CSG Actuarial continues to monitor the latest news in the insurance industry.  In the past week, updates on the Aetna/Humana merger and Medicare Advantage contracts were released.

Missouri Pushes Back on Aetna and Humana Merger

Regulators in Missouri have raised a red flag on Aetna‘s $34 billion acquisition of Humana, calling the deal anti-competitive for the state’s Medicare market. It’s the first hurdle in the state merger approval process the insurers have encountered.

The state’s director of the department of insurance, John Huff, issued a preliminary order saying that if deal is approved by federal regulators the two firms will have to “cease and desist from doing business throughout the State of Missouri with respect to… Medicare Advantage Markets.”

Read the full article on www.cnbc.com here.


Bailout for Low-Quality Medicare Advantage Contracts Slipped into Bipartisan Bill

A new bill making the rounds on Capitol Hill has a hospital-centric theme. But private Medicare Advantage insurers with bad quality ratings would also benefit from one surreptitious provision.

Last week, Reps. Pat Tiberi (R-Ohio) and Jim McDermott (D-Wash.) introduced the Helping Hospitals Improve Patient Care Act of 2016. A key component of the legislation would take into account socio-economic factors into Medicare readmission rates for hospitals.

Most of the other provisions call for changes or updates that affect Medicare providers, except for Section 301.

That section would delay for three years the CMS’ authority in terminating Medicare Advantage contracts for plans with bottom-of-the-barrel quality scores.

Read the full article on www.modernhealthcare.com here.


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