increase for Medicare Advantage plans in 2027, far below the 4% to 6% payers expected. MA payments stay essentially flat…

Read this article

Senate Report Finds UnitedHealth Turned Medicare Advantage Risk Adjustment into a Profit Strategy

January 12, 2026

Our Take: A 105-page Senate Judiciary Committee report, based on 50,000 pages of UnitedHealth’s own internal documents, concludes that the nation’s largest MA insurer built an engine to inflate risk…

Read this article

Payer Roundup – December 2025

December 31, 2025

Our Take: The December roundup documents an accelerating Medicare Advantage contraction with UnitedHealth projecting a 1 million-member enrollment drop in 2026. More than 40 health systems have severed MA contracts…

Read this article

Insurers not fully complying with price transparency rules

December 9, 2025

Our Take: A peer-reviewed analysis of 2025 Transparency in Coverage files from Aetna, Cigna, and UnitedHealthcare finds significant gaps in completeness, particularly for hospital inpatient data. No insurer has been…

Read this article

Insurer use of algorithms cuts SNF length of stay

December 1, 2025

Our Take: A peer-reviewed study confirms that an MA insurer’s adoption of NaviHealth produced an immediate 13% decline in SNF length of stay, with stays over 30 days falling by…

Read this article

A Digest of How SNF Operators Are Navigating Medicare Advantage Complexity

November 30, 2025

Our Take: Growing financial and administrative pressures on skilled nursing facilities from Medicare Advantage is triggering broader industry education and sharing of best practices. Operators are managing MA with new…

Read this article

Prior Authorization Reform Heats Up

November 24, 2025

Our Take: At least 18 states enacted prior authorization reforms in 2025, outpacing federal regulators by requiring faster approval timelines, demanding evidence-based clinical review, and limiting AI-driven denials. These reforms…

Read this article

Chart Reviews Increase Payments to Medicare Advantage Insurers for 1 in 6 Enrollees

November 20, 2025

Our Take: Insurer-initiated chart reviews added diagnoses for 1 in 6 Medicare Advantage enrollees and generated an estimated $24 billion in additional federal payments to payer in 2023. Removals of…

Read this article

Complaints About Medicare Advantage Network Gaps Are Common. Federal Enforcement Is Rare

November 20, 2025

KFF

Our Take: CMS sent network adequacy violation letters to only five Medicare Advantage insurers over a six-year period and has never imposed civil monetary penalties, despite rampant complaints about provider…

Read this article

Push in Congress to Rein in Medicare Advantage

November 15, 2025

Our Take: Congress continued scrutiny of AI-driven denials and debating new prior authorization legislation. While these activities show continued momentum to reduce one of SNFs’ most persistent pain points –…

Read this article

Medicare Advantage Enrollment Among Long-Stay Nursing Home Residents Rose 183% From 2010 to 2023

November 14, 2025

Our Take: MA enrollment among long-stay nursing home residents tripled over 13 years, reaching 36.5% in 2023. But a recent sharp spike in MA disenrollment at the point of nursing…

Read this article

Provider-Led I-SNPs Reduce Nursing Home Hospitalizations but Raise Quality Questions

November 9, 2025

Our Take: Nursing homes that launch provider-led I-SNPs see hospitalizations fall and I-SNP enrollment surge. But the same financial incentives correlate with increased antipsychotic use, hypnotic drug use, and pressure…

Read this article

Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes

November 6, 2025

American Journal of Managed Care

Our Take: When Medicare Advantage plans pay home health agencies on a per-visit basis and dictate visit counts and disciplines, patients face a 12% higher risk of inpatient transfer compared…

Read this article

Study Finds Medicare Advantage Beneficiaries Use Fewer Post-Acute Care Days With Equal or Better Outcomes

October 29, 2025

JAMA

Our Take: A study published on JAMA found that Medicare Advantage beneficiaries used 6.3 fewer SNF days and 3.6 fewer home health days than comparable traditional Medicare patients – and…

Read this article

Payer Roundup – September 2025

September 30, 2025

Our Take: The September digest raises the strong likelihood of a contraction in Medicare Advantage enrollment, with CMS projecting a decline of 900,000 enrollees in 2026. Yet HCSC is expanding…

Read this article

Are Hospital Stays Longer in Medicare Advantage?

