2026 Star Ratings Shift: 4 Strategies for MA Plans

Further change in the Star Ratings program is inevitable, but one thing won’t change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher overall rating. The post 2026 Star Ratings Shift: 4 Strategies for MA Plans appeared first…

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TrumpRx: What’s the Value for Customers?

In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.

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DOJ, Ohio File Antitrust Suit Against OhioHealth Over Payer Contracts

The Department of Justice and the state of Ohio filed an antitrust lawsuit against OhioHealth this week, alleging the health system used “all-or-nothing” contracts that force insurers to include all of its hospitals and physicians. The case highlights federal and state scrutiny of hospital consolidation and restrictive contracting practices — with potential implications for payers,…

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Which types of health insurers make the most money?

It turns out the answer is Medicare Advantage plans according to a KFF analysis released today. However the reason why Medicare Advantage is more profitable may not be obvious: At the end of 2024, gross margins per enrollee ranged from $608 in the Medicaid managed care market to $1,655 in the Medicare Advantage market. Gross…

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