#medicare

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?

If you are 65 or older, sign up for Medicare (Parts A and B) even if it means paying the income-based surcharge. If you lose your job, Medicare will only begin on the first day of the following month, and it can take time to get supplemental plans in place. COBRA will not cover you once you are eligible for Medicare. If you have an accident or a serious illness during that gap, you could be left without any coverage.