Alignment Health Plan launches new 5-star Medicare Advantage HMO in Nevada with $0 premiums

While others retreat, we're pressing forward. Today, we announced an exciting expansion of our agreement with Intermountain Health to launch a new 5-star, co-branded plan. The Alignment Health + Intermountain Health HMO is designed to deliver high-quality, integrated care to even more seniors in Nevada. Our members in Clark County already have access to Intermountain’s 65+ clinics, including 35 senior primary care locations, bringing care closer to where our members live and thrive. This new plan is built on Alignment’s legacy Nevada HMO contract, which earned a 5-star rating for 2026, becoming our second 5-star contract in the state – one of only 18 5-star contracts in the country. #MedicareAdvantageDoneRight #MedicareAdvantage #AEP #MedicareEnrollment #Nevada

🔦 Though published back in March 1, 2024, the article "Enabling Better Integration For Dually Eligible Participants In Medicare Value-Based Care Models" by Mike Monson and Sarah Barth is still relevant today as it was back in March of 2024. 🧲 There are significant differences between the CMS VBC models and MA. For example, MA plans leverage a variety of tools to manage cost that are not available to Medicare VBC models, such as utilization management, selective networks, and benefit design. Medicare VBCs, on the other hand, have a variety of advantages over MA, such as auto enrollment of beneficiaries, physician alignment, and flexibility in use of funds. And there is a substantial debate about the relative value of each model. (See "Born On Third Base: Medicare Advantage Thrives On Subsidies, Not Better Care" by Richard Gilfillan and Donald W. Berwick) 🪃 VBC programs are designed to meet the triple aim of improving the experience of care, improving the health of populations, and reducing per capita costs of health care. In some ways, these programs are similar to Medicare Advantage (MA), the managed care version of Medicare, in their focus on population health, managing chronic conditions, reducing overuse, and alignment of incentives. In fact, many MA plans employ VBC models with their providers. 🧠 Dual eligible beneficiaries are unique because of their status. Integration of the Medi/Medi programs have long been the "holy grail" of service anticipated to unlock high-quality outcomes. Why aren't we there yet? Curious to hear your thoughts?

For years, Medicare Advantage has been a proving ground for how data can inform care delivery. What we’re seeing now – plans embracing higher-risk patients – signals a growing confidence in the ability to understand, predict, and manage disease burden through data.   That’s what value-based care is all about: when payers and providers share a clear view of patient risk, they can align incentives around outcomes. The payer sends dollars to support the expected cost of care; the provider applies their expertise to manage that population more effectively. The result? Smarter allocation of resources, stronger financial sustainability, and ultimately better outcomes for patients with the most complex needs. https://lnkd.in/ef2QqaZe

A great perspective from Michael Meucci — this is the kind of data maturity that lets payers move from managing costs to managing outcomes for their most complex members.

What are supplemental benefits in Medicare Advantage actually for? That was the question at last week’s Strategic Solutions Network Supplemental Benefits to Drive Health Outcomes Conference, where I had the privilege to share my thoughts on the quiet revolution underway in this critical corner of MA. It used to be that supplemental benefits were meant to attract new members, end of story. Today, many plans are actively striving to curtail their own growth. That’s placed new demands on benefit providers to demonstrate more value — or risk getting cut entirely. The new expectation in supplemental benefits is that vendors have to act as an extension of the plan. Vendors need to assume responsibility for complex processes such as member segmentation and enrollment, while being laser-focused on the same revenue drivers that plans are focused on every day, namely Stars, cost of care, and retention of members — particularly critical with marketing spend plummeting. At Bold, we’re experiencing this shift in real time, working with top-performing plans to address measures rising in importance, like HOS, while engaging members in clinically rigorous programs that drive clinical outcomes. It’s an approach we’ve been honing for years, one that meets this moment head on. Medicare Advantage plans are expected to deliver quality care that reduces costs for taxpayers while delivering an excellent member experience. The best supplemental benefits help to do just that. Laura Garza-Wojciechowski Nikki Rital Hungate, MS, MHA Kimberly Switlick-Prose Katie Lavelle Jotham Cortez

