#medicare

Presbyterian Healthcare Services announced 150 layoffs. These layoffs affect administrative roles. The affected positions are not in hospitals or clinics. The organization will also discontinue most Medicare Advantage plans in 2027. Direct patient care roles will remain unaffected.

Albuquerque, New Mexico

https://www.koat.com/article/presbyterian-layoffs-albuquerque-new-mexico/71475392

I just realized I have 15 years until I can get Medicare. I don’t know how I’m going to last that long. Every day at WF is miserable and there are no jobs out there to go to.

https://www.statnews.com/2026/04/30/elevance-health-fraud-doj-says-access-blocked-key-witness/

Is the medical benefit worth much? I see retirees complaining about it being cr-p and they just go with a paid Obamacare option instead. Maybe not worth sticking around for?

Layoffs and all the nonsense narratives that are spewed on this site have NOTHING to do with stock price. It's all about Medicare reimbursements, gov regulations and to a very small degree public sentiment. A huge amount of our stock is owned by massive mutual fund managers who KNOW it's significantly undervalued. The stock had a perfect storm last year of leadership instability and the gov coming after big insurance. Face it, the mu---r of Brian started a horrific downturn for the company which was roaring at the time. Then public sentiment and government tanked it.
Letting Gl 26's to GL 32's go and hiring offshore doesn't move the scale one bit. Sorry but that narrative is immature and un-insightful.
And ANYONE here who who says they want the company to fail isn't someone who has a career goal or isn't an employee at all.
Now throw all your shade and down arrows at me and call me a boomer but the truth is the truth.

Has anyone else noticed the recent increase in VTO offerings across Medicare/Medicaid member services?

Trying to better understand if this is just volume-related or part of a larger shift. If anyone has any general insight or perspective, it would be helpful.

Always good to stay aware of what’s going on.

When will it end?

A new report released by the bipartisan Senate Joint Economic Committee (JEC) on Tuesday found that overpaying for Medicare Advantage (MA) plans caused Medicare Part B premiums to rise across the board.

According to the JEC’s report, overpayments to MA plans caused standard monthly Medicare Part B premiums to go from $185 in 2025 to $203 in 2026.

The report defined “overpayments” as the difference between what the federal government government paid for MA plans versus Traditional Medicare (TM) plans. When payments to MA plans exceeds those for TM plans, premiums go up for both groups.

In 2025, MA plans were paid $84 billion more than it would have cost to cover the same amount of beneficiaries with TM plans, an average of 120 percent more.

Medicare Part B covers medically necessary services like doctors visits, supplies and some outpatient prescriptions as well as preventive services. Roughly 63 million people are enrolled in Medicare Part B and a little more than half are on Medicare Advantage, which combines both Part A and Part B.
The JEC further noted that the burden of MA overpayments are spread unevenly across the country as some districts and states have lower rates of MA enrollment. The report gave the example of Wyoming, where only 21 percent of Medicare beneficiaries are enrolled in MA, estimating that payers in the state will pay $25.4 million in excess premiums, with most of that from TM enrollees.

“Let’s be honest about the math, when Medicare Advantage is overpaid, that money doesn’t just disappear, it shows up in the Medicare Part B premiums seniors pay every month, including those paid by traditional Medicare beneficiaries who are not getting extra benefits,” said JEC Chair David Schweikert (R-Ariz.) said in a statement.

“If Congress is serious about affordability, fiscal responsibility, and fairness, we must take a hard look at Medicare Advantage and make sure the rules are the same for everyone,” he continued.

“Today, between aggressive upcoding, questionable quality bonuses, and structural overpayments in Medicare Advantage, seniors who stay in traditional Medicare are effectively subsidizing the system. That’s not sustainable, it’s not fair, and it can be reformed.”

What are the chances CMS will move off their proposed 0.09% rate for 2027?
It was approximately 5.0% for 2026 but they decided to basically eliminate it for 2027. After they announced the rate all health insurance stocks dropped massively.

Does anyone know anything about Medicaid or Medicare centralization work?

