Latest news with #Aetna
Yahoo
2 days ago
- Business
- Yahoo
Insurers may still cover COVID vaccine
Although the U.S. Department of Health and Human Services is removing the recommendation that healthy children and pregnant women receive the COVID-19 vaccine, major insurers in North Carolina may still cover the cost of vaccinations. Secretary Robert F. Kennedy Jr. said last week that the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule. Under the Affordable Care Act, most private insurance plans and Medicaid are required to cover recommended vaccines at no cost. If a vaccine is no longer recommended, insurers may choose not to cover it, leading to increased costs for individuals seeking vaccination. The News & Observer reached out to Blue Cross and Blue Shield of North Carolina, Aetna and UnitedHealthcare, major insurers in the state, as well as the state treasurer's office, which oversees the North Carolina State Health Plan, which provides health coverage for state employees. Asked whether coverage policies for COVID-19 vaccinations will change in response to Kennedy's announcement, Blue Cross NC spokeswoman Sara Lang said: 'We will review any formal recommendation when it becomes available but expect to continue to offer coverage for members in previously approved age groups who wish to receive the vaccine.' Loretta Boniti with the State Health Plan said the State Health Plan Board of Trustees voted on benefits for 2026 on May 20. 'We don't anticipate making any additional benefit changes. The State Health Plan will continue to cover the COVID-19 vaccine for Plan members at 100%, which means no cost-share for members,' she said in an email. The board will vote on 2027 benefits in May 2026, she wrote. Pat Ryan, North Carolina spokesperson for Aetna, said: 'Aetna is monitoring any changes made by the federal government' and 'will evaluate whether coverage adjustments are needed.' UnitedHealthcare did not reply prior to publication. Distributed by Tribune Content Agency.
Reuters
2 days ago
- Business
- Reuters
US judge rules health insurers, MultiPlan must face price-fixing lawsuits
June 3 (Reuters) - A U.S. judge on Tuesday said healthcare providers can pursue claims that technology provider MultiPlan and a group of insurers conspired to underpay them billions of dollars in reimbursements for out-of-network health services. U.S. District Judge Matthew Kennelly in Chicago ruled, opens new tab that doctors and other providers who filed the proposed class action had plausibly alleged a price-fixing conspiracy that relied on insurers collectively sharing sensitive information with MultiPlan to set reimbursement rates. MultiPlan, which rebranded as Claritev in February, processes payments for out-of-network healthcare services. Major insurers, including defendants UnitedHealth, Aetna and Cigna, have contracts with the company and use its software. In a statement on Tuesday, MultiPlan said it was 'confident in the strength of our legal position' and that the lawsuits have no merit. Aetna parent CVS in a statement said, 'we stand ready to argue the substantive facts of the case and defend ourselves vigorously in this matter.' UnitedHealth and Cigna did not immediately respond to requests for comment. All of the defendants have denied any wrongdoing. Kennelly is presiding over consolidated, opens new tab lawsuits that were first filed in 2023. MultiPlan processes more than 80% of out-of-network claims across the country, or abut 370,000 daily claims, according to the plaintiffs. In a statement, attorneys for the health providers said MultiPlan and the insurance defendants 'orchestrated a cartel through the sharing of competitively sensitive confidential pricing information to illicitly coordinate on out-of-network reimbursements.' MultiPlan and the insurers have argued that health providers are free to reject an insurance company's payment and instead seek full compensation from patients. MultiPlan told the court its services provide industry more flexibility, lowering costs to insurers and patients. Kennelly in his ruling said "whether or not MultiPlan's calculated rates are labeled as 'recommendations,' the plaintiffs plausibly allege that they are more akin to mandates." The U.S. Justice Department submitted a court filing in March backing claims in the health providers' case. The case is In re MultiPlan Health Insurance Provider Litigation, U.S. District Court for the Northern District of Illinois, No. 1:24-cv-06795. Read more: US Justice Department backs medical providers' lawsuit over data analytics software Hospital sues data analytics company MultiPlan in US court antitrust case
Yahoo
7 days ago
- Business
- Yahoo
1 Large-Cap Stock with Exciting Potential and 2 to Think Twice About
