Podcasts about Medicare Advantage

Welcome back to another episode of The Insurance Dudes! Craig and Jason sit down with the energetic and insightful Julian Chambers. From his early days dabbling in network marketing straight out of high school, to finding his stride in life insurance and then crushing it in Medicare sales, Julian shares his journey as a young entrepreneur in the insurance world.You'll hear firsthand about the mindset shifts, personal development rituals inspired by Tony Robbins and Grant Cardone, and the actionable strategies that helped Julian go from rookie uncertainty to writing ten Medicare Advantage policies a week.If you're an agent looking to up your game or just need a dose of motivation, you won't want to miss this episode packed with real talk, practical tips, and a whole lot of inspiration. Let's dive in!Join the elite ranks of P&C agents. Sign up for Agent Elite today and get exclusive resources to grow your agency!

Right up front here, let me just state loudly that there are some amazing independent TPAs (third-party administrators) out there who have the expertise, the scrappy willfulness, and the deep desire to do right by their clients, their self-insured employer clients. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And look, they may be facing some of the same headwinds that plan sponsors themselves face, like anticompetitive contracts, brokers who are up to no good, etc. So, just keep that in mind as you listen. And the main point of all of this if you are a plan sponsor is, find a good TPA partner, which, as Bryce Platt has said about consultants but same rules apply about TPAs here, the difficulty is being informed enough to tell the difference. So, the goal of this show is to help with that, the “be informed enough to tell the difference.” All of this being said, this is technically a Take Two; but we trimmed it down and welcome to a whole new intro. So, call this a refresher and an update about a really, really important topic from last year that is becoming extremely (maybe even more) relevant this year. Really relevant. Consider, for example, the show with Claire Brockbank (EP453) about carrier/TPA RFPs (requests for proposal) and all of the landmines that are really expensive, that are buried in some of these contracts. Then there was the Cynthia Fisher show (EP457) from last year about the millions, maybe billions of dollars in aggregate going missing in medical (ie, TPA or ASO [administrative services only]) spread pricing. We had “The Mystery of the Weekly Claims Wire” show with Justin Leader (EP433), again, revealing money that's being disappeared when the TPA is withdrawing dollars from plan sponsor checking accounts. And then there's the payment integrity episode with Kimberly Carleson (EP480) from a few weeks ago with just another wrinkle on this, namely TPAs or ASOs who insist on auditing themselves and how that turns out for members and plan sponsors. Oh, and last, but certainly not least, is the whistleblower show with Ann Lewandowski (EP476) on how a TPA arm of an EBC (employee benefit consultant) allegedly pocketed $20 million—$20 million of their client's pharma rebates—and used that $20 million to fund their executive bonus pool. What a time to be alive! All of this just highlights the huge stakes for plan sponsors to really understand what their TPA is all about. And when I say high stakes, I mean from both a legal standpoint and also just vast dollars in play here. But this episode with Elizabeth Mitchell is also, I'm gonna say, extremely relevant given just a few ripped from the headlines and news articles such as these. I'm gonna start actually with a post from Kimberly Carleson, and I like the comment by Jeff Evans, who wrote, “How does $8,710 equal $104,266?” Spoiler alert, it doesn't. Lots of missing dollars there. Someone's hands are in the cookie jar. Oh, look, the TPA has entered the chat. In a nutshell, and I'm quoting something Peter Hayes wrote, he wrote, “TPAs have received relatively little public attention. [There's an article in Health Affairs] that describes how TPAs impose hidden fees, benefit from their own form of spread pricing, and otherwise prioritize their own financial interests over those of their plan clients.” Also, here's a totally other issue. Let me quote Luke Prettol highlighting something Jason Shafrin had written about a paper by Jeff Marr, Daniel Polsky, and Mark Meiselbach. Let me slightly rephrase what Luke said. He wrote, “Employers pay, on average, a 4.7% [so almost 5%] price markup when hospitals are in their TPA's [Medicare Advantage] network.” Right? Dr. Eric Bricker talked about this in that episode (EP472) just how TPAs with MA (Medicare Advantage) business negotiate their commercial clients to pay higher rates so that then they can pay lower rates for their own MA members. As Luke wrote, “On its face, this overpayment does not appear to be solely in the interest of participants.” No kidding. Now, let's spin the wheel here. There are barriers for TPAs themselves, even the ones who have a deep desire to do the right thing. As Patrick Moore wrote, “Most TPAs still can't do [many of the things that employers might want because there are] PPO contracts.” So, is it a rock in a hard place situation? I mean, if the TPA has no other options than using a carrier's PPO (preferred provider organization) network with all its attendant contractual issues, then yeah, that is one definite challenge. Along these lines, let me read a post by Rina Tikia, because I think she sums up this really well. “When independent TPAs … push for transparency, they're blocked under the banner of ‘fiduciary risk.' “Meanwhile, the largest carriers and PBMs, with Cayman shell subsidiaries, DOJ kickback probes, [huge] hedge fund ties, [$10 million-plus] lobbying budgets, and antitrust violations continue unchecked. They are not only allowed to operate but celebrated as mainstream options. “Why the double standard? Political donations? Foundation smokescreens? Nonprofit status as a PR shield?” These are excellent questions. And here's another challenge: brokers. Ramesh Kumar Budhani wrote about this one, just how hard it is sometimes to find—for TPA, an independent TPA, trying to do the right thing—to find brokers who prioritize doing the right thing for employers and helping their clients save money. The summary of all of this: There are TPAs and there are ASOs who aren't even trying. They are going to ride the flywheel, the gravy train, and catch all of the dollars flying off of it for as long as they can manage to cling to it with all 10 of their fingers. Then there are TPAs, mostly indies, trying super hard to do the right thing. But how successful they are is going to depend on how boxed in they are by the PPO networks or the carriers that the brokers or even plan sponsors may insist on. Just how courageous they are and just how smart they are and experienced they are about the market and how it actually operates. So, the show that follows is about all of this, including how we can inspire TPAs, which, in the show that follows, subsumes ASOs kind of into it. But in the show that follows, I hope it's inspiring to create an environment so that the market demands TPAs that do all of the things, and we make inertia not a viable business strategy. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. Also mentioned in this episode are Purchaser Business Group on Health; Bryce Platt; Claire Brockbank; Cynthia Fisher; Justin Leader; Kimberly Carleson; Ann Lewandowski; Jeff Evans; Peter Hayes; Luke Prettol; Jason Shafrin; Jeff Marr; Daniel Polsky; Mark Meiselbach; Eric Bricker, MD; Tom Nash; Patrick Moore; Rina Tikia; Ramesh Kumar Budhani; Mark Cuban; Harold Miller; Chris Deacon; Moby Parsons, MD; Benjamin Schwartz, MD, MBA; Mishe Health; Rik Renard; and Cora Opsahl. You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), advances its strategic focus areas of advanced primary care, functional markets, and purchasing value. She leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability. At PBGH, Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health (the Maine Health Management Coalition), worked within an integrated delivery system (MaineHealth), and was elected to the Maine State Legislature, serving as a State Representative. Elizabeth served as vice chairperson of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a guiding committee member for the Health Care Payment Learning & Action Network. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics.   08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What's missing from the conversation on changing health plans?   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan vs. #jumboemployer inertia on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts)  

