Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

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• Three Largest Medicare Advantage Organizations Had The Highest Denial Rates For Long-Term Acute Care Requests
• The Three Largest Medicare Advantage Organizations Denied Requests For Long-Term Acute Care & Inpatient Rehabilitation At Some Of The Highest Rates
• Older Adults In 41 States & D.C. Projected To Outlive Retirement Savings
• Medicare Spending Projected To Continue Rising Through 2034; Medicaid & Private Insurance Growth To Slow
• Nursing Home Closure Rates Averaged 0.9% Before COVID & 1.1% During Public Health Emergency
• CMS Strengthens Oversight Of Accrediting Organizations, Prohibits Mock Surveys Before Accreditation Reviews
• Connie Health Acquires Clearlink Insurance Agency & Announces Series B Funding To Accelerate Growth In Medicare
• 95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed
• GoHealth Medicare & Health Insurance Broker Files Chapter 11 Bankruptcy
• New York Governor Hochul Announces Completion Of $54 Million Supportive Housing Development On Manhattan’s Lower East Side
• Percentage Of Florida Older Adults Hospitalized For Mental Disorders Increased By 16% Between 2022 & 2024
• Five-Star Hospitals Increased 32% While One-Star Hospitals Declined 12% In Medicare’s 2026 Quality Ratings

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Three Largest Medicare Advantage Organizations Had The Highest Denial Rates For Long-Term Acute Care Requests

Medicare Advantage organizations (MAOs) denied 65% of prior authorization requests for admission to long-term care hospitals (LTCH) and 54% of requests for admission to inpatient rehabilitation facilities (IRF), according to a federal analysis of data from 19 MAOs during June 2024. The three largest MAOs by enrollment (CVS Health, Humana, and UnitedHealth) had the highest volume of prior authorization requests for these two post-acute settings and issued denials at higher rates than other MAOs. The… Read

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