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UP Health System to leave Humana’s Medicare Advantage network in 2027
The coverage will end effective Jan. 1, 2027, and may impact some patients’ in-network access to UP Health System offerings.
Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
Clover Health Sees PPO Edge, Cohort Gains as Medicare Advantage Pricing Tightens
Clover Health Investments (NASDAQ:CLOV) is positioning its Medicare Advantage business to benefit from industry pricing discipline, member retention and the maturation of member cohorts, Interim Chief Financial Officer Clay Thornton said at Jefferies’ Healthcare Services and Technology Conference in
Kettering Health will not renew contract with Medicare Advantage insurer Anthem
Kettering Health, one of the largest health systems in the Dayton region, will not renew its contract with private Medicare Advantage insurer Anthem, including Anthem MyCare, according to an announcement from Kettering Health.
Sauer: Mass. must get ahead of health care fraud
If policymakers drag their feet, Medicare Advantage’s waste, fraud, and abuse problems could erode public trust, drive up taxpayer costs, and threaten the long-term viability of the program.
White River Health leaving UnitedHealthcare Medicare Advantage network in 2027
White River Health announced Wednesday that its hospitals and facility-based services will leave the UnitedHealthcare Medicare Advantage network effective Jan. 1, 2027.
Jefferson Health-Independence contract dispute worries Jefferson patients with IBX Medicare Advantage plans
IBX Medicare Advantage customers who are Jefferson Health patients have a choice: switch plans or risk losing access to their Jefferson doctors next year.
The U.S. Healthcare System is Already Mostly Socialized
Now that Abdul El-Sayed is the Democratic nominee for Michigan’s open Senate seat, the outcome of this crucial race will depend mainly on two things: Whether Republicans succeed in demonizing El-Sayed because he’s brown and a Muslim, and whether they succeed in demonizing him as a left-wing radical. I will defer for the now the question of whether bigotry will be effective this year, although I will address it another day. What I want to address instead is El-Sayed’s signature issue — healthcare. Yes, El-Sayed advocates Medicare for All, a position the usual suspects denounce as “socialism.” I will get to the politics of his stance soon. Today, however, I want to talk about the substance. We should be clear that El-Sayed doesn’t even call himself a socialist. On the contrary, he explicitly disavows the label, saying “I’m a capitalist who just knows about capitalism”. In fact, as I explained in a previous post, the policies that El-Sayed advocates qualify him as a social democrat, not a socialist. Still, El-Sayed advocates a system under which the government would pay almost all medical expenses. Isn’t that socialism? Well, if that is the criterion then much of U.S. healthcare is already socialist. In fact, the government’s role is so large that U.S. healthcare is better described as partially privatized socialism than as anything resembling a free market. Let’s start with the raw numbers on health insurance, which pays the bulk of Americans’ medical expenses. Americans receive health insurance either from private companies or from public programs, overwhelmingly Medicare and Medicaid. Here’s what the breakdown of coverage and spending between private and public looked like in 2024: While a majority of Americans with health insurance get it from private companies, well over 100 million of us are covered by government programs instead. And these government programs pay more total dollars for medical bills than the private insurers do. Why do government programs that cover a minority of the population account for a majority of health insurers’ outlays? Mainly because Medicare covers seniors, and we’re expensive. Also, while Medicaid covers many younger Americans, disabled and elderly beneficiaries account for most of its spending. Even by the raw numbers, then, U.S. health insurance looks as much public as private. But that understates the government’s role: Private health insurance in the U.S. is both highly regulated and heavily subsidized. This is obviously true for the insurance coverage purchased by tens of millions of Americans through the exchanges established by the Affordable Care Act. But employment-based health insurance, which covers 161 million Americans, is far more of a government creation than most people realize. For employment-based insurance exists largely because of huge implicit government subsidies that come with major strings attached. Here’s how that works. If your employer pays you $10,000, that’s taxable income. But if your employer pays $10,000 toward a company health insurance plan that meets certain criteria, it isn’t taxable. That’s a huge effective subsidy, running at more than $300 billion a year. Take that subsidy into account, along with the more than $100 billion per year spent subsidizing policies purchased under the ACA, as well as the outlays on Medicare and Medicaid, and net effect is that the government pays for more than two-thirds of Americans’ health insurance. Granted, there are strings attached. Roughly speaking, employment-based health plans can’t discriminate based on medical history — that is, they can’t deny coverage to employees with pre-existing conditions — and they also can’t offer the plans only to highly compensated employees — a health plan that is only for the C-suite is considered taxable income. So given