A federal judge has halted recent changes to the Affordable Care Act exchanges. More Medicare patients are leaving the hospital against medical advice, according to a new report. And satisfaction with Medicare Advantage plans is falling, fueled in part by declining trust. These stories and more are on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.

Insurers pull Medicare Advantage plans as profit pressures mount: This from the "Medicare Advantage Minute" In the "Your Medicare Benefits 2025" we learn how Medicare is likely to cover Outpatient hospital services. Friend of the podcase, Steve sent an article addressing "Targeted Medicare Cuts" and how they can save money while reducing risk. How about a side trip to Social Security Land? Someone named Rusty has an advisory column and fielded a question from a reader about when the best time might be to start collecting Social Security benefits might be. Normally Democrats are on the opposite side of almost every possible subject from me but we now find ourselves connected like Siamese twins over support for the freedom from prior authorization in Original Medicare.                                        I am dazed and confused by my unexpected alliance! Finally, we have a new member of the podcast audience who hangs her hat in South Dakota ...er Nebraska sometimes. I expect her to join the ranks of my happy clients as well!   Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

In this episode of Healthcare Americana, host Christopher Habig sits down with Dr. Marion Mass, pediatrician and co-founder of Practicing Physicians of America, to uncover widespread fraud and abuse in the Medicare Advantage program. They break down how insurers use practices like upcoding, assigning patients exaggerated or false diagnoses, to collect billions in taxpayer dollars each year, with UnitedHealthcare highlighted as a major offender. Dr. Mass explains the systemic conflicts of interest, lack of accountability, and the urgent need for audits, penalties, and transparency to protect both patients and federal budgets. The conversation also highlights the importance of informed healthcare choices and explores how direct care models offer a more sustainable alternative. This episode is a must-listen for anyone concerned about Medicare, insurance oversight, and the integrity of America's healthcare system.More on Freedom Healthworks & FreedomDoc HealthSubscribe at https://healthcareamericana.com/More on Dr. Marion Mass & Practicing Physicians of AmericaFollow Healthcare Americana: Instagram & LinkedIN

The power of Health Savings Accounts (HSAs) as a tool for both managing health expenses and building your retirement savings is often overlooked. On this episode, I'm sharing the basics of HSAs, highlighting their triple tax-free advantage, and explaining why they might be one of the best ways to maximize your retirement savings, even compared to more familiar accounts like IRAs and 401(k)s. I also unpack some important upcoming changes to HSAs thanks to the One Big Beautiful Bill Act, set to take effect in 2026. These changes expand HSA eligibility, especially for those on healthcare exchange plans and direct primary care memberships. Whether you're new to HSAs or looking to fine-tune your retirement strategy, my practical tips—like how to track reimbursements, invest your HSA funds wisely, and ensure you're making the most of every retirement planning opportunity.  You will want to hear this episode if you are interested in... [00:00] HSA contributions and eligible expenses. [03:33] HSA eligibility and individual plans. [07:27] HSA vs. 401(k) savings benefits. [12:10] HSAs and tax-free retirement reimbursements. [14:57] HSA contributions and Medicare Timing. [16:44] Top HSA provider tips. What is an HSA and Who Qualifies? Health Savings Accounts (HSAs) are often overlooked as powerful retirement planning vehicles. They are tax-advantaged accounts that allow individuals with high deductible health plans (HDHPs) to save and pay for qualified medical expenses. To be eligible, you must be enrolled in a qualifying HDHP; not all plans make the cut, so check with your insurer or employer to confirm eligibility. For 2025, annual contribution limits are $4,300 for individuals and $8,550 for families, with an additional $1,000 catch-up allowed for those age 55 and over. Both you and your employer can contribute, but the total combined contribution cannot exceed these limits. Triple Tax Advantage: The Unique HSA Benefit HSAs are the only accounts that offer a triple tax advantage: Pre-tax contributions: Contributions reduce your taxable income for the year, helping you save on federal and (in most cases) state income taxes. Tax-free growth: Money in your HSA can be invested, and all interest, dividends, and capital gains are tax-free while in the account. Tax-free withdrawals: Withdrawals used for qualified medical expenses remain tax-free, even in retirement. This makes HSAs one of the most tax-efficient savings vehicles available. HSAs as a Retirement Strategy While the primary purpose of an HSA is to cover medical expenses, its value extends far beyond that, especially for forward-thinking retirement planners. Many people cover their current medical out-of-pocket expenses with regular cash flow, allowing their HSA investments to grow tax-free for years, even decades. Upon reaching age 65, you are allowed to withdraw funds for non-medical expenses without penalty (although you will owe income tax, much like a traditional IRA). For medical expenses—including Medicare Part B, D, and Medicare Advantage premiums—withdrawals remain tax-free. However, Medigap policy premiums are not eligible for tax-free reimbursement from your HSA. A strategic approach can involve tracking your unreimbursed eligible medical expenses over the years. You can reimburse yourself in retirement with HSA funds for past qualified expenses, effectively turning your HSA into a tax-free retirement “bonus.” New HSA Legislation on the Horizon Looking ahead to 2026, recent legislative changes will further expand HSA eligibility and flexibility.  Expanded Access for Health Care Exchange Plans: Before 2026, only certain HDHPs on the healthcare exchange allowed HSA contributions. The One Big Beautiful Bill Act will enable individuals enrolled in any Bronze-tier plan through the health care exchange to qualify for HSA contributions, potentially making over 7 million more people eligible. Direct Primary Care Compatibility: Membership in direct primary care plans—where patients pay a monthly fee for enhanced access to primary care services—will now be compatible with HSA eligibility, subject to fee limits ($150/month for individuals, $300/month for families, indexed to inflation). Previously, participating in such plans disqualified individuals from contributing to HSAs. Common HSA Mistakes and Best Practices Investing your HSA balance (beyond a buffer for immediate health costs) can help you harness the benefits of compound growth over time. Compare fees and investment options among HSA providers to maximize long-term gains. Be mindful when approaching Medicare eligibility. HSA contributions must stop six months before you enroll in Medicare Part A, due to retroactive coverage. Resources Mentioned Retirement Readiness Review Subscribe to the Retire with Ryan YouTube Channel Download my entire book for FREE  IRS List of Covered HSA Expenses Connect With Morrissey Wealth Management  www.MorrisseyWealthManagement.com/contact   Subscribe to Retire With Ryan

