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Cigna Group is reportedly in negotiations to sell its Medicare Advantage division to Health Care Service Corp (HCSC) for around $3-4 billion. This is a significant move that could have implications for the Medicare Advantage market and the health insurance industry as a whole. Why is Cigna looking to sell its Medicare Advantage business? There could be several reasons, but one possible explanation is that Cigna wants to focus on its core businesses and streamline its operations. Cigna acquired Express Scripts, a pharmacy benefit manager, in 2018 for $67 billion, and it may want to invest more in this area. Cigna’s Medicare Advantage business accounted for only 4.4% of its total revenue in 2024, and it may not see enough growth potential or profitability in this segment. Cigna operationally may not be efficient in running the segment profitably. Potential regulatory changes from the Biden administration look to strengthen the Medicare program and lower the eligibility age. What does this mean for the industry? If the deal goes through, HCSC would become one of the largest Medicare Advantage players in the country, with more than 3 million members. HCSC already operates Blue Cross and Blue Shield plans in five states, and it could leverage its existing network and brand to expand its Medicare Advantage presence. With #Humana leading market share of Medicare Advantage, additional players look to compete. The deal could also trigger more consolidation and competition in the Medicare Advantage market, which has been growing rapidly in recent years. According to the Kaiser Family Foundation, more than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans in 2023, up from 19% in 2007. Medicare Advantage plans offer lower costs, higher quality, and more benefits than traditional Medicare, and they appeal to a diverse and aging population. #Healthcare #MedicareAdvantage #Cigna #HCSC #HealthcareIndustry #HealthcareNews #HealthcareMarketing

Different types of health insurance plans. HMO (Health Maintenance Organization): HMO plans usually require members to choose a primary care physician (PCP) and get referrals from the PCP to see specialists. These plans often have lower out-of-pocket costs, but they offer less flexibility in choosing healthcare providers. PPO (Preferred Provider Organization): PPO plans offer more flexibility in choosing healthcare providers without a referral. Members can see specialists without needing approval and can go out of network, although at a higher cost. PPO plans generally have higher premiums but provide a wider range of coverage options. EPO (Exclusive Provider Organization): EPO plans combine elements of HMOs and PPOs. Like PPOs, members don't need referrals to see specialists, but EPOs do not cover out-of-network care, except in emergencies. EPOs often have lower premiums compared to PPOs. POS (Point of Service): POS plans are a mix of HMO and PPO features. Members choose a primary care physician and need referrals to see specialists, similar to HMOs. However, POS plans also allow members to go out of network, though with higher out-of-pocket costs. Choosing the right plan depends on individual preferences, healthcare needs, and budget considerations. hashtag #healthcare hashtag #health hashtag #healthcarebilling hashtag #healthinsurance hashtag #medical hashtag #medicalbilling hashtag #medicalcoding hashtag #medicalbillingservices hashtag #medicalbillingcompany hashtag #medicareadvantage hashtag #medicare hashtag #insurance hashtag #information hashtag #billing hashtag #billingexperts hashtag #billingspecialist hashtag #billingservices

🔍 Decoding Health Insurance: HMO vs. PPO - Which Is Right for You? 💼 🌟 HMO - Health Maintenance Organization: -🏥 Network-Centric: HMOs usually have a network of healthcare providers. To maximize benefits, you typically need to stick within this network. -💲 Cost-Efficiency: HMOs often come with lower premiums and predictable, fixed copayments. Ideal for budget-conscious individuals. -👩⚕️ Primary Care Physician (PCP): With an HMO, you'll select a PCP who coordinates your care. Referrals from your PCP are often required to see specialists. 🌟 PPO - Preferred Provider Organization: -🏦 Provider Flexibility: PPOs offer greater flexibility in choosing healthcare providers. You can see specialists without referrals and even go out-of-network (though it's costlier). -🚀 No PCP Requirement: PPOs don't typically require a primary care physician, allowing you to consult specialists directly. -🌐 Geographic Freedom: If you frequently travel or reside in different areas, a PPO's nationwide coverage can be advantageous. 💡 The Choice is Yours! The decision between HMO and PPO largely depends on your healthcare needs, budget, and preferences. Ask yourself questions like: "Do I want the freedom to see any specialist without referrals?" "Am I comfortable with a more defined network of providers?" "What's my healthcare budget, and how do I manage unexpected medical expenses?" Have you made a choice between HMO and PPO? What factors influenced your decision? Share your experiences and insights in the comments below. Let's learn from each other! 💬 . . . . Need any advice on Healthcare Coverage? Get in touch! Danilo Coité (630) 596-7398 Danilo.coite@ushadvisors.com #healthinsurance #insurance #healthcare #healthcarecoverage #affordablehealthcare #youngprofessionals #recentgraduates #IndividualHealthInsurance #COBRAAlternatives #employeebenefits #healthinsuranceplans #healthcareoptions #healthcaretips #healthcareeducation