the restrictions of the federal tax code, employer-based health insurance is a lot like Obamacare, which also prohibits discrimination based on medical history and provides subsidies to make insurance affordable to lower-paid workers. The fact is that virtually all of private healthcare insurance is already well under some form of government control through regulation and tax subsidies. How should we think about this system? First of all, is Medicare socialist? Don’t tell anyone, but the way Medicare operates — it covers every senior’s medical expenses, whatever they turn out to be, while being funded by taxes that depend on one’s income — could be summarized by the old Marxist slogan “From each according to his ability, to each according to his need.” And back in 1961, when Ronald Reagan was the face of a last-ditch effort by the American Medical Association to block the creation of Medicare, he denounced Medicare as “socialized medicine” and warned that it would destroy our freedom. In reality, American freedom survived until Jan. 20, 2025, while Medicare is immensely popular, with an 82 percent favorable rating in the most recent KFF survey. Medicaid, government health insurance for lower-income Americans, comes in at 73 percent. This is in sharp contrast to public views about private insurers, who are widely disliked if not hated and accused of denying essential care. Furthermore, if Medicare is socialism, then the whole U.S. health insurance system, with the government paying most of the bills and placing conditions on private insurers, is almost equally socialist. If you insist on calling any program the government pays for and regulates socialist, then U.S. healthcare would best be described as a partially privatized form of socialism. And one must ask, what is the point of the part that is privatized? Do private insurers add anything positive? Or are they simply parasites, skimming off money that could have been paying for care? The case for viewing insurers as parasites is strong. Many Medicare benefits are now delivered via Medicare Advantage, that is, plans paid for by the government but run through insurance companies. MedPAC, an independent advisory commission, estimates that last year Medicare Advantage plans were overpaid by $84 billion, thanks to practices such as “upcoding,” in which patients’ health problems are overstated to get larger sums from Medicare. Assessing the waste from employer-based insurance is harder, but most evidence suggests that private insurers have substantially higher administrative costs than Medicare does. Furthermore, the complexity of private insurance, with multiple payers all trying to deny care when they can, is a huge burden both on providers — doctors, nurses, and hospitals — and on patients. What do private insurers offer to compensate for these costs? One must go through intellectual contortions to avoid the conclusion that they are, in fact, parasites. Which brings me back to El-Sayed. In supporting Medicare for All, he’s basically calling for an end to the partial, parasitic privatization of a healthcare system that is already hugely dependent on public funding. When one looks at it that way, it’s not at all a radical proposal. Admittedly, the political lift requires overcoming the opposition to higher taxes to pay for Medicare for All. Political realism rather than economics was the reason I and many other progressives supported Obamacare, with all its complexities, rather than demanding an immediate move to Medicare for All. But the political calculus may very well have shifted since the 2000s, as Americans are fed up with a system of unaffordable premiums, rampant claim denials, and byzantine claim administration. Moreover, funding healthcare insurance through taxation would allow for a much more progressive distribution of the cost. That is, compared to the present system, middle-income households would pay less as high-income households would pay more. And the U.S. would stop wasting large sums on pointless administrative costs. So let’s be clear: El-Sayed’s healthcare platform is perfectly reasonable on the merits of cost, fairness and health efficacy. And with private insurers never more hated, while millions of Americans are losing their health insurance, 2026 may be its time. MUSICAL CODA
Patients face higher costs as White River Health goes out of network with UnitedHealthcare
Starting April 1, patients with UnitedHealthcare commercial and Medicare Advantage plans are out of network at White River Health.
Senators press UnitedHealthcare and other Medicare Advantage giants over denied care
Demand for more information on prior authorization rules follows a federal watchdog report in June and growing pressure on health insurers grows.
ArchWell Health opens 4 new senior care clinics in Northeast Ohio
The Medicare Advantage-focused health provider will host grand openings throughout April in Cleveland Heights, Euclid and two Cleveland neighborhoods, bringing its regional total to nine centers.
Jacksonville-based Complete Health to pay $14M in Medicare Advantage settlement
Complete Health Partners Holdings has agreed to pay $14.1 million to settle allegations that it caused false diagnosis codes to be submitted to boost payments from the Medicare Advantage program, the Department of Justice said.
Florida health system settles Medicare Advantage fraud claims for $542M
In a statement, the U.S. Department of Justice confirmed that Villages Health System self-reported the upcoding and fully cooperated with an investigation. The incidents occurred between 2020 and 2024.