Are you getting what you pay for with your Medicare plan? This eye-opening conversation between healthcare insiders Nathan Kaufman and Rich Helppie pulls back the curtain on what they provocatively call "Medicare Disadvantage" plans.When something sounds too good to be true, it usually is. Medicare Advantage plans tempt seniors with zero premiums, dental coverage, vision benefits, and even gym memberships. But these apparent perks mask a troubling reality: significantly restricted healthcare options when serious illness strikes. Our experts explain how insurance companies profit from delaying and denying care while creating increasingly narrow provider networks that limit access to specialists and top medical centers.The most alarming revelation? The trap many seniors find themselves in when they discover these limitations. Once enrolled in Medicare Advantage, leaving becomes nearly impossible if you develop a serious condition, as new supplemental plans can exclude pre-existing conditions. Meanwhile, those with Traditional Medicare maintain freedom to choose providers nationwide, including prestigious research hospitals like Mayo Clinic or MD Anderson, without administrative barriers or insurance company gatekeepers.For anyone approaching Medicare eligibility or reconsidering their current coverage, this episode provides crucial guidance. Our experts recommend a clear path: Medicare Parts A, B, and D, plus a comprehensive Medigap policy. While this combination involves upfront premiums, it offers something priceless: control over your healthcare decisions precisely when you need it most.Subscribe to Healthcare Bridge on your favorite podcast platforms or find us at the Common Bridge on Substack to continue exploring the vital connections shaping our healthcare landscape. Your health decisions matter—make them with complete information.Support the showEngage the conversation on Substack at The Common Bridge!

The Department of Health and Human Services announces plans to start an advisory committee to help reimagine federal health insurance programs. A federal court ruling strikes down a Medicare Advantage marketing rule introduced during the Biden administration. And, Johnson & Johnson commits to a major investment aimed at strengthening domestic pharmaceutical manufacturing. Those stories—and more—on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.

In this episode of HIPcast, Lorie Mills focuses the episode to our patient community to discuss the differences in a traditional Medicare plan versus a Medicare Advantage plan. The goal of this presentation is to educate our seniors on their options and rights as a patient to make the most informed decision for their situation. If you are a community organization and would like to share this with your seniors, please feel free to do so. #HIPcast with Shannan and Seth.https://primeauconsultinggroup.com/lmills@primeauconsultinggroup.comHIPcast brought to you by Enterprise Social Record

The Evolution and Future of Medicare Call Centers

The Unified Program Integrity Contractors (UPICs) are household names in healthcare compliance.But their track record tells a troubling story, according to senior healthcare analyst Frank Cohen. These Medicare fraud enforcement contractors are using controversial extrapolation techniques that providers successfully challenge over 60 percent of the time on appeal.Cohen, who will be the special guest during the next live edition of Monitor Mondays, said he will examine how the 2016 consolidation created five regional enforcement powerhouses, along with why their statistical methodologies are devastating practices based on flawed assumptions. Cohen intends to show how misaligned incentives are creating systematic accuracy problems, while revealing why the current UPIC system might be fundamentally broken, despite everyone agreeing that fraud prevention matters.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

The American Academy of Pediatrics releases a new childhood vaccination schedule and diverges from federal guidelines. Employers prepare for rising healthcare costs in the year ahead. And Elevance Health faces a legal setback in its Medicare Advantage star ratings dispute. Catch these stories on today's episode of the Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.

