MGB exiting certain Medicare Advantage primary care networks, impacting 19,000 patients.
MGB’s Response to Primary Care Shortage MGB has initiated several strategies to tackle the ongoing shortage of primary care. One notable proposal involves teaming up with CVS to deliver primary care services through retail clinics located within pharmacies. Blue Cross Blue Shield’s clientele includes patients from two of MGB’s physician groups: Harbor Medical Associates and […]
Thousands of Vermonters will lose access to Medicare Advantage in 2026.
Tens of Thousands of Vermonters to Lose Medicare Advantage Option in 2026 Nearly all Vermonters enrolled in Medicare Advantage plans are expected to lose their current coverage come 2026. New information from the Centers for Medicare and Medicaid Services indicates that every provider in the state, except one, will cease to offer these plans for […]
Medicare Advantage members discover that St. Charles might exit the network on January 1, while discussions are ongoing.
Bend, Oregon Update on St. Charles Health System Negotiations A week after the St. Charles Health System finalized a contract with Aetna and Cigna, talks with various other insurers are still in progress. PacificSource, one of the insurers involved, has informed its Medicare Advantage patients that they may be out of the network come January […]
Marijuana stocks rise following Trump’s support for Medicare coverage of CBD
On Monday, cannabis stocks experienced a significant rise following a video by President Donald Trump promoting the inclusion of cannabidiol (CBD) under Medicare coverage. The Tilray brand saw a jump of nearly 20%, with its shares increasing by 36% shortly after the market opened. Canopy Growth also grew by around 20%, while Cronos Group climbed […]
Federal agencies launch AI pilot program for Medicare evaluations in Washington
Medicare Changes in Washington State In Washington, individuals enrolled in Medicare might soon need extra approval for various medical procedures. This change comes as part of a pilot program that started on January 1 and involves states like Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, utilizing artificial intelligence to assess coverage for certain services. […]
Medicare Advantage sign-ups likely to decrease in 2026 as insurers reduce unprofitable options
Changes Ahead for Medicare Advantage Plans On July 25, 2023, supporters gathered at a press conference in front of the U.S. Capitol to discuss the Medicare Advantage plan. As reported by the Centers for Medicare and Medicaid Services, for the first time in nearly two decades, Medicare Advantage enrollment is expected to see significant changes. […]
Medicare to Implement AI for Prior Authorization in 2026 Pilot Program
Medicare to Implement AI in Treatment Approval Process Medicare is set to incorporate artificial intelligence (AI) into its decision-making processes. The goal is to see if algorithms can effectively determine which treatments will be covered under this major public health program. Beginning in 2026, federal pilots will explore whether AI can streamline advance approvals and […]
Private health insurance companies are using AI to decide on care approvals and denials. Medicare is expected to do the same soon.
Medicare Pilot Program to Utilize AI for Pre-Authorization The Trump administration is set to initiate a program next year aimed at assessing how artificial intelligence can help save costs by denying certain Medicare services. This initiative reflects an approach similar to that of private insurance companies. The pilot program intends to cut down on what […]
Medicare needs to include GLP-1 medications for obesity treatment
In the United States, obesity has become increasingly common and impactful, yet it took over four decades before bariatric surgery was included as a covered treatment under Medicare. This delay meant that countless Americans suffered and even died from conditions related to obesity while waiting for access to crucial care. Let’s not allow history to […]
Medicare fraud will amount to $54 billion in 2024, here’s how to safeguard yourself.
Medicare Scams Targeting Seniors Scammers see Medicare as a lucrative opportunity, and it’s not hard to see why. With billions in taxpayer dollars flowing through the program, the potential for exploitation is huge—improper payments alone reached about $54 billion in 2024. Some fraudsters create fake companies and submit false claims, while others go directly after […]