Providence Health Plan to close completely after Medicare Advantage deal falls through
The regional health plan was in talks with an unnamed national insurer to keep its MA plans afloat. But the agreement sputtered “despite significant effort on all sides,” a Providence spokesperson said.
ACO Expansion Might Change The Case For Investing In agilon health Stock (AGL)
In late September 2026, agilon health reported that The Jackson Clinic and Springfield Clinic would expand their partnerships by joining agilon’s Senior Health Connect ACOs. This extends value-based care support to roughly 30,000 additional Traditional Medicare beneficiaries on top of existing Medicare Advantage panels. The moves deepen agilon health’s integration with large multi-specialty groups, tying more senior lives into full-risk accountable care models that rely heavily on the...
Cancer patient feels "like collateral damage" after MGB Health Plan removes Dana-Farber from Medicare Advantage network
Cityblock in talks to buy fellow General Catalyst-backed startup Homeward Health
Cityblock Health in talks to acquire General Catalyst-backed rural care startup Homeward, expanding into Medicare Advantage, source says.
Top Boston hospitals clash over Medicare Advantage network after split
First, Mass General Brigham split with Dana-Farber. Now its Medicare Advantage plan is dropping the cancer hospital.
Cityblock to Acquire Homeward Health, Secures $116M Series E
Cityblock Health plans to acquire rural healthcare provider Homeward Health and has raised $116 million to expand its value-based care model to rural and Medicare Advantage populations.
SMH and United Healthcare at odds on Medicare Advantage pact
Dispute does not affect traditional Medicare coverage or commercial contract negotiations
A Clover Health Director Sold Over 67,000 Company Shares. Here's a Closer Look at the Transaction.
This healthcare technology firm, focused on Medicare Advantage plans, reported a notable insider sale amid muted stock performance.
DOJ settles lawsuit with Medicare Advantage homecare company for $2M
Tennessee-based Monogram Health was accused of upcoding claims in violation of the False Claims Act. The company does not admit to wrongdoing.
Medicare Advantage's next golden goose: Special Needs Plans
Chronic Condition Special Needs Plans enrollment has more than doubled since 2024.
UnitedHealth, Aetna, HCSC star ratings slip
Only fifteen Medicare Advantage contracts earned the highest score under the Star Ratings program for 2027.
Health insurers are dumping Medicare Advantage plans. Here’s how many seniors could be affected.
Older adults could be scrambling for new health coverage next year, especially in rural markets that have fewer insurance choices.
Elevance pays CMS $342M to assuage concerns of noncompliance and overbilling
The Medicare Advantage insurer said the payout is equal to what a CMS audit stated was the total amount the company was overpaid for patient care services. Despite receiving the cash, the agency has yet to officially withdraw its enforcement action, as the two parties are still negotiating.
Mostly, Health Insurers Maintain Medicare Advantage Markets For 2027
Health insurers in privatized Medicare Advantage are for the most part maintaining their 2027 geographic footprints after a multi-year period of retrenchment.
Health insurers rise after US lifts 2027 Medicare Advantage payment rates
Shares of U.S. health insurers climbed in premarket trading on Tuesday after the government said it plans a larger-than-expected increase in 2027 payment rates for Medicare Advantage plans.
Elevance sues government over $115 million tied to Medicare Advantage star ratings
The health insurer says CMS didn't calculate its star ratings appropriately.
Medicare Advantage Continues To Grow Despite Health Insurer Exits
Medicare Advantage is the choice of 55% of eligible beneficiaries for health insurance for Americans 65 and older.
Lawmakers introduce bipartisan bill to speed up prior authorization in Medicare Advantage
Several healthcare stakeholders have voiced their support for the effort, including the Medical Group Management Association.
Health Brief: Watchdog flags Medicare Advantage denials
Plus: New polling shows how health care could shape the midterms
Medicare Advantage plans denied prior authorization requests at unusually high rates, HHS report finds
UnitedHealthcare, CVS Health and Humana had the highest denial rates for long-term care requests, according to a report from the agency’s inspector general.
Elevance Health sues CMS in latest challenge to Medicare Advantage star rating methodology
The complaint accuses the Centers for Medicare & Medicaid Services of failing to properly recalculate its grades for Medicare Part C plans, something it promised to do in June.
SMH and United Healthcare at odds on Medicare Advantage pact
About 33,000 UnitedHealthcare Medicare Advantage subscribers who receive healthcare services at both Sarasota Memorial Hospital and First Physicians Group will be out of network starting Jan. 1, 2027, unless the two sides sign a new contract before the end of the year.