September 8, 2025

Our Take: From 2017 to 2023, Medicare Advantage patients experienced disproportionately longer hospital stays than traditional Medicare patients. For patients headed to skilled nursing facilities, they were 3.1 percent more…

Read this article

Caregiving Among Dually Enrolled Older Adults

August 21, 2025

Our Take: A study in JAMA Network Open finds that despite MLTSS program coverage nearly doubling among community-dwelling dual enrollees between 2012 and 2022, unpaid family caregivers still account for…

Read this article

Long-Term Services and Supports in Supplemental Benefits in Medicare Advantage Plans

August 11, 2025

Our Take: Six years after gaining the ability to offer LTSS supplemental benefits, Medicare Advantage plans have barely expanded availability. Only 12% of plans offered any LTSS benefit in 2025,…

Read this article

Health Care’s Colossus

August 11, 2025

STAT

Our Take: STAT’s eight-part “Health Care’s Colossus” series documents how UnitedHealth Group built a vertically integrated machine, leveraging physicians, algorithms, and self-funded research. The UHG machine can systematically extract Medicare…

Read this article

Expanding PACE could further reduce taxpayer burden, improve care, report finds

August 7, 2025

Our Take: A new Pacific Research Institute analysis finds PACE saves taxpayers more than $2.8 billion annually – averaging $33,600 per participant per year – by keeping frail older adults…

Read this article

Medicare Advantage in 2025: Enrollment Update and Key Trends

July 28, 2025

Our Take: More than half of eligible Medicare beneficiaries are now enrolled in Medicare Advantage. Enrollment growth slowed to 4% in 2025, but SNP enrollment – especially C-SNPs – surged…

Read this article

Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

July 28, 2025

KFF

Our Take: KFF’s 2025 analysis finds that three quarters of Medicare Advantage enrollees pay no premium beyond Part B, while 99% are in plans that require prior authorization for skilled…

Read this article

Most Medicare Advantage Markets are Dominated by One or Two Insurers

July 14, 2025

KFF

Our Take: Despite doubling the number of available MA plans since 2018, virtually every U.S. county in 2024 remained highly or very highly concentrated, with one or two insurers controlling…

Read this article

Enrollment in Dual-Eligible Special Needs Plans and Disenrollment Rates

July 3, 2025

Our Take: Dual-eligible beneficiaries in fully integrated D-SNPs disenroll at just 8.1% annually – versus 28.2% in standard MA plans – demonstrating that deeper Medicare-Medicaid integration produces substantially stronger member…

Read this article

Payer Roundup – June 2025

June 30, 2025

Our Take: The June digest reports on a Medicare Advantage market under regulatory and legal pressure. UnitedHealth’s CEO resigned amid a criminal fraud investigation and a Guardian exposé revealing secret…

Read this article

June 2025 Report to the Congress: Medicare and the Health Care Delivery System

June 12, 2025

Our Take: MedPAC’s June 2025 congressional report identifies “design flaws” in Medicare Advantage programs serving nursing home residents and calls on Congress to enact meaningful MA reform. The report warns…

Read this article

Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent

June 1, 2025

Our Take: A study covering 30 percent of the MA market found that plans denied 17 percent of initial claims. Even after winning 57 percent of those denials on appeal,…

Read this article

Congress Focuses on Reforming Medicare Advantage Prior Authorization

May 23, 2025

US Congress

Our Take: Congress has introduced multiple bills since mid-2024 targeting Medicare Advantage prior authorization reform. Reform efforts have broad support from providers, payers, and lawmakers on both sides of the…

Read this article

CMS Launches Aggressive Overhaul of Medicare Advantage RADV Audit Program

May 21, 2025

Our Take: In May 2025, CMS announced a sweeping expansion of its Medicare Advantage Risk Adjustment Data Validation audit program. Annual audits will increase from roughly 60 plans to all…

Read this article

Find More Medicare Advantage Resources