Although a step in the right direction, without data standards, inconsistencies across payer data sets will make it difficult to compare in-network, out-of-network, and historical pharmacy prices across plans offered by health insurance companies. #healthinsurance #cms #cx #customerexperience #patientexperience #datastandards #pricetransparency #pricecomparison

How to Choose the Right Health Care Providers for Your Plan If you’re thinking about changing your health insurance plan during Open Enrollment, you may be wondering how it will affect your health care providers. Will you be able to keep seeing your current doctors, specialists, and hospitals? Or will you have to find new ones? T he answer depends on the type of plan you choose and the network of providers it offers. Some plans have more flexibility and choice than others when it comes to providers. For example, PPO plans allow you to see any provider you want, but you may pay more if they are out of network. HMO plans require you to see providers within their network, but they may have lower costs and better coordination of care. To find out which providers are in your plan’s network, you can use the online tools on our website or call the customer service number on your ID card. Remember, if you change your plan, you will receive new ID cards from your new health plan in January 2024. Choosing the right providers for your plan is important for your health and wellness. You want to make sure you have access to quality care, convenient locations, and affordable prices. Here are some tips to help you choose the best providers for your plan: Ask for recommendations from your friends, family, or coworkers who have similar plans or health needs as you. Check the ratings and reviews of the providers on our website or other online platforms. Visit the provider’s website or social media pages to learn more about their services, credentials, and philosophy. Schedule a consultation or a trial visit with the provider to see if you feel comfortable and confident with them. Compare the costs and benefits of different providers and plans using our online tools or by contacting our experts. Don’t settle for less than the best when it comes to your health care providers. Find the ones that match your plan, your needs, and your preferences. Contact us today and let us help you find the right providers for your plan. Get a free quote https://lnkd.in/dtsERuBd Schedule a consultation https://lnkd.in/dp2D-hwe #openenrollment #healthinsurance #california #epiainc #providers #network #2024

Hey everyone, happy Thursday! Are you confused about the differences between HMOs and PPOs? Let's take a second to break it down! HMO stands for Health Maintenance Organization, while PPO stands for Preferred Provider Organization. Both are common types of health insurance plans, but they have some key differences you should know about. HMO: With an HMO, you'll be assigned a primary care physician (PCP) from a network of healthcare providers. Your PCP will coordinate your care and refer you to specialists within the network when needed. HMOs often have less extensive networks of hospitals and doctors (typically limited to zip code or state), and require referrals for specialist visits. Out-of-network services are typically not covered (meaning the payment will come out of pocket) except in emergencies. PPO: PPOs offer more flexibility in choosing healthcare providers, allowing you to see both in-network and out-of-network doctors. You can visit specialists directly without needing a referral from a primary care physician. While PPOs offer more freedom, they typically do have higher premiums. On the same hand, they do also usually offer lower deductibles. Out-of-network services are covered, but at a higher cost compared to in-network providers, although it is much harder to end up out of network compared to an HMO. Ultimately, the right choice depends on your individual needs and preferences. Consider factors like cost, access to specialists, size of network, the amount you may be considered "out of network", and provider options to find the best fit for you! Stay informed and make the right decision for your healthcare journey! #HMOvsPPO #HealthcarePlans #BeInformed

Between jobs? Let’s talk healthcare benefits for a second. Everyone knows that COBRA is incredibly overpriced, but what are you getting for all that cash? Traditional insurance options include: $15-$300 Copays, high deductibles, a limited network of providers, and no access to your benefits until your deductible has been paid. 😵 😵 😵 So, for hundreds of dollars a month in premium payments, your health insurance company still expects you to pay a multi-thousand-dollar deductible BEFORE they will cover a single procedure.   Thankfully, there’s a better option! 👉 Your family could be seeing the Dr, Specialist, Urgent Care, Emergency room, Chiropractor, Therapist, and more all without paying a copay OR having to meet a deductible! 🎉 In fact, with this plan there’s no deductible unless you spend 24 hours in the hospital. So, if you go to the hospital at 8 in the morning and you’re discharged at 7 in the morning the following day, you still will not have to pay a deductible! You’ll also get access to a huge PPO network of providers, BUT you’ll have the freedom to use your benefits at ANY PROVIDER!   All at 40%-50% LESS cost to you! So what are you waiting for? Request a quote to start saving: https://revolt.health/w9z #COBRA #Jobs #JobSearch #jointhealliance #healthinsurance #medicalinsurance