UnitedHealthcare extends coverage at ECU Health hospitals
UHC says the extension runs through August 6th for commercial, Medicare Advantage, and Individual Family Plan participants.
Why Lee Health's insurance standoff stands out from others across the US
More than 30 health systems across the country are currently in disputes with insurance companies, and many of those battles center around Medicare Advantage.
Medical Advantage plans to leave NH including CVS Health, BMC Health System
There are major upcoming changes to Medicare Advantage plans that will impact thousands of Granite Staters.
After her insurer denied coverage of medication, she ended up in the ER
After switching Medicare Advantage plans, a woman with a weakened immune system got tangled in the preapproval process, which the insurance industry has vowed to improve.
Walmart is partnering with a nonprofit insurer to sell Medicare Advantage plans
The co-branded plans will be available to more than 2 million Medicare enrollees in two states when open enrollment begins Oct. 15
Medicare Advantage plans cut as CVS Health and WellSense leave N.H.
Options for Medicare Advantage plans are shrinking again in New Hampshire, with two major providers — CVS Health and BMC, which offers WellSense — leaving the state as of January 1. A fairly new firm, Devoted Health, will start providing plans in portions of the state. These do not include Coos County, which won’t have […]
Elevance Health (ELV) Stock May Be Undervalued Despite 2027 Medicare Advantage Plans
Elevance Health has delivered a solid share price run recently, and that move puts a spotlight on a simple question for investors who care about fundamentals. Is the current valuation of the stock properly anchored to the earnings the business is generating today? Over the past year, Elevance Health has returned 19.2%, which puts fresh pressure on the question of whether the earnings profile can carry the current share price. The planned 2027 Medicare Advantage offerings aim to simplify...
Trump administration finalizes better-than-feared Medicare Advantage payment rate in boost to health insurers
The Trump administration will increase average Medicare Advantage payments by 2.48%, or more than $13 billion, in 2027.
Clover Health (CLOV) Stock Looks Fairly Priced Despite Profit Turnaround
Clover Health Investments has staged a very strong three year run, yet the current checks still suggest the stock leans cheap rather than fully pricing in that shift in fortunes. The share price has returned about 3.3x over three years, which puts recent trading firmly in the high move bracket for this period. Profitability progress and Medicare Advantage membership growth can support the case for the current valuation, while higher medical costs and healthcare usage remain a clear risk to...
Medicare Advantage star ratings 2027: Winners and losers
Medica and Humana saw the greatest increases in the share of enrollees with plans that earned high star ratings.
Main Line Health, United Healthcare contract dispute could leave 32,000 patients out-of-network later this month
The nonprofit health system's current UnitedHealthcare contracts for employer-sponsored insurance and Medicare Advantage plans expire June 30. The plans cover 32,000 Main Line patients.
CHRISTUS Health Plan to withdraw from Medicare Advantage
TEXARKANA, Texas -- Thousands of East Texas seniors with CHRISTUS Medicare Advantage plans will need to find a new provider for coverage by Dec. 7 this year.
Former Sunnyvale resident pleads guilty to health care fraud
Authorities say Sevindik Huseynov aided and abetted as scheme to submit thousands of bogus claims to Medicare Advantage programs.
Batesville’s White River Health dropping UnitedHealthcare Medicare Advantage
White River Health will end its relationship with UnitedHealthcare Medicare Advantage on Jan. 1, 2027, due to frequent claim denials and administrative hurdles.
Seniors with UnitedHealth Medicare Advantage may lose access to Fairview hospitals, clinics
Once again, the Minneapolis-based health system notified 11,000 patients by email this week about changes that would happen in 2027. The Minnetonka-based insurer calls the message a “scare tactic.”
Medicare Advantage health plans may cut extra benefits in 2027
Americans enrolled in Medicare Advantage health plans should expect to see fewer extra benefits like gym memberships and vision and dental coverage next year, investors and industry experts say.
Health insurers secured a better Medicare Advantage rate for 2027, and their stocks are soaring
Shares of health insurers rallied in premarket trading on Tuesday after the government improved the initial Medicare Advantage rate increase for next year.
Cityblock Health Expands in North Carolina to Support Nearly 20,000 Dual-Eligible and Medicare Advantage Members
/PRNewswire/ -- Today, Cityblock Health announced a program to bring comprehensive, accessible care to almost 20,000 Medicare Advantage and dual-eligible...
Has Elevance Health (ELV) Earned Its Discount After Medicare Updates?