“We've been able to show that even by 30 days of age, we can predict with some accuracy if a child is going to have a diagnosis of autism,” says Dr. Geraldine Dawson, sharing one of the recent advancements in early diagnosis being aided by artificial intelligence.  Dr. Dawson -- a leading scholar in the field and founding director of the Duke Center for Autism and Brain Development – explains that an AI examination of a child's pattern of visits to medical specialists in its very early life is an objective diagnostic tool that can supplement the current subjective reports from parents which vary in reliability. Another objective diagnostic tool in development uses a smartphone app developed at Duke that takes video of babies watching images and applies AI-aided Computer Vision Analysis to measure for signs of autism. This enlightening Raise the Line conversation with host Lindsey Smith is loaded with the latest understandings about Autism Spectrum Disorder including advancements in early therapeutic interventions, the interplay of genetic and environmental factors, and the role of the mother's health and exposures during pregnancy. You'll learn as well about what Dawson sees as necessary societal shifts in how autism is perceived, the numerous factors contributing to a near tripling of diagnoses over the past two decades, and how early intervention and informed advocacy can make a meaningful difference in the lives of countless families.Mentioned in this episode:Duke Center for Autism and Brain Development If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

By Adam Turteltaub There's a lot new going on in healthcare enforcement, and, at the same, there's a lot that hasn't changed, reports Greg Demske (LinkedIn), partner at Goodwin Proctor and, formerly, Chief Counsel to the Inspector General at HHS. While the US Department of Justice has changed its priorities in areas such as anticorruption, if you look at what they and the Office of Inspector General (OIG) at Health and Human Services have been doing, he observes, the long-time bipartisan effort to stop fraud in healthcare is continuing. Yet, there are some significant changes.  At CMS a major shift has occurred when it comes to Medicare Advantage.  In the past there were audits of fifty plans a year, but now the goal is to audit all six hundred or so annually.  Backing that up is an expansion in the number of coders from 40 to 2000.  This has huge implications both for the plans and providers. Meantime the Department of Justice and HHS have created a False Claims Act Working group to further their efforts. Then, of course, there are qui tam claims, which hit a record high in 2024, and we have dispositions in the courts as well. So what should compliance teams do?  He recommends keeping a close eye on what the government is saying to ensure your program is staying ahead of the curve. And, of course, you should listen to this podcast to gain more of his insights from private practice and over 16 years at HHS.

More management and insurance knowledge in my newsletter: https://www.odysseymgmt.com/newsletter   Did you know 80% of dental claim denials can be overturned with the right strategy? I love meeting fellow insurance nerds! My time with Dr. Christie Bateman was packed full! She shared how to master PPOs, Medicare Advantage plans, and complex prior authorization rules while protecting your bottom line. Dr. Christie breaks down the exact methods she uses to reverse denials, clear documentation, targeted patient photos, and short, persuasive appeals that insurance carriers can't ignore. Get the inside scoop on Liberty Medicare Advantage's extensive prior auth requirements and how direct advocacy led to changes that benefit dentists. We discussed the concept of “provider gold cards” that could dramatically reduce administrative workload.  The conversation wraps up with real talk about how patient education can guide smarter insurance plan choices. It's not just about better coverage - it's about a smarter patient. Connect with Dr. Christie Website: Bateman & LaMond Milford Dentistry Instagram: milforddentist Facebook: Bateman & Lamond Milford Dental   ------------- I created Dental Revenue Network to foster collaboration and networking amongst RCM professionals. Billing company owners and billing professionals will have access to skill building sessions, current carrier news and insurance discussions beyond “what's the code?" Check it out - I hope you'll join! https://dentalrevenuenetwork.mn.co/ ------------- Medical Billing Made Easy! Dental Classroom Online: https://www.dentalclassroomonline.com/ Use ODYSSEY for a 10% courtesy ------------- Synergy Dental Partners offers lower prices for your dental supplies and services https://www.odysseymgmt.com/synergy NTMT listeners receive a 2 Month Free Trial + a 3rd Month if you buy anything from any vendor during the trial period. Also, new Darby customers receive a $200 Darby statement credit with a purchase.  ------------- My insurance course Dental Insurance Design and Management is geared toward those who want to understand the how and why of insurance. As a loyal podcast listener, please use "NTMT" for a $75 courtesy toward your investment.  ------------- Visit odysseymgmt.com to check out my book, webinars and courses. ------------- Don't forget to check out my other podcast Chew on This - A Dental Podcast!    **If you like the show then I'd appreciate a good rating. Tell your friends. Even podcasters ask for referrals!** YouTube: https://youtube.com/@odysseymgmt  

 CareOregon, the largest Medicaid provider in the state, will soon stop covering mental health and substance use treatment from out-of-network providers. Coverage will end on Oct. 1 for Medicaid members and on Jan. 1 for members of Medicare Advantage. The decision will disrupt care for an estimated 15,000 patients, or about 15% of the organization’s members who use behavioral health services. The organization says the changes will bring it back into alignment with industry best practices after making provisions to expand access to mental health care during the COVID-19 pandemic.   Amit Shah is the chief medical officer at CareOregon. He joins us with more details about the decision.  

Medicare decisions can feel overwhelming, but they're among the most essential choices you'll make in retirement. In this episode of Purposeful Planning, we break down the four parts of Medicare, explain the difference between Medicare Advantage and Medigap coverage, and share crucial timing information about enrollment periods. Whether you're approaching 65 or helping a parent navigate these decisions, understanding Medicare basics can provide peace of mind about healthcare costs in retirement. Sources: http://news.ehealthinsurance.com/news/health-care-costs-top-the-list-of-financial-worries-in-retirement-new-research-from-ehealth-and-retirable-shows https://www.aarp.org/medicare/understanding-medicare-the-plans/ https://www.ssa.gov/benefits/medicare/medicare-premiums.html https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options https://www.ncoa.org/article/what-is-the-difference-between-medicare-advantage-and-medigap/ https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start https://www.investopedia.com/terms/c/creditable-coverage.asp https://www.aspenwealthmgmt.com/blog/webinars/medicare-made-easy-preparing-for-healthcare-costs-in-retirement/ https://www.aspenwealthmgmt.com/contact-us-fee-only-advisors-fort-worth https://www.aspenwealthmgmt.com/resource-center/retirement/medicare-made-easy-retirement-healthcare-costs The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. This information has been derived from sources believed to be accurate and is intended merely for educational purposes, not as advice. Aspen Wealth Management is a registered investment advisor with the SEC. This recorded posting utilizes AI generated voiceovers. While the Firm strictly prohibits the use of AI for advisory activities constituting investment advice, financial plans, portfolio analysis and management, and reporting, the use of AI for other purposes, such as voiceovers, is permitted and utilized for the firm's recordings. Hosted on Acast. See acast.com/privacy for more information.

