The Two-Midnight Rule: Additional Changes Expected for Medicare Advantage Members
This year is bringing even more changes for Medicare Advantage (MA) plans. One of the predominant adjustments is that MA plans will now follow the two-midnight rule. This means members’…
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The Medicare Advantage Playbook for 2025: New Rules, New Opportunities
In early April, the Centers for Medicare and Medicaid Services (CMS) finalized the 2025 Medicare Advantage Rule. This legislation also included changes to Medicare Part D, which covers prescription medications.…
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Medicare Advantage Spending Surge: What the 2023 Data Reveals & What Your Health Plan Needs to Know
A review of last year’s data shows a spike in service utilization for members with Medicare Advantage (MA) plans in 2023. This information came from an AHIP survey, which found…
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Inaccurate Reports of Vaping History Impacting Health Insurance Premiums
Vaping has been highly criticized due to its negative health effects, especially as the Food and Drug Administration (FDA) has cracked down on banning flavored e-cigarette products. As vaping use…
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Proposed Federal Legislation Intended to Expedite Prior Authorization Approval Process
Recent legislation proposed by the Biden administration aims to address member dissatisfaction with insurance approval wait times. If passed, this rule will apply to prior authorization requests through government insurance…
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Safeguard Your Pharmacy Reimbursement and Avoid Audits
With ongoing medication shortages and astronomical costs for specialty drugs, nearly all members can benefit from medication savings. Furthermore, managing costs helps payers keep reimbursement rates steady for their partners.…
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