Elevance Health has delivered solid gains over the past year, and fresh product updates in its Medicare business keep the story moving. The open question for anyone looking at the stock now is whether that share price is adequately backed by the company’s earnings power. With a 19.2% return over the past year, Elevance Health has rewarded holders, which puts more focus on whether that move lines up with its earnings profile. The planned 2027 Medicare Advantage offerings aim to provide more...
Medicare Advantage in 2026: Enrollment Update and Key Trends
More than half (55%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026. To better understand trends in the growth of the Medicare Advantage program, this brief provides current information about enrollment, including by plan type and firm
‘Medicare for All’ message attracts voters buckling under medical bills
Support for Medicare for All is at its highest in at least a decade, according to a new KFF poll. The survey found two-thirds of Americans now favor expanding the government health program that largely covers seniors (about half of whom are enrolled in private plans through Medicare Advantage).
Health insurance stocks: UnitedHealth Group, CVS, and Humana are rising on Medicare Advantage news
Backtracking on an earlier proposal after intense lobbying, the Trump administration will now increase insurer payments more than expected.
In Pittsburgh, Medicare Advantage shopping can be a trial. AI to the rescue?
If there was ever a job tailor-made for artificial intelligence, choosing a Medicare Advantage plan is it. Seniors in Western Pennsylvania have a blizzard...
House committee advances radiology-backed legislation to curb prior authorization
The Improving Seniors’ Timely Access to Care Act seeks to streamline the “often cumbersome and time-consuming” task of approving requests for medical imaging in Medicare Advantage.
As It Walks Toward Its Doom, Providence Health Plan Gets More Bad News
In change of plans, the Portland-based health insurance company say it would be closing down its Medicare Advantage line too after negotiations with a national big insurance company failed.
Healthcare startup Devoted Health could be valued at $25 billion
Devoted Health, co-founded by Ed and Todd Park, is raising a round that might value it at $25B, spotlighting the booming Medicare Advantage sector.
Can AI solve our mental health access problem?
Last week I asked you what worries you most about AI in health. It was close, but your top answer was “AI giving bad health advice.” Last week’s poll results: You’re in good company. This concern was top of mind at a conference I joined at Stanford last week, where researchers, clinicians, and people who build AI systems spent a day debating trust and safety in health AI. Stepping back, I’m also hearing your emerging concerns about AI’s impact on our well-being generally. I see this as a matter of public health, and we’ll take it in pieces as we learn together. Today we’ll focus on AI chatbots used for therapy for mental health. Early this month, Governor Newsom vetoed Senate Bill 903, California’s most ambitious attempt to regulate AI use for mental health. It’s at the center of active debate, and raises the questions patients, family members, citizens, and voters will face as AI moves deeper into health care. Let’s work through it. What is “AI-based therapy”? It’s really two things: purpose-built mental health apps designed to deliver structured support, and general chatbots like ChatGPT, Claude, and Gemini that people increasingly use for emotional support—even if they weren’t built for it. Spoiler alert: I don’t know whether the shift toward AI therapy is good or bad. The evidence isn’t there yet. But I do know it’s already happening, and I have some ideas about how we can roll it out with safety in mind. The therapy dilemma, in a nutshell Mental health challenges are common, and strain health and well-being across populations. Therapy (interactive dialogue with a trained, empathetic practitioner) helps many people heal. The demand for licensed therapists far exceeds the supply in California, and AI-based therapy can narrow that gap. AI-based therapy remains novel, unproven, and not well tested. Right off the bat, we can see we’re dealing with trade-offs here. Since the main driver of demand for therapy from a robot is lack of access to therapy from a human, we’ll start there. It’s too hard to find and afford a human therapist California is short roughly 55,000 licensed, non-prescribing therapists and counselors, about 40% of what we need. Psychiatrists, who rely on talk therapy as a complement to prescribed medications, are even more scarce. Eight counties have none, and density ranges from 1.7 per 100,000 residents in San Benito County, to 68.1 in Marin County. My wife is a psychiatrist in Marin, and even here access is tight. If it’s hard in the best-supplied county, imagine rural Sierra County, or the San Joaquin Valley. In 2024, more than half of Californians who tried to make a mental health appointment struggled to find a provider who took their insurance, compared with 14% for physical health care. When Senate staff posed as “secret shopper” patients and called 120 mental health providers in Medicare Advantage networks, they landed an appointment less than once for every five tries. Insurers pay behavioral health clinicians about 22% less than medical and surgical clinicians for comparable office visits. On top of that, billing denials and prior authorizations hit hardest at the solo and small practices common in mental health. Psychiatrists opt out of Medicare at the highest rate of any specialty. In many places, a cash practice for therapy fills quickly with patients paying $250 or more an hour, with no insurance paperwork at all. Families who can pay cash find providers more easily. Those who rely on insurance, including Medi-Cal enrollees, older adults, rural