There just might be a reign of terror being experienced at many of America's hospitals and health systems. Professionally delivered patient care apparently seems to be getting hijacked by auditors compelled to deny claims of omission.Aided by the Centers for Medicare & Medicaid Services (CMS) and abated by auditors private and public, the lingua franca appears be an entanglement of descriptors, namely “inpatient versus outpatient.”During the next live edition of the venerated Monitor Monday broadcast, several of the most recognized names in healthcare will not add to the confusion, but offer advice for those on the front lines of battle.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

"Burnout and trauma are not mental illnesses. They live in your physiology. They live in your biology. They live very specifically in your nervous system,” Dr. Rola Hallam says with a conviction rooted in her own successful journey to overcome the effects of chronic stress she accumulated during many years on the frontlines of humanitarian crises in Syria and other conflict zones. Out of concern for the multitudes of health professionals who, like herself, spend years carrying the weight of their traumatic experiences without seeking help, or who pursue ineffective remedies for relieving it, Dr. Rola -- as she's known – has shifted her focus to being a trauma and burnout coach. Among her offerings is Beyond Burnout, a twelve-week program that includes multimedia content as well as live coaching and teaching about developing nervous system awareness and regulation. “Most wellness initiatives fail because they're not rewiring the nervous system to come out of survival mode and back into what is called the ventral-vagal state, which is our state of social connection and of healing and repair.” She also stresses that healing is not an individual pursuit, especially for providers who work in a relational field, and teaches about the benefits of borrowing from a colleagues' state of calm and offering them the same. Don't miss this insightful and giving conversation with host Lindsey Smith that covers Dr. Rola's wrenching experiences providing care in desperate conditions, the critically important distinction between empathy and compassion, and how empowering frontline workers to heal their trauma can uplift individuals and empower entire communities. Mentioned in this episode:Dr. Rola CoachingBeyond Burnout AssessmentCanDo - Humanitarian Aid If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Navigating the Busy Season: Partnering for Success in the Insurance WorldWelcome to another exciting episode where Dan from Agent Boost shares insights into the bustling world of insurance during the busy July and August months. This episode dives into the strategic partnership with Senior Market Advisors, featuring CEO Josh Borders, EVP of Sales Cassie Smith, and EVP of Distribution Andy Watkins. They discuss the benefits of collaboration, the importance of diversifying your offerings, and upcoming changes in the industry, including the significant role of ACA. Listen in for valuable tips on navigating AP, innovating your approach to compliance, and taking your agency to the next level.00:00 Introduction and Weekly Updates01:17 Special Guests from Senior Market Advisors03:35 Discussing Industry Challenges and Partnerships05:55 The Importance of Strategic Partnerships13:42 Overcoming Mid-Size Agency Challenges21:50 The Value of True Partnerships30:17 Carrier Partnerships and Distribution Insights30:56 Challenges for Independent Agents31:42 Path to Partnership and Business Growth32:14 Pipeline Calls and Agency Development34:00 Equity and Deal Structures39:37 Integration and Support Post-Acquisition44:28 ACA Contracting and Future Planning46:08 Medicare and Market Adaptation49:23 Diversification and Compliance56:58 Final Thoughts and Partnership OpportunitiesNeed to take your AHIP certification to sell Medicare Advantage plans? Use our official Agent Boost link to get started today. It's accepted by all major carriers and includes the $50 discount—bringing your cost down to just $125.

In the "Medicare Advantage Minute" segment:                                                       We enjoy a tutorial designed to help defeat the various methods companies use to avoid speaking with their customers.  In "Your Medicare Benefits" the subject concerns how Medicare would cover Opioid Use Disorder Treatment Services.  Brand new client Curt just had his Medicare supplement plan approved on July 4th. A few weeks later he received a job offer that included company-paid health insurance. What to do, what to do? Medicare maven Toni King is warning us about a new Medicare scam making the rounds. This one has to do with hospice care, which could be a little creepy. Finally, I try (and fail) to construct a quiz based on the states where nurse burnout is perceived to be highest and lowest. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Steven M. Lieberman of the University of Southern California, Los Angeles on his recent paper that explores how Medicare Advantage has seen significant enrollment growth and what reform efforts can be attempted to rebalance traditional Medicare and MA.Order the August 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

With adherence measures playing a major role in Star Ratings, Medicare Advantage plans are rethinking how they engage members—moving beyond transactional reminders to personalized, story-driven content that inspires real behavior change. In this episode, leaders from Zing Health, Horizon Blue Cross Blue Shield of New Jersey, and SmartStory share how they're using storytelling, data, and behavioral insights to: Improve medication adherence and close gaps at scale Design culturally relevant, human-centered messaging Translate member engagement into measurable Star Rating gains Avoid common pitfalls in content strategy and execution Whether you lead pharmacy, Stars strategy, or member engagement, this discussion offers actionable insights to improve performance heading into the 2026 Star Ratings year. Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download here. here. Thank you to SmartStory for supporting this episode. SmartStory delivers secure, app-like digital experiences that help health plans improve medication adherence, member satisfaction, and quality performance—without requiring downloads or logins. Learn more at  https://www.smartstory.com/ How to Engage: Chat with Us: Share your thoughts with Producer Vekonda Luangaphay at vluangaphay@brightspotsventures.com  

