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Humana reported a profit of $480 million for Q3, down from $832 million a year ago, but revenue rose to $29.4 billion, exceeding expectations. The company updated its full-year earnings per share forecast to "at least $16" and boosted its Medicare Advantage membership growth outlook by 40,000 to 265,000, despite anticipating member losses in 2025 due to market exits. Total membership stood at 16.4 million, down from nearly 17 million in the previous year.
Humana Inc. reported a strong third-quarter profit, surpassing Wall Street expectations with adjusted earnings of $4.16 per share. The company also raised its profit forecast for the year to at least $16 per share, contrasting with challenges faced by larger competitors in managing medical costs.
Molina Healthcare reported a third-quarter revenue increase of 18% year-over-year, surpassing financial expectations, with adjusted net income rising 19% to $6.01 per diluted share. Despite higher medical costs and a retroactive premium rate reduction in California, the company remains optimistic about future rate adjustments and growth initiatives in Florida and Michigan. Shares of Molina surged 23%, reflecting positive market sentiment, while peers like Centene and Elevance Health also saw gains.
Medicare Advantage plans received $7.5 billion in risk-adjusted payments, raising concerns over potential upcoding by major insurers like UnitedHealth Group and Humana. A federal report revealed that $4.2 billion stemmed from at-home visits, which accounted for only 13% of chart reviews in 2022, with many diagnoses lacking follow-up care. The report urged stricter oversight from CMS, highlighting that 75% of payments were linked to just 13 conditions, primarily identified through at-home assessments.
MDisrupt has secured a $1 million investment from American Heart Association Ventures, enhancing its AI-powered health expert marketplace designed for healthcare companies seeking specialized expertise. This collaboration will provide thousands of Association members with opportunities to engage in health technology and life sciences, advancing evidence-based solutions. The partnership aims to address the critical need for clinical, regulatory, and commercialization guidance in a challenging healthcare landscape.
Centene has filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) over the 2025 star ratings, claiming that a miscategorized secret shopper call unfairly impacted their scores. The insurer argues that the call failure was due to CMS's software, not their service, and estimates a $73 million revenue loss from the rating drop. This legal action follows similar lawsuits from other insurers like UnitedHealth and Humana, highlighting ongoing disputes over the fairness of CMS's scoring system.
Cigna and Humana are reportedly nearing a significant merger that could reshape the healthcare industry. This potential deal raises important questions regarding the implications of consolidation within the health insurance and pharmacy benefit manager sectors.
Humana is suing the Centers for Medicare & Medicaid Services (CMS) over its 2025 star ratings, claiming the agency's actions violate the Administrative Procedure Act and that it failed to disclose recalculation criteria. The lawsuit highlights issues with the scoring of customer service calls, which Humana argues were unfairly penalized due to external factors. With a significant drop in members in high-rated plans, the outcome could have major financial implications for the insurer.
Humana has filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) over the 2025 Medicare Advantage and Part D Star Ratings, claiming the agency did not adhere to its own rules and failed to provide necessary data. The complaint highlights significant changes in cut points that drastically reduced Humana's star ratings, impacting the quality bonus payments essential for lowering costs or enhancing benefits for enrollees. Humana seeks the retraction and recalculation of the ratings, emphasizing the critical importance of these ratings in the half-trillion-dollar Medicare program.
Elevance Health's CEO, Gail Boudreaux, announced the company is exploring options following a decline in its Medicare Advantage Star Ratings for 2025, which affects member enrollment in higher-rated plans. Despite improvements in nearly 60% of measures for 2026, a narrow miss on a key contract led to significant rating impacts. The situation reflects broader industry challenges, with other insurers like UnitedHealthcare and Humana also contesting their ratings amid increased cut points.
Humana Inc.
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