Starting January 1, 2026, the Ohio Department of Medicaid (ODM) will launch the Next Generation MyCare program in 29 counties with statewide expansion to follow throughout the year. MyCare is designed specifically for Ohioans who are eligible for both Medicare and Medicaid, making it easier for them to understand, access and coordinate their health care benefits. This enhanced program builds on the success of the current MyCare plan by: - Offering members more support through a dedicated care team. - Providing better transportation options to get members to and from their appointments. - Expanding in-home provider access. - Reducing wait times for prior authorizations. ODM selected four OAHP member health plans — Anthem Blue Cross and Blue Shield, CareSource, Molina Healthcare of Ohio and Buckeye Health Plan — to provide coverage under this program. Learn more about Next Generation MyCare here: https://lnkd.in/ekptPM4E

📰 WHA IN THE NEWS: Some hospitals and health systems are stepping away from Medicare Advantage plans. “For those in health care, this adds to significantly shifting sands occurring in the Medicare Advantage market,” said Christian Moran, WHA’s Senior Director of Medicaid & Payer Reimbursement Policy. He adds, “With so many options to consider before the Medicare open enrollment deadline, it is important for Wisconsin seniors to begin comparison shopping now and consult with trusted resources to find the Medicare plan (traditional or Advantage) that best meets their needs and budget.” 🔗 Learn more: https://lnkd.in/gmjNXqMR

Tue, Oct 21st. 1st week of Medicare AEP is almost under our belt, WATCH this video for next steps. This week I am briefly discussing Medigap-Supplement vs Advantage plan pros and cons. Lets talk! #yourhealthyourmoneyaz #medsuppvsadvantage Medigap (Supplement) Plans Pros: Predictable Costs: Typically have fixed premiums and cover most out-of-pocket costs, providing a clearer picture of healthcare expenses. Flexibility: Allow you to choose any doctor or hospital that accepts Medicare. Expanded Coverage: Can cover additional costs that Medicare doesn't. Cons: Higher Premiums: Monthly premiums can be higher compared to Medicare Advantage plans. Limited Benefits: Doesn't include additional services like dental, vision, or hearing coverage unless purchased separately. Not Integrated: Requires a separate policy for prescription drug coverage (PDP). Medicare Advantage Plans Pros: Lower Monthly Premiums: Often have lower or $0 premiums compared to Medigap plans. Extra Benefits: May include additional services such as dental, vision, hearing, and wellness programs. Integrated Coverage: Typically include Medicare Part D (prescription coverage) within the plan. Cons: Network Restrictions: May require you to use a network of doctors and facilities, which can limit options. Out-of-Pocket Costs: Can have copays and deductibles, leading to unpredictable costs for services. Plan Variability: Benefits might change annually, including costs and provider networks.

Important perspective from Sylvia Hastanan on what it will take to lead in Medicare Advantage going forward: provider partnerships, high-touch care models, on demand access to specialists, meaningful advanced directive discussions, and a longitudinal patient-first approach. The old risk adjustment playbook isn’t enough. At Quintuple Aim Ventures, we’re aligned on many of these themes and committed to helping our partners drive toward outcomes that matter. #valuebasedcare #MedicareAdvantage Greater Good Health PicassoMD Koda Health

"Prior authorization requirements are intended to ensure that health care services are medically necessary by requiring approval before a service or other benefit will be covered. Medicare Advantage insurers typically use prior authorization, along with other tools, such as provider networks, to manage utilization and lower costs. This may contribute to their ability to offer extra benefits and reduced cost sharing, typically for no additional premium, while maintaining strong financial performance. At the same time, prior authorization processes and requirements, including the use of artificial intelligence to review requests, may result in administrative hassles for providers, delays for patients in receiving necessary care, and in some instances, denials of medically necessary services, such as post-acute care."