Howard Gleckman, a senior fellow at the Urban Institute and Forbes columnist, provided a comprehensive overview of recent public policy changes affecting older adults. Drawing from his expertise in aging and tax policy—stemmed from personal caregiving experiences—Gleckman analyzed the implications of the Trump administration's "big beautiful bill" and related executive actions as of August 2025. The focus was on Medicaid and Medicare reforms, which could reshape long-term care, costs, and access for millions of seniors and people with disabilities.Medicaid, which supports about 7.2 million seniors and 4.8 million younger disabled individuals (dual eligibles), faces a $1 trillion reduction in federal spending over the next decade. Key changes include:Work Requirements and Paperwork: Starting potentially in December 2026, states must impose work mandates, though older adults and those with disabilities are exempt. Family caregivers' status remains unclear, risking benefit loss for those quitting jobs to provide care. Recertification is now required at least twice yearly, increasing administrative burdens and potentially deterring eligible recipients.Funding Reductions: Limits on state provider taxes (e.g., on nursing homes) will cut federal contributions by about $120 billion starting in 2028. Expansion states under the Affordable Care Act lose extra funding from January 2026, forcing tough choices: cut benefits, limit eligibility, or raise taxes. Gleckman warned that optional home and community-based services (HCBS) are most vulnerable, as nursing home care remains mandatory. While the bill allows states to expand HCBS for less needy individuals without lengthening waitlists, funding cuts make this unlikely.Staffing and Workforce Impacts: The bill repeals Biden-era minimum staffing rules for nursing homes until 2034. Combined with mass deportations, this exacerbates shortages of direct care workers, driving up costs for facilities and families.Gleckman emphasized that states may prioritize institutional care over community-based options, potentially worsening outcomes for older adults preferring to age at home.Despite campaign promises to protect Medicare, changes aim to curb fraud, boost efficiency, and emphasize prevention—but at the risk of higher costs and reduced access:Prior Authorization Expansion: For the first time, traditional fee-for-service Medicare will require prior approval for 17 procedures (e.g., back surgeries, pain injections) in a six-state demo (New Jersey, Ohio, Oklahoma, Texas, Arizona, Washington). CMS plans to use AI for reviews, with human oversight.Payment Adjustments: Skilled nursing facilities see a 2.8% payment increase for 2026, deemed insufficient by the industry. Home health agencies face a 6.4% cut ($1 billion+), sparking bipartisan opposition. The Labor Department repealed Obama-era rules, allowing home care workers to earn below federal minimum wage ($7.25/hour) and exempting them from overtime, per state laws.Enrollment and Programs: Easier enrollment in Medicare Savings Programs (for low-income beneficiaries) is delayed until 2034. The GUIDE program for dementia care navigation continues but with penalties if it fails to improve outcomes or save money. Value-based care is expanding, rewarding providers for quality over volume.Drug Pricing and Hospice: Trump favors "most favored nation" pricing to align U.S. drug costs with foreign markets, potentially supplementing Biden's negotiations. Hospice faces crackdowns on alleged fraud, though details are pending.Gleckman noted deregulation of nursing homes (e.g., rolling back transparency rules) and potential reductions in Medicare Advantage supplemental benefits like gym memberships due to insurer financial pressures.

ACA Updates & Insights: Major Changes, Compliance & Future Outlook | Agent Boost PodcastWelcome to another episode of the Agent Boost Podcast!

Although the lawsuit was filed by a pharmacist in New Mexico, a federal judge in New York has ordered CVS Omnicare to pay $949,000 to settle a False Claims Act (FCA) case.According to news sources, the Pharmacy Benefits Manager (PBM) allegedly prescribed drugs to individuals in long-term residential facilities that were not supported by valid prescriptions and then submitted claims for reimbursement for those prescriptions to Medicare, Medicaid, and TRICARE. Although a jury trial was held last spring, with the judge rejecting post-trial arguments by Omnicare, it is understood that Omnicare plans to appeal.Reporting details of this whistleblower lawsuit during the next edition of Monitor Mondays will be Max Voldman, a partner at Whistleblowers Law, LLP.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