Large-cap stocks are known for their staying power and ability to weather market storms better than smaller competitors. However, their sheer size makes it more challenging to maintain high growth rates as they've already captured significant portions of their markets. These trade-offs can cause headaches for even the most seasoned professionals, which is why we started StockStory - to help you find high-quality companies that can grow their earnings no matter what. Keeping that in mind, here is one large-cap stock with attractive long-term potential and two whose momentum may slow. Market Cap: $79.42 billion With over 9,000 retail pharmacy locations serving as neighborhood health destinations across America, CVS Health (NYSE:CVS) operates retail pharmacies, provides pharmacy benefit management services, and offers health insurance through its Aetna subsidiary. Why Does CVS Give Us Pause? Scale is a double-edged sword because it limits the company's growth potential compared to its smaller competitors, as reflected in its below-average annual revenue increases of 7% for the last two years Estimated sales growth of 2.5% for the next 12 months implies demand will slow from its two-year trend Earnings per share fell by 2.9% annually over the last five years while its revenue grew, showing its incremental sales were much less profitable At $62.78 per share, CVS Health trades at 10.2x forward P/E. Read our free research report to see why you should think twice about including CVS in your portfolio, it's free. Market Cap: $33.52 billion With over 2,500 research experts guiding organizations through complex technology landscapes, Gartner (NYSE:IT) provides research, advisory services, and conferences that help executives make better decisions about technology and other business priorities. Why Are We Hesitant About IT? Earnings growth over the last two years fell short of the peer group average as its EPS only increased by 9.3% annually Gartner's stock price of $435.88 implies a valuation ratio of 35.1x forward P/E. If you're considering IT for your portfolio, see our FREE research report to learn more. Market Cap: $61.71 billion Aiming to be a one-stop shop for the DIY customer, AutoZone (NYSE:AZO) is an auto parts and accessories retailer that sells everything from car batteries to windshield wiper fluid to brake pads. Why Will AZO Beat the Market? Store expansion strategy is justified by its healthy same-store sales Unique assortment of products and pricing power result in a best-in-class gross margin of 51.8% Robust free cash flow margin of 10.6% gives it many options for capital deployment AutoZone is trading at $3,700 per share, or 22.3x forward P/E. Is now the right time to buy? See for yourself in our comprehensive research report, it's free. Donald Trump's victory in the 2024 U.S. Presidential Election sent major indices to all-time highs, but stocks have retraced as investors debate the health of the economy and the potential impact of tariffs. While this leaves much uncertainty around 2025, a few companies are poised for long-term gains regardless of the political or macroeconomic climate, like our Top 9 Market-Beating Stocks. This is a curated list of our High Quality stocks that have generated a market-beating return of 183% over the last five years (as of March 31st 2025). Stocks that made our list in 2020 include now familiar names such as Nvidia (+1,545% between March 2020 and March 2025) as well as under-the-radar businesses like the once-micro-cap company Kadant (+351% five-year return). Find your next big winner with StockStory today for free. Sign in to access your portfolio
Axios
27-05-2025
- Health
- Axios
Midi launches insurance-backed longevity program for women
The women's telehealth company Midi said Tuesday it's launching a longevity care program that will be covered by private insurers nationwide. Why it matters: Longevity care is booming, but it mostly serves the wealthy. As preventive health messaging and midlife care becomes more common, telehealth businesses are pushing to broaden access. Midi is advertising the program, called AgeWell, as the first longevity offering designed specifically for women — and covered by payers in every state. The company contracts with some major health insurers including Aetna, BlueCross BlueShield and UnitedHealthcare. How it works: Accepted insurance will cover an annual diagnostic visit as well as hormone therapy, bloodwork and screenings. There isn't a membership fee, but copays could still apply. Patients who join will be asked to complete a panel of blood tests, come back for a virtual visit to discuss the results and receive a tailored care plan. What they're saying: This isn't "fancy longevity doctors and cash blood tests" or "biohacking," said Joanna Strober, CEO and founder of Midi Health. Women need "really good care that's grounded in biology, backed by science" that isn't just "reserved for rich people." Yes, but: Some genetic tests are not yet covered. Also, Midi is not in-network with managed care plans and doesn't participate in Medicaid or Medicare. Between the lines: As longevity becomes a health buzzword, more companies are thinking of ways to expand familiar services with preventive care in mind. Women, specifically, who are becoming more educated about menopause myths and outdated advice, are increasingly seeking personalized, expert care. Hormone therapy has also shown promise for longevity, not just treating perimenopause symptoms. What we're hearing: Telehealth companies including Elektra, which accepts insurance and government plans, are working to further expand plan offerings, Elektra's chief medical officer, Nora Lansen, told Axios earlier this year. "It's great that you're hearing about [menopause care] from celebrities and online, on social media and — you know — from your neighbor and your sister, but if you can't use your health insurance to pay for it. … That just feels not fair." On the policy front, there's been an uptick of menopause-related legislation in at least dozen states — some of which could expand insurance coverage, too.
Yahoo
22-05-2025
- Business
- Yahoo
N.J. public health plans are in distress — how would our governor hopefuls fix the mess?