Happening in Medicare

Just had a talk with my adviser about this whole voluntary layoff thing….With me I am so close to 65, I plan to get out of telecomm and pick up a mediocre part time job to cushion the loss of CC funds. Come to find out the upcoming deposit of my severance, any upcoming bonus, banked PTO, etc etc….will be held against me when I start my Medicare…the large deposit will be a IRMAA surcharge on both my Medicare part B and part D premiums. This sliding scale of 5 brackets will no doubly kick my Medicare premiums a few more hundred dollars per month. To those of my coworkers who plan to jump into retirement after the severance comes may take this into consideration. If anyone has any constructive criticism on this matter, I’m all ears.

They say you can apply within 30 days to Medicare after your termination. Does anybody know when actually Medicare enrollment starts? In 2 month? January 1? Or when?

All health insurers are not doing great currently. Quickly look at their profit margin for the past 2-3 years and it’ll often be low single digit or negative

Medicare advantage is going to be tough again this year, so, not surprised

For those who were laid off — especially in Medicare/Medicaid Member Services (Community & State):

Looking back now, what were the real signs you were about to be laid off?

Not rumors. Not assumptions.
Actual changes you noticed in hindsight — workload shifts, meetings, metrics, access changes, team restructuring, communication patterns, etc.

I’m not asking to stir fear or spread speculation. I’m asking so those of us still here can be informed, prepared, and realistic.

If you’re willing to share, I’d appreciate it. Facts matter.

Honest question for those who were laid off (especially Medicare/Medicaid – Community & State, Member Services):

Before it happened, what were the signs you ignored or didn’t recognize at the time?

What changed first?

I’m not looking for reassurance. I’m looking for patterns.

Honest question for those who were laid off (especially Medicare/Medicaid – Community & State, Member Services):

Before it happened, what were the signs you ignored or didn’t recognize at the time?

What changed first?

I’m not looking for reassurance. I’m looking for patterns.

Based on what people are hearing, when do you think layoffs will start for Medicare? We know there may be some with the integration work coming.

I do believe HC is essentially in trouble. With 2027 projected MA revenue change of 0.09% which indirectly affects 2026 projections, projected further MA membership attrition (up to 3 million), HC will inevitably shrink.

“They’re choosing profitability over membership in certain books (expecting membership attrition as they reprice / exit margin-dilutive segments).” Basically dropping millions of members where they’re supposedly losing money. It doesn’t look good at all.

layoffs coming

Get ready for new titles and new assignments in multiple divisions in February.

Commercial IFM and Medicare impacted.

On Wednesday, January 14, Noridian Healthcare Solutions announced staff reductions.Noridian is a Medicare administrative contractor that processes aspects of Medicare services, including including Medicare Part A and Part B medical claims and Durable Medical Equipment claims for Medicare Fee-For-Service beneficiaries in select states.

https://www.inforum.com/business/noridian

Anyone know if they will layoff non RN MSW coordinators? They hired many bachelors level social workers and other specialities under old guidelines… merged the care coordinator and service coordinator role and said those non RN MSW were grandfathered in…. Now whispers of laying those off? Not sure with the so many transfers from other insurances to UHC and merging Medicare Medicaid how they could function…. But anything can happen!

Thoughts on our new leader in Medicare, Martin, coming from Amazon? Thoughts on our good old Aaron leaving us after 29 years’ of service?

Does anyone have thoughts on the whole One Medicare thing after the meeting today?

What am I not seeing?

With Medicare advantage issues, are there layoffs within Medicare division?

Legal and regulatory issues
Kickback allegations: The U.S. Department of Justice filed a False Claims Act complaint alleging Elevance, along with Aetna and Humana, paid hundreds of millions of dollars in illegal kickbacks to insurance brokers for steerage into their Medicare Advantage plans, notes the Department of Justice and Healthcare Finance News.

Medicare star ratings: A federal judge ruled against Elevance in its lawsuit challenging the government's calculation of its Medicare star ratings, reports Reuters and STAT News.

Behavioral health claims: The company is facing a class-action lawsuit and reached a preliminary settlement of $12.9 million for allegedly improperly denying coverage for residential treatment for mental health and substance use disorders, according to Becker's Payer Issues.