residents, and non-English speakers, compete for what’s left. So we can’t pretend the human system works, and we can’t blame people for turning to AI for support when they’re in distress. AI is filling the gap It’s estimated that roughly a quarter of AI users use it for mental health support. If you have internet, it’s available 24/7, it’s cheap, and it speaks your language. Uninsured adults are about twice as likely as insured adults to do it (30% vs. 14%). It feels anonymous in ways that may enable people to ask things they’re unsure or embarrassed about. The largely hidden, personal use makes it hard to study whether it’s actually helping people with their mental health issues, but researchers are trying. Does AI therapy work? A 2026 analysis of nearly 40 randomized trials found chatbots showed a real but small reduction in depression symptoms. But most of these trials were compared to an alternative of no therapy, not a human therapist. So the benefit of AI therapy is probably real, but modest, and mostly untested against the alternative of human contact. We need more studies. Serious concerns OpenAI’s own estimate is that more than a million ChatGPT users each week show signs of suicidal planning or intent. These are high stakes encounters, and AI doesn’t always get it right. That’s partly because a chatbot can sound like a therapist, but it has no license, no duty of care, and it’s not clear who to hold accountable when it gets things wrong. AI is also designed to help users in whatever task they’re seeking to accomplish. People may feel like they’re getting therapy, but they’re mainly getting a convincing conversation. It’s easy for an AI companion to wander into gray areas, like playing along with “creative writing” that may be about the user’s own suicidal intent. Courts are driving safety conversations A wave of lawsuits have been filed on behalf of families claiming that chatbots pushed people they loved toward self-harm, including teens who died by suicide. The first settlements came this year. OpenAI is headquartered in San Francisco, and dozens of cases alleging that ChatGPT drove users to suicide or self-harm are now before a San Francisco judge. Character.ai has filed for bankruptcy after several states brought lawsuits accusing the chatbot of pushing dangerous content to kids. But the technology seems to be improving. Last month, an independent evaluation found that newer AI models “almost never endorse suicide.” That’s progress, but our societal appetite for even one preventable death is very low. So how do we move forward? Finding a middle ground Earlier this month the governor vetoed Senate Bill 903, a bill designed to place guardrails on the use of AI for therapy. The bill would have prohibited any AI-based platform from being advertised as psychotherapy, and would have required a licensed professional to review and approve each encounter where AI was used to support therapeutic decisions. Newsom called it overly broad, since even routine screening questions would have needed clinician sign-off. Knowing we’re already short on mental health providers, requiring human review of AI encounters may not relieve our access problems. Still, the answer isn’t no oversight. Here’s one feasible short term solution. Rather than reviewing each encounter, a licensed clinician can design the guardrails: what counts as a crisis, what triggers an immediate handoff to a human, and what gets sampled for audit each month. The AI runs inside that structure. Conversations get checked, failures get reported, and a real clinician owns the framework. Medicine already has models to learn from. The FDA process for rolling out newly approved medications is an example. After a product reaches patients, we keep watching for adverse events. Patient-facing AI needs the same “digital pharmacovigilance”: systematic tracking of harms, near misses, and the types of groups that get hurt and why. It’s also critical that users know that they can reach a human if they’re in crisis. Most chatbots now include messages like these: Bottom line The rush to use unproven AI tools for mental health support is mostly a workaround, a sign of a health system people can’t get into. We need better access to proven care from licensed clinicians. That takes reimbursement that makes accepting insurance viable, and a bigger workforce. But, built and tested well, AI could be part of the answer. It could be the 2 a.m. check-in when no one else is awake, or a way for patients to practice skills their therapist taught them. It could be the first step to get someone the right level of care, and take paperwork off clinicians’ plates so they spend more time with patients. None of this is simple. The SB 903 veto doesn’t end the debate, and the legislature will be back. In the meantime, those of us using these tools need to stay informed, ask hard questions, and hold the companies building them accountable. I’ll try to do my part, and we’ll keep learning together. Love,Matt P.S. If you or someone you know is struggling with mental health challenges, emotional distress, substance use problems, or just needs to talk, call or text 988- you’ll reach a real person— or chat at 988lifeline.org 24/7. Dr. Matt Willis is the author of Your Local Epidemiologist in California. A California native, he’s served as a primary care physician, CDC epidemiologist, and public health officer for Marin County, where he guided the pandemic response. He lives in Marin with his family and their dogs, Teddy and Ramona. Thank you Cynthia He, MD, PhD, and Parnika Saxena, MD, for their guidance in preparing this article. Cynthia works in an outpatient mental health clinic, treating patients who have Medi-Cal or, sometimes, no insurance. Parnika works in an inpatient psychiatric unit, treating patients with public or private insurance or self-pay ability. All opinions are their own and do not represent their employers.