New Jersey's would-be governors said competition, more oversight, and price transparency could pull the State Health Benefits Program out of a death spiral. (Dana DiFilippo | New Jersey Monitor) Riven by years of municipal departures, soaring premiums, and surging prescription drug use, the local government part of the State Health Benefits Program is on a path to complete collapse, and New Jersey's gubernatorial hopefuls differ on how to fix it. The plan, which in January provided health coverage to 56.2% of the state's local government employers and has repeatedly seen double-digit premium hikes in recent years, faces even sharper increases and will collapse absent wholesale changes to benefits, entry and exit rules, and governance, the Treasury warned in a report released Tuesday. Plans that provide coverage to local government face cumulative premium increases set to exceed 60% over the next four years and will likely collapse as more towns, authorities, and counties flee, the Treasury said. That collapse could leave towns with small or sickly workforces facing high rates in the private market. Because premiums under the local part of the State Health Benefits Program are paid largely by local revenue like property taxes — whether through withholdings from local government workers' salaries or directly from public coffers — spiking premiums stand to raise tax burdens at the local level. There are 11 candidates running in the June 10 gubernatorial primaries (Gov. Phil Murphy, a Democrat, can't run for a third term this fall). They presented disparate paths on how to control escalating costs under the state's public health plans, with some favoring increased competition, new drug pricing rules, or thinner plan requirements. 'We need more competition,' said former radio host Bill Spadea and former Assemblyman Jack Ciattarelli, both Republicans. On top of boosting competition, Republican candidates want to lower the number of public plans' coverage requirements as a method of controlling costs. Murphy in late 2023 signed a law to allow the state's public health plans to have more than one third-party administrator. Aetna has since joined Horizon Blue Cross Blue Shield of New Jersey in administering the state's self-funded public health benefits, but its entry was not expected to generate savings in the current fiscal year, with benefits unclear for out years, according to budget documents. It's not clear any other New Jersey insurers have the capacity to administer health benefits across the breadth of state. Aetna and Horizon were the only two bidders for contracts to administer the public health plans, a Treasury spokesperson said. Spadea and Sen. Jon Bramnick (R-Union) suggested reducing plan coverage requirements, allowing the state to offer cheaper, less fulsome coverage in a bid to lower premiums. 'Right now, we have insurance policies that mandate a whole bunch of different services. I want to bring in companies that have options where you can choose policies that have less mandated requirements than we require in New Jersey,' Bramnick said. In its report, the Treasury listed high-cost health care services among the primary driver of cost increases, alongside surging use of expensive medications, especially new weight loss drugs. It's not clear what services candidates would seek to limit or whether their plans would include a winnowing of existing health care plans. Treasury's report notes that most local government workers remain on older plans with generous benefits and high costs. Most candidates provided answers on how to control escalating costs in public worker health plans before the release of the Tuesday report that warned the plan had entered a death spiral. Newark Mayor Ras Baraka, Rep. Josh Gottheimer, and teachers union chief Sean Spiller — all Democrats — provided responses after its publication. Democrats' proposed solutions were more varied than their Republican counterparts. Some, like Jersey City Mayor Steve Fulop, backed increased competition, though Fulop also wants limits on hospital mergers. 'You have an increase in costs for New Jersey because you have this hospital monopoly as well, which has put a stranglehold on doctors,' Fulop said. 'I think that Trenton needs to be more aggressive in not allowing that consolidation within hospitals or them acquiring medical practices downstream.' Others favored boosting oversight of plan spending, targeting certain insurance middlemen, or broader changes like those the school workers' public health plan saw in 2020. Gottheimer and Rep. Mikie Sherrill (D-11) both suggested increased plan oversight, her through audits of the State Health Benefits Program and him through compliance reviews. The two also said they want greater regulation of pharmacy benefit managers, third-party firms that negotiate prescription prices on behalf of insurance providers and have been blamed for rising prescription drug prices. 'They've driven up pharmaceutical costs up to 10 times,' Sherrill said. Baraka backed reference-based pricing, which would tie prices for some services or drugs to those charged by Medicare. He also supports shifting some regulatory authority over the public plans to the Department of Banking and Insurance. 'We need reference-based pricing to bring costs down and increase transparency in this state and we need to lay the foundation for a true public option — one that prioritizes people, not profit,' the mayor said. Treasury's report partly blames the structure of plan design committees for rising costs within the State Health Benefits Program, saying those bodies, whose membership is split evenly between management and labor, had entrenched the status quo of expensive benefits. Ceding some authority to Treasury could lower costs, the report says. At present, only the committees or the Legislature can change plan designs by, for example, changing copay levels, shifting reimbursement rates, or eliminating specific insurance plans within the program. The State Health Benefits Commission and its schools counterpart set premium levels. Spiller and former state Sen. Steve Sweeney highlighted past reforms to state plans, including the 2020 changes that moved most school workers enrolled in the School Employee Health Benefits Program to cheaper public plans. They also suggested reverse auction rules that see pharmacy benefit managers bid each other down for state contracts. 'When I did the reverse auction on pharmaceuticals, it saved half a billion dollars a year, so that's one of the lower-hanging fruits,' Sweeney said. 'The other one is sitting down with the unions to see where we can negotiate and reduce healthcare costs like we did with the (New Jersey Education Association).' The 2020 changes, which came when Spiller was the teachers union's vice president, succeeded in providing some relief to public school plans, but Treasury's report warns the dynamics that sent the local part of the State Health Benefits Program into a death spiral could do the same for the school workers' plan. Multiple Democrats, including Gottheimer and Baraka, said they want more transparency over hospital pricing, while Spiller blamed hospitals' political heft for public plans' present distress. 'We've seen it where we can make changes to some of the plan's structures. They refuse to do it. Over and over, they refuse,' he said. 'And let me tell you, I am sure it is because the biggest donors in New Jersey politics are the hospitals, the insurance companies, their brokers, all the other folks. We never get the change we need.' Dana DiFilippo and Sophie Nieto-Muñoz contributed. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