The Friday Five for August 8, 2025: Ritter Insurance Marketing Summits Linda Yaccarino Enters Health Industry iOS 26 and iPadOS 26 Public Beta Takeaways New Instagram Features 2025 MA Enrollment Stats & Trends   Register to Attend Ritter Insurance Marketing Summits Work with Ritter Insurance Marketing – the FMO that powers the Agent Survival Guide Podcast!   Linda Yaccarino Enters Health Industry: “eMed® Population Health Announces Appointment of Former X (Twitter) CEO Linda Yaccarino as New Chief Executive Officer.” Emed.Com, eMed, 5 Aug. 2025, www.emed.com/media/exploring-glp1. Capoot, Ashley. “Former X CEO Linda Yaccarino Takes Helm at Digital Health Company eMed.” CNBC.Com, CNBC, 5 Aug. 2025, www.cnbc.com/2025/08/05/former-x-ceo-linda-yaccarino-takes-helm-at-digital-health-company-emed.html. Roy, Sriparna, and Sneha S K. “Former X CEO Yaccarino Takes Helm at GLP-1 Focused Telehealth Firm eMed.” Reuters.Com, Reuters, 5 Aug. 2025, www.reuters.com/sustainability/boards-policy-regulation/former-x-ceo-yaccarino-takes-helm-glp-1-focused-telehealth-firm-emed-2025-08-05/. Silberling, Amanda. “Linda Yaccarino Joins Health Tech Platform eMed as CEO after Leaving X.” Techcrunch.Com, TechCrunch, 5 Aug. 2025, techcrunch.com/2025/08/05/linda-yaccarino-joins-health-tech-platform-emed-as-ceo-after-leaving-x/.   iOS 26 and iPadOS 26 Public Beta Takeaways: “Apple iOS 26 Will Screen Cold Calls.” Collincadmus.Com, Collin Cadmus, www.collincadmus.com/blog/apple-ios-26-will-screen-cold-calls. Accessed 6 Aug. 2025. Teague, Katie. “Can You Download the iOS 26 Beta Today? Here's a Comprehensive List of All Compatible iPhones.” Engadget.Com, Engadget, 6 Aug. 2025, www.engadget.com/mobile/can-you-download-the-ios-26-beta-today-heres-a-comprehensive-list-of-all-compatible-iphones-191854920.html. Stimac, Blake. “iOS 18 vs. iOS 26: How Much Does Liquid Glass Impact Your iPhone's Look?” CNET.Com, CNET, 4 Aug. 2025, www.cnet.com/tech/services-and-software/ios-18-vs-ios-26-how-much-does-liquid-glass-impact-your-iphones-look/. Halton, Clay. “I Tried the iOS 26 Beta—These 5 Features Make My iPhone Feel Like New Again.” Pcmag.Com, PC Mag, 5 Aug. 2025, www.pcmag.com/news/i-tried-the-ios-26-beta-these-5-features-make-my-iphone-feel-like-new-again. McAuliffe, Zachary. “Say Goodbye to Spam Calls With Call Screening in iOS 26.” CNET, cnet.com, 5 Aug. 2025, www.cnet.com/tech/services-and-software/say-goodbye-to-spam-calls-with-call-screening-in-ios-26/.   New Instagram Features: “How to Repost a Reel or a Post on Instagram.” Help.Instagram.Com, Instagram, help.instagram.com/1059575985490156. Accessed 7 Aug. 2025. Gallaga, Omar. “Instagram Adds New Features, Including Reposts and Maps.” CNET.Com, CNET, 6 Aug. 2025, www.cnet.com/news/social-media/instagram-adds-new-features-including-reposts-and-maps/. Pathak, Khamosh. “Instagram's Latest Update Added Reposts and a Snap Map Clone.” Lifehacker.Com, Lifehacker, 6 Aug. 2025, lifehacker.com/tech/instagram-added-reposts-and-snap-map-clone. Malik, Aisha. “Instagram Takes on Snapchat with New ‘Instagram Map.'” Techcrunch.Com, TechCrunch, 6 Aug. 2025, techcrunch.com/2025/08/06/instagram-takes-on-snapchat-with-new-instagram-map/. Heathera. “New Instagram Features to Help You Connect.” About.Fb.Com, Meta Newsroom, 6 Aug. 2025, about.fb.com/news/2025/08/new-instagram-features-help-you-connect/.   2025 MA Enrollment Stats & Trends: Ochieng, Nancy, et al. “Medicare Advantage in 2025: Enrollment Update and Key Trends.” KFF.Org, KFF, 28 July 2025, www.kff.org/medicare/issue-brief/medicare-advantage-enrollment-update-and-key-trends/.   Resources: 5 Things About ICHRA 5 Things From the 2025 Budget Reconciliation Bill 2026 D-SNP Market Snapshot 2026 Maximum Broker Commissions for Medicare Advantage & Medicare Part D How to Organize a Turning 65 Seminar on a Budget ICHRA vs. QSEHRA vs. Group Health Plans: Sales Opportunities for Insurance Agents The One Big Beautiful Bill: What Health Insurance Agents Should Know The Pros and Cons of Working with Regional and National Carriers   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance     Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Send feedback, questions, and topic suggestions to ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.   Not affiliated with or endorsed by Medicare or any government agency.

The Medicare Advantage (MA) landscape is shifting dramatically. With over half of all Medicare beneficiaries now enrolled in MA plans, the program faces unprecedented scrutiny from lawmakers, regulators, and beneficiaries themselves. During this 40-minute podcast, MA policy experts Carrie Graham and Neil Patil dissect the changing political and regulatory climate surrounding MA and offer crucial insights for health plans navigating these turbulent waters. They explore how the Trump administration is approaching MA reform through payment adjustments, increased oversight, and technological innovation.Graham and Patil delve into hot-button issues driving the reform conversation: prior authorization practices that frustrate both providers and patients, marketing tactics that have drawn Department of Justice attention, and the accuracy of provider directories that directly impact beneficiary access to care. They discuss key bipartisan legislative proposals gaining traction, including the No UPCODE Act and the Improving Seniors' Timely Access to Care Act.Want to learn more? Graham and Patil will speak at RISE West 2025, the Medicare Advantage senior leadership event of the year, August 25-27, at Paris Las Vegas. Also check out additional information from the Medicare Policy Initiative blog posts, publications, tools, and resources, including a compendium of Medicare Advantage policies and a comparison tool of legislation that's been rumored to be included in a potential end-of-the-year legislative package (the Improving Seniors Access to Timely Care Act) and CMS regulations.Carrie Graham, Ph.D., is a research professor and the director of the Medicare Policy Initiative at Georgetown University's Center on Health Insurance Reform (CHIR), where she oversees a portfolio of policy analysis, research, and technical assistance for policymakers on Medicare Advantage and original Medicare. Previously she was the director of aging and disability policy at the Center for Health Care Strategies. She also holds an adjunct professor appointment at the University of California, San Francisco, Institute for Health and Aging.Neil Patil, MPP, is a senior fellow and the policy director at the Medicare Policy Initiative at CHIR, where he conducts policy analysis and provides technical assistance to policymakers on Medicare Advantage issues. Prior to joining CHIR, he was a senior analyst at the Centers for Medicare & Medicaid Services Office of Legislation, where he provided technical assistance to Congress on issues related to Medicare Advantage and the Medicare Drug Price Negotiation Program. In this role, he served as the lead analyst on Medicare Advantage issues. 