What agilon health (AGL)'s Jackson Clinic ACO Expansion Means For Shareholders
In late September 2026, The Jackson Clinic expanded its relationship with agilon health by joining agilon’s Senior Health Connect ACO. This extended value-based care support from roughly 8,000 Medicare Advantage seniors to an expected 9,000 additional Traditional Medicare beneficiaries. This move deepens agilon health’s role in coordinating prevention-focused primary care across Medicare programs, which could influence medical cost trends, operating efficiency, and long-term contract...
Minnesota seniors navigating ‘incredibly complex’ system for Medicare Advantage
More than 300,000 in Minnesota are being forced to shop as insurers change the lineup of health plan options. Here are some tips.
Medicare Advantage plans appear to be cutting benefits in 2027
The cuts are intended to boost insurers' margins.
Two more insurers sue CMS over Medicare Advantage star rating methodology
The lawsuits come days after Elevance Health filed a complaint of its own, asking a court to compel the Centers for Medicare & Medicaid Services to remain consistent in how it doles out stars.
Kettering Health will not renew contract with Medicare Advantage insurer Anthem
Kettering Health, one of the largest health systems in the Dayton region, will not renew its contract with private Medicare Advantage insurer Anthem, including Anthem MyCare, according to an announcement from Kettering Health.
NC State Health Plan board approves Medicare Advantage plan benefit changes despite retiree concerns
Retirees on the state's Medicare Advantage will face higher out-of-pocket maximums next year, as well as higher copays for many medical services.
New Medicare Payment Rate Expected. Why It’s a Big Deal for Healthcare Stocks.
About 35 million beneficiaries are in Medicare Advantage plans this year, according to the health research group KFF.
SCAN Health Plan, Walmart partner on Medicare Advantage plans
SCAN Health Plan is partnering with retail giant Walmart to launch a co-branded Medicare Advantage plan in two states, the companies
Humana To Divest End-Of-Life Care Business For $900 Million
Humana, one of the largest U.S. sellers of Medicare Advantage insurance for older adults, will divest its stake in a provider of end-of-life services for $900 million.
Presbyterian to lay off more than 100 employees, shifts health care offerings
Presbyterian said it will end most Medicare Advantage plans in 2027 and cut about 150 health plan and administrative jobs.
Business briefs, July 27
New CMS voting memo sparks concerns over resident assistance in nursing homes … Initial jobless claims decline 22K week over week, falling to a seasonally adjusted tally of 187K … House Energy and Commerce Committee passes package to streamline Medicare Advantage prior authorization … 1 in 4 US workers sticking with a job strictly for health insurance … Fitch Ratings affirms Greenwood Village South at BBB-; outlook stable
UHC Medicare Advantage patients set to lose in-network access to Brown Health physicians
Rhode Islanders insured under UnitedHealthcare’s Medicare Advantage plans may once again have to find new doctors amid contract negotiations between the insurer and Brown University Health.
Preserving access for vulnerable communities should be a top priority in Congress
By Tony Henderson As both a minister and as president of the NAACP Denver, I believe access to high-quality, accessible health care is a right that should be afforded to each and every one of us. To that end, Medicare Advantage has become a critical component of our health system, helping secure access to care […]
Presbyterian Healthcare Services to layoff workers and discontinue some health plans
Presbyterian Hospital has announced the layoffs of 150 workers along with the discontinuation of most Medicare Advantage plans in 2027.
SMH talks with United Healthcare on Medicare Advantage pact stall
Talks could affect 33,000 SMH and First Physicians Group patients in 2027 if a deal is not reached by Dec. 31
Alignment Healthcare Turns Profit As Insurer Gets Handle On Costs
Alignment Healthcare’s second quarter net income more than doubled to $36.6 million compared to the year ago period as costs in its Medicare Advantage plans eased.
CMS appeals court ruling on Medicare Advantage star rating methodology as insurers file lawsuits
The agency announced its appeal of a court ruling it lost to Clover Health, which resulted in the agency recalculating the grades it gave to the payer’s Medicare Part C plans. Other insurers are now asking for the same redo, spurring CMS to appeal the initial ruling.
