GMS CONNECT’s Post

CVS Health has revised its expectations for enrollment in its Medicare Advantage plans for individuals aged 65 and above, anticipating surpassing earlier targets in 2024 due to robust sales and member retention. The company, which owns health insurer Aetna, now aims to add at least 800,000 members to its Medicare Advantage plans in 2024, up from the previous forecast of 600,000. CVS' Medicare Advantage plans, competing with UnitedHealth and Humana, received favorable "star ratings" from the Centers for Medicare & Medicaid Services, influencing reimbursement levels and member choices. The company has reaffirmed its 2024 adjusted profit forecast of at least $8.50 per share. CVS had adjusted its 2024 earnings forecast in November, considering potential higher medical costs. Tom Cowhey has been formally appointed as the chief financial officer, succeeding Shawn Guertin, who will leave the company on May 31, 2024. Ed Gonzalez, egonzalez@gmsconnect #medicare #healthcare #insurance #medicaid #healthinsurance #health #callcenter #business #contactcenter #bpo #customerservice #telemarketing #marketing #outsourcing #callcenterlife #callcenteragent https://lnkd.in/eECnfD8m

Highlights from this week's Week in Washington: 📰 - CMS released its annual proposed 2026 Notice of Benefit of Payment Parameters - VP Harris released a proposal this week broadening Medicare benefits to include home health care - Ballot initiatives that increase taxes on managed care programs in California, Medicaid work requirements in South Dakota, and Washington operating a long-term care insurance program - KFF annual survey of employer-sponsored insurance found that ESI premiums went up by 6% for single coverage and by 7% for family coverage - CBO estimates that Congress authorizes Medicare to cover anti-obesity drugs, increasing federal spending by about $35 billion from 2026 to 2034 Read more here and sign up to get more timely news delivered directly to your inbox: https://lnkd.in/gGiFnJmk #WeekinWashington #Medicare #Medicaid #longtermcare

The cost of healthcare often leads to delayed treatment. The Kaiser Family Foundation reports that 35% of adults in the U.S. postpone dental care due to expenses. This is significant, reflecting the high out-of-pocket costs not fully covered by insurance. Vision care is the second most delayed at 25%. These expenses, including eye exams and corrective lenses, are sometimes not included in standard health plans. Doctor visits are third, with 24% of adults postponing due to costs, even with insurance, due to copays and deductibles. Delaying these essential services due to financial constraints can lead to more severe health issues and increased costs over time. For instance, neglected dental care can result in advanced decay, requiring more complex treatment. These trends underscore the importance of selecting health insurance that provides adequate coverage for these essential services to prevent postponement of necessary care. It also emphasizes the need for better healthcare coverage and cost-effective solutions. 👉🏼To receive more information about healthcare costs and insurance options, contact us at https://lnkd.in/dm9iH9RP. Stay connected with us on social media for the latest updates and helpful tips! #MarbleCityInsurance #MarbleCity #Knoxville #insurance #insurancematters #insuranceawareness #lifeinsurance #healthinsurance #carinsurance #homeinsurance #businessinsurance

The stocks of several health insurance companies — including Humana, CVS Health, UnitedHealth and Elevance Health— took a hit during morning trading on Tuesday after federal regulators didn’t raise payments for Medicare plans above industry expectations. The Centers for Medicare and Medicaid Services announced Monday that government payments to Medicare Advantage and Medicare Part D programs — Medicare insurance plans operated by private companies — will increase on average by 3.7%, or $16 billion, year-over-year in 2025. Analysts view the rate increase as an effective decline of 0.16%

📈 Today's Healthcare News: Marketplace Enrollment Reached Record High for Third Consecutive Year 📈 During the 2024 Open Enrollment Period (OEP), a record 171,376 Kansans selected or were automatically re-enrolled in health #insurance plans through the federally facilitated marketplace, marking a 37.7% increase from last year. This is the third consecutive year of record high enrollment in Kansas and nationwide, with 21.5 million consumers enrolling in 2024 — a 31.1% increase from the previous year. Key Highlights: - Kansas Enrollment: 171,376 enrollees, with 26.5% new consumers. - Financial Assistance: 93.5% of Kansas enrollees received financial aid, reducing monthly #premiums significantly. - Plan Selection: Over half of the enrollees chose silver plans, while gold plan selections decreased. - Premiums: Average monthly #premium paid by Kansas enrollees receiving APTC decreased from $97 in 2023 to $77 in 2024. Increased subsidies from the American Rescue Plan Act (ARPA) and the Inflation Reduction Act of 2022 have significantly contributed to this surge in enrollment. However, the continuation of these enhanced subsidies remains uncertain beyond 2025. Stay updated on healthcare coverage trends and prepare for future changes. #HealthInsurance #MarketplaceEnrollment #HealthcareCoverage #OpenEnrollment #KansasHealthcare #MCG #ACA #SBMU #SBM101 🏥📊💡 https://lnkd.in/ejVh2mQK

Another one bites the dust... Many don't realize the ground is shifting underneath the Medicare Advantage space. Commercial payers depend on traditional healthcare sources to provide enhanced quality and reduced utilization to maximize government payments for these services When the traditional system is incentived off of increased utilization and sickness... The math quits mathing #healthcare #insurance #business #trends #hr #benefits

📊 U.S. healthcare spending surged to $4.8 trillion in 2023, rising 7.5% and outpacing GDP growth of 6.1%. Medicaid and private health insurance drove this growth, with 93% of the population now insured. Medicare spending increased by 8.4% to over $1 trillion. #Healthcare #USSpending #Medicaid

Whether you're filling a prescription or scheduling a procedure, chances are you've been asked whether you have prior authorization. Prior authorization is approval from a health plan before a service, prescription or other benefit is covered by a patient’s insurance to ensure that health care services are medically necessary. To learn more about prior authorizations regarding Medicare, please see the article link below. #medicare #medicareresources #priorauthorization #medigap https://lnkd.in/eTBERnCK

As you approach or reach the age of 65, a significant milestone awaits: enrollment in Medicare. The initial Medicare enrollment period begins three months before turning 65 and extends for three months afterward. However, you may be eligible for a special enrollment period if you still work and have health coverage through your employer. If you have health insurance through an employer, there are several factors to consider when deciding whether to enroll in Medicare, including spouse and family coverage, prescription drug coverage, provider access and costs. The choice will be different for everyone, so it comes down to what’s best for you and your family. The decision to enroll in Medicare while continuing your employer-provided coverage depends on your unique needs and circumstances. Talk to HR if you have any benefits-related questions. #medicare #medicareplans #employeehealthplans #healthplans #healthinsurance

#feeforservice is broken #valuebasedhealthcare is the solution Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill. https://lnkd.in/gJgvaZxC Aetna, a CVS Health Company , Cigna Healthcare , UnitedHealthcare , MultiPlan ..."The answer is a little-known data analytics firm called MultiPlan. It works with UnitedHealthcare, Cigna, Aetna and other big insurers to decide how much so-called out-of-network medical providers should be paid. It promises to help contain medical costs using fair and independent analysis. But a New York Times investigation, based on interviews and confidential documents, shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee...."