Interesting new approach for connecting consumers to health care service providers. Some consumers may find this to be a more affordable or more immediately available option than what is provided by their current health insurance in many circumstances. Similarly, consumers who investigate whether a pharmacy discount card program such as HealthCare.com's prescription discount card [ https://lnkd.in/gAvEpA5V ] may provide opportunities to pay less for some of their prescriptions when compared to the consumer's out-of-pocket expense under their health insurance policy.

Are you looking for a doctor — or specialist — and not sure where to start? Medicare.gov makes it quick and easy to find and compare doctors and other providers in your area. Here's how: ✅Visit Medicare.gov/care-compare. Select "Doctors & clinicians," and enter your location. You can also search by specialty, like general practice or internal medicine. ✅Review details about the doctors you're interested in, like their contact information, practice locations, hospital affiliation, or if they offer telehealth services. ✅You can also select the "Compare" button for a side-by-side comparison of up to 3 different doctors. Once you're ready to schedule a visit with a new doctor, be sure to call ahead to verify general information, like office location, if they're accepting new patients with Medicare, and if you need a referral. For more information, Call MedicareMisty @ 423-240-0794 and we’ll help you analyze your needs before deciding. "We do not offer every plan available in your area. Any information we provide is limited to our plans in your area. Please get in touch with State Health Insurance Programs (SHIPs) at 1-877-801-0044, Medicare.gov, or 1-800-MEDICARE to get information on your options." #medicarebus #medicaremistyletstalkmagazine #medicaremistycookingshow #medicaremistypodcast #medicaremistyyoutube #medicaremistyradioshow #medicaremistytalkshow #medicaremistywine #medicaremistycigar #HealthIsWealth #MedicareMisty

#InsurViewDaily Clover Health trends upward after Q4 earnings, posts adjusted EBITDA loss of $19M   Insurtech Clover Health execs are reiterating their path to profitability is headed in the right direction.   The Medicare Advantage company posted an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year, marking a significant improvement over 2022. The company recorded an adjusted EBITDA of $80 million for the fourth quarter and a full-year loss of $290.4 million during 2022.   But Clover Health executives touted the company's improved medical cost ratio (MCR) of 81.2% for 2024, during its fourth-quarter and full-year earnings call on Tuesday. The company also issued guidance indicating MCR would be between 79% and 83%. It also expects adjusted EBITDA profit up to $20 million and revenue to hit up to $1.3 billion, while continuing to invest in Clover Assistant.   "We will then be in a position to return to growth during a period where we anticipate our competitors will be retreating, and we'll aim to continually build on the strategic lead we have developed," said CEO Andrew Toy during the call.   He said the company has improved its insurance MCR by approximately 25%, a huge improvement from its MCR of 106% in 2021. That has driven an 181% increase in per-member/per-month insurance growth profit since 2022.   Clover's stock price is up, at the time of publication, around 11% Wednesday after its earning call took place Tuesday evening.   "Many in the industry have spent decades constructing their operations to manage utilization and financial performance within a narrow network HMO context," Toy said. "While this strategy was historically successful, we now see that the landscape is shifting rapidly. In fact, PPOs are growing at over two times the rate of these tightly controlled HMOs over the past five years. This is a clear reflection of consumer preference for choice.   "What that means is that we don't necessarily have to improve or increase the richness of our plans," he added. "As others pull back, we will enjoy a decrease in the overall customer acquisition cost."   The company did not see unusual utilization trends last quarter, though the company is layering in an "additional buffer" in reserving and 2024 forecasting.   In December, Clover exited the ACO REACH program.   "This transition creates both financial cost savings for Clover beyond our 2023 performance and also allows the team to focus more specifically on what we believe to be our competitive advantage," said interim CFO Terrence Roman.   Roman said the company's liquidity position is strong and there is no need for additional capital now, but the company will consider "opportunistic financing." (Source: Fierce Healthcare)