Medicare Advantage and Part D
Ohio Shuts Out Three ‘Pure Play’ Firms in New Medicaid AwardsFrom Medicare Advantage News - When Ohio awarded $1.2 billion worth of contracts to managed care organizations April 6, the three incumbent pure-play Medicaid MCOs — Amerigroup Corp., Centene Corp. and Molina Healthcare, Inc. — were excluded. In response, Centene said it intends to file a formal protest. And securities analysts said Medicaid MCOs remain capable of strong revenue growth over the next few years, and described pure-plays as unlikely to be shut out from many state awards going forward. Of the five companies getting Ohio Medicaid contracts for coverage starting Jan. Read more
Extra Benefits for MA Enrollees Average $73, Vary Widely by StateFrom Medicare Advantage News - Medicare Advantage beneficiaries generally are getting substantial amounts of supplementary benefits and/or reduced cost sharing now, and that is likely to continue through next year, according to a new analysis by consulting firm Avalere Health LLC and comments in an interview with its CEO. Read more
CMS in Call Letter Moves to Clarify Cost Sharing in Plans’ Nonpreferred Rx NetworksFrom Medicare Advantage News - The issue of cost sharing in preferred versus nonpreferred pharmacy networks of Medicare Part D plans clearly has landed on CMS’s radar screen. The preliminary 2013 Medicare Advantage and Part D call letter issued by CMS Feb. Read more
Managed Medicare and Medicaid Data
- [Managed Medicare Enrollment](/medicare-advantage-and-part-d/data/managed-medicare-enrollment)
- [Managed Medicaid Enrollment](/medicare-advantage-and-part-d/data/managed-medicaid-enrollment)
On the Medicare Advantage & Part D Bookshelf
Medicare Advantage & Part D Blog
By James Gutman - May 11, 2012
For those of us crazy enough to listen to all the quarterly earnings calls of publicly held Medicare Advantage and Part D plan sponsors, there always are a few "rewards" in the form of especially quotable remarks of company executives. And the just-completed first-quarter 2012 round of calls was no...
By James Gutman - May 4, 2012
Let it not be said that the health insurance industry is easing off the throttle in its campaign to save Medicare Advantage plans in the coming battles on what to cut when it's time to slash the federal budget deficit. The newest evidence of this campaign is a report put out by the America's Health...
By James Gutman - April 27, 2012
By now, the basic details of WellPoint, Inc.’s 2011 Medicare Advantage debacle are known. The company made its regional MA PPO too attractive for high-cost seniors, especially in Northern California, and wound up with huge claims that translated into huge losses and a medical loss ratio (MLR) above...
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