September 4, 2025

In 2023, UnitedHealthcare and Humana received up to $785 and $423 more per beneficiary, respectively, than local nonprofit plans, resulting in over $6 billion in excess Medicare payments. This has raised concerns, with groups like the Alliance of Community Health Plans (ACHP) suggesting that these large corporations may be “gaming” the Medicare Advantage risk adjustment system through upcoding.

This week, around 1,000 HHS employees sent a letter to RFK Jr., asking him to step down from his role as HHS secretary. The concerns in the letter stem from Kenney’s controversial decisions like the dramatic reshaping of the department, firing thousands of employees, and halting grants for medical research.

Vaccine skepticism has grown since COVID-19, with parents pushing for more choice in childhood immunizations. Surgeon General Joseph Ladapo has called vaccine mandates “wrong” and “immoral,” even as measles cases rise across several states.

In AHEAD, each state receives a Medicare total cost of care growth target and an all-payer cost growth benchmark to encourage them to align payer efforts to slow cost growth. The 1-year extension gives states more time to manage their costs. Also, CMS plans to attribute Medicare beneficiaries not participating in an ACO into provider groups that assume risk for managing members’ care by geographic region.

Out of 476 ACOs, 75% of them, representing 80% of the 10.3 million assigned beneficiaries, are earning performance payments totaling $4.1 billion, data showed.