"Ghost network" lawsuit: Elevance is involved in a second lawsuit accusing it of maintaining "ghost networks," which are inaccurate provider directories, causing members to be misled about in-network providers, notes Modern Healthcare News.
Securities investigation: The company is also under investigation for potential securities law violations, as reported by GuruFocus.

Healthcare Insurance premiums for 2026.

ACA (Affordable Care Act) Medicaid.

Medicare for (most normal civilian) retirees over 65.

No one knows.

The plight of their future health.

The ACA (Affordable Care Act) Medicaid is (not) free for the Majority that are (actually) enrolled in it..

For many, their ACA Medicaid healthcare premiums will double; starting in 2026.

Many ACA Medicaid participants have Very Serious illnesses like cancer with Very High healthcare, and associated prescription costs.

For (most normal civilian) retirees, once they reach 65; the standard Medicare Part B premium for 2026 will (Increase) to $206.50 per month.

In fact, Medicare premiums for (most normal civilian) retirees Increases every year.

2026 Medicare premiums -

None of this is free (except for Part A much-reduced benefits).

Part A - Payers - $310.00 a month (30-39 work credits) and $563.00 a month (<30 work credits).

Some do the free but with much-reduced benefits.

Part B - Payers - $206.50 per month.

Part D - Prescriptions - $50.00 per month.

Healthcare Insurance premium costs tend to (Increase) every year (no matter the plan) ACA, workplace; Medicaid; Medicare; or private.

Why is the Medicare Advantage leadership still with the company after tanking the MA business? Fire them all.

Many Providers, Specialists, and Hospitals are exiting being part of Humana’s network and in some cases are outright refusing to accept Medicare Advantage Plans.

This is because they see how difficult Humana, and MA in general, are to work with. Especially in regards to delaying and denying claims and the slowness for which Humana and other MA private companies pay their bills.

The crumbling of the MA infrastructure has already begun. Maybe the mighty companies are not too big to fail…

For those 65+ in the HSA medical plan. If you have to cancel your HSA contributions 6 months before you begin receiving Medicare, then you are basically giving the company 6 months notice that you will be leaving. Am I right?

The Trump Tax bill -

What things are (truly) about.

Should (never) have been passed.

Which provided $600.0+ Billion in Tax savings to the wealthy over a 10-year period.

The (Interest alone) paid on the $38.0+ Trillion (and rising) U.S. National debt by U.S. taxpayers is (currently) $963.0 Billion a year (almost a Trillion a year).

The Trump Tax bill (alone) will increase the U.S. National debt by (another) $3.74 Trillion (minimum) over a 10-year period.

While taking away Medicare subsidies from the lower income, and the poor; who (actually) need them to help with healthcare costs.

While taking away Medicare subsidies from rural hospitals that (actually) need them to stay in operation for their respective communities.

There is (no) negotiating.

The Medicare subsidies (need) to be restored, or the U.S. government remains shutdown until the Trump party agrees.

Starting a thread.
Medicare retirees will no longer have dental coverage as of next year.
Would they try doing this to current employees too?

In the news...

Humana loses challenge to 2025 Medicare Advantage ratings

October 14, 20251:58 PM EDT

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https://www.axios.com/2025/10/10/unitedhealth-aarp-health-coverage-medicare

UnitedHealth paid AARP $9B to sell Medicare products

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IBM does offer great Medicare advantage plans. When you make it here the grass is greener.

So, I have been daily reposting an analyst’s article on Medicare Advantage struggling. The article listed all the main MA companies, including Humana.

I also had added a not how folks could switch to Original Medicare during this upcoming open enrollment.

Well, guess what?! I just checked and Ll of my reposts of that article in LinkedIn, including today’s repost, has been removed from my profile.

Guess deep pockets Humana must have paid off gutless (no scruples) LinkedIn.

This of course is mere speculation and cannot be proven by myself.

Hospitals no longer accept Humana Medicare Advantage plans in 2025

https://m.youtube.com/watch?v=8gvJTbIru-Q&pp=0gcJCRsBo7VqN5tD

I was surplused in July and qualify for retirement and Medicare; is the ATT retiree Medicare advantage plan…any good to pair with Medicare B?