A key Medicare Advantage announcement is due today
Today's announcement will set the tone for how the Trump administration wants to work with private Medicare insurers.
Changes to the NC State Health Plan will make retirees pay more. Here’s what it means for you
Retirees on the state’s Medicare Advantage plans will pay more for hospital stays, specialist visits and some drugs next year.
Monogram Health to pay $2.4M to settle Medicare Advantage upcoding allegations
The Justice Department told Healthcare Dive that Monogram, a home health company, overcharged Medicare through contracts with Cigna and Humana by inflating diagnostic codes.
CVS Health (CVS) Opens New Pharmacy Sites As Undervalued Narrative Holds
CVS Health (CVS) is expanding its pharmacy-focused format by opening nearly 20 smaller neighborhood locations across the US in 2026, including a new Roxbury site in the Boston area. Recent headlines around CVS Health have mixed signals for investors, with Medicare Advantage star rating setbacks and a legal probe weighing on sentiment, while the extended Cardinal Health distribution deal and a reaffirmed dividend provide a steadier backdrop. Even after a one-day share price decline of 1.87%...
America's largest health insurance companies cancel nearly 1M Medicare Advantage plans — here's what that means for recipients
State Health Plan to vote on price hikes for older state workers, retirees
People on the Medicare Advantage version of the State Health Plan could soon face higher drug prices, copays and deductibles as the state struggles to pay for rising healthcare costs.
Providence to end Medicare Advantage plans after deal with national insurer fails
Roughly 55,000 Oregonians will need to find new Medicare coverage next year after Providence's proposed sale collapsed.
Readers Write: Women’s sports and trans athletes, health care, Medicare Advantage
So conservatives support women athletes, huh?
Healthcare startup Devoted Health could be valued at $25 billion
Devoted Health, co-founded by Ed and Todd Park, is raising a round that might value it at $25B, spotlighting the booming Medicare Advantage sector.
New Poll: 94% of Americans Say Congress Must Act on Health Care Costs, as Families USA Convenes Bipartisan Policy Symposium
Both House and Senate committees are marking up legislation on hospital price transparency, prescription drug and Medicare Advantage reform. WASHINGTON, D.C. – A new national poll shows that 94% of Americans believe it is important for the President and Congress to take action to lower health care costs. The poll was commissioned by Families USA, […]
Exclusive | Connie Health Grabs $40 Million to Give Local Medicare Advantage Brokers an AI Lift
HealthQuest Capital led the financing for Connie, which helps local brokers compete with national players.
Why Minnesota seniors face the nation’s biggest health insurance shake-up
An era of low costs and more generous benefits may be ending for hundreds of thousands enrolled in Medicare Advantage plans in Minnesota.
MGB Health Plan removes Dana-Farber Cancer Institute from Medicare Advantage network
AHA releases Q1 2026 Health Care Plan Accountability Update
The AHA today released its Health Care Plan Accountability Update, covering the latest developments in Medicare Advantage, legislation and regulation of private health insurers, as well as other resources from the last quarter.
New research: For lower costs without worse outcomes, vertically integrate healthy health systems with certain health plans
Hospital-operated Medicare Advantage plans can help streamline post-hospitalization care of discharged inpatients while cutting episode-of-care costs and maintaining good patient outcomes.
Tips for covering Medicare open enrollment
It's that time of year again when traditional Medicare enrollees can change their Part D prescription drug plan, move from a Medicare Advantage plan back to original Medicare, and in a handful of states, switch Medigap plans.
More than 3 million Medicare Advantage enrollees need to find new plans for 2027 in third year of turmoil
Millions of senior citizens and other enrollees will have to find new Medicare Advantage plans because their policies are being terminated, while others could have to pay more for their coverage and care.
MetroPlusHealth Achieves 4-Star Medicare Advantage Rating
MetroPlusHealth, New York City’s high quality, affordable health plan, announced today that its Medicare Advantage plans have been awarded a 4-Star rating
Health insurers score major win with higher 2027 Medicare Advantage rates
The stocks of major Medicare Advantage insurers surged on the announcement.
2 major health insurance companies cancel Medicare Advantage plans covering 1 million people
The two companies are the largest private health insurance companies for older adults in the U.S.
MetroPlusHealth Earns 4-Star Medicare Rating for Second Consecutive Year
New York, NY – MetroPlusHealth, New York City’s high-quality, affordable health plan, announced today that its Medicare Advantage plans have earned an