August 8, 2025 In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advantage plans, what it really means, and how to prepare your front desk and billing staff for potential patient coverage changes. Stay informed, stay proactive!PRS Coding and Reimbursement HubAccess the HubFree Kidney Stone Coding CalculatorDownload NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and AdminsPRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a Quote Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.         https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ 

“Seeing that you can get through the most difficult times in life, succeed, and then also return to your community and work in service to your community was a lesson that has stuck with me,” says Dr. Uche Blackstock, the Founder and CEO of Advancing Health Equity and our guest on this inspiring episode of Raise the Line with Osmosis from Elsevier. It was a lesson the Harvard-trained physician learned from her own mother – also a Harvard trained physician – who overcame poverty, sexism and racial bias to forge an inspiring path.  In her bestselling book, Legacy: A Black Physician Reckons with Racism in Medicine, Dr. Blackstock weaves her mother's remarkable story with her own and argues for systemic change in a healthcare system riddled with racially-biased practices and policies that impact patient outcomes. As she explains to host Lindsey Smith, Advancing Health Equity's work to drive measurable and sustainable change is focused on embedding equity as a core value in the leadership, strategy, and organizational practice of health systems. “We exist to challenge inequities, empower underrepresented communities, and help build a healthcare system where everyone can thrive.” Don't miss a thought-provoking conversation with a nationally respected voice that also addresses race correction factors that impact the care of Black patients, and the work required of health institutions to build trust in effected communities.Mentioned in this episode:Advancing Health EquityLegacy: A Black Physician Reckons with Racism in Medicine If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Learn how to sponsor the Seven Figure Medicare Agent Summit: https://sevenfiguremedicareagentsummit.com/On this episode of the Seven Figures or Bust podcast, we dive into the growing concern around non-commissionable Medicare Advantage plans. What does this shift mean for agents heading into AEP—and how should you adjust your strategy? Tune in to get the insights you need to stay ahead.Learn more about getting your own VA with Hire Heroes here: https://app.hireheroes.com/signup?fpr=christian43Join our free private Facebook group for insurance agents: https://www.facebook.com/groups/551409828919739/Welcome to the Christian Brindle channel brought to you by Christian Brindle & Christian Brindle Insurance Services. This channel is here for the sole purpose of bringing training, tips, success stories, and personal development from Christian Brindle. Christian is a published author, hosts the ever popular Everything Medicare Podcast, and made six figures in the Medicare business by the time he was 25 years old.

Learn how to sponsor the Seven Figure Medicare Agent Summit: https://sevenfiguremedicareagentsummit.com/On this episode of the Seven Figures or Bust podcast, we dive into the growing concern around non-commissionable Medicare Advantage plans. What does this shift mean for agents heading into AEP—and how should you adjust your strategy? Tune in to get the insights you need to stay ahead.Learn more about getting your own VA with Hire Heroes here: https://app.hireheroes.com/signup?fpr=christian43Join our free private Facebook group for insurance agents: https://www.facebook.com/groups/551409828919739/Welcome to the Christian Brindle channel brought to you by Christian Brindle & Christian Brindle Insurance Services. This channel is here for the sole purpose of bringing training, tips, success stories, and personal development from Christian Brindle. Christian is a published author, hosts the ever popular Everything Medicare Podcast, and made six figures in the Medicare business by the time he was 25 years old.

In this episode of Quality Talks, NCQA President Peggy O'Kane speaks with Dr. Farzad Mostashari, Co-founder and CEO of Aledade. Farzad brings decades of experience in health IT, policy and primary care transformation to a candid and energizing conversation about what's holding back US health care and how we can move it forward.Farzad and Peggy explore the structural flaws in our system, from fragmented care and fee-for-service incentives to the undervaluing of primary care. They discuss how ACOs, Medicare Advantage and data-driven models can help shift the system toward better outcomes and lower costs.Peggy and Farzad explore:The Issue of Incentives: Farzad argues that while good care happens daily, it often occurs despite the system—not because of it. Misaligned financial incentives and lack of structural support hinder progress.The Key to Accountable Care: Access, point-of-care intelligence, care transitions and targeted wraparound services form the core of Farzad's actionable framework for improving outcomes.Medicare Advantage and ACOs: A nuanced discussion of how MA and ACOs compare, what each gets right, and how to align incentives across Medicare.What Works? A call for smarter learning networks that identify and spread what's truly effective in improving care and reducing cost.This conversation offers a timely and practical roadmap for advancing value-based care. Farzad's clarity, humor and strategic insight make complex topics accessible—and energizing. Whether you're a policymaker, provider or health system leader, this episode delivers ideas worth implementing. Key Quote:The most expensive thing in health care is the thing that no one wants. It isn't the fancy doctor's office or the upgraded scan. It's the hospitalization.Hospitalizations are ridiculously expensive and the cost has been going up. There's classic charts that show inflation and TVs are down 98% in cost, and hospitalizations are up. Like, the thing in the American economy that has had the most inflation over the past two decades is hospitalization. And no one wants that. No one wants to be hospitalized. And, look, if you need to be hospitalized, you're gonna be hospitalized. That's where we can break apart that concept of not needing a hospitalization is the highest quality hospitalization. What's the highest quality hospitalization? The one you didn't have!-- Farzad Mostashari, MDTime Stamps:(01:20) Distinguishing Incentives in Health Care(06:25) Unlocking the Potential of Primary Care(09:31) Thinking Holistically About Accountability (15:22) Measurement, Medicare, ACOs and More(26:07) The Doctor's Role in the Era of AI(33:04) Peggy's ReflectionsLinks:Connect with Farzad Mostashari

Plastics Cause Over $1.5 Trillion in 'Health-Related Economic Losses'. Texas Dems Defiant as Abbott Threatens Them With Expulsion. We will continue to tell the truth about the Medicare Advantage scam.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

Medicare Advantage is a corporate-driven scheme that restricts care, overcharges taxpayers, and traps seniors in inferior plans—undermining Traditional Medicare and enriching private insurers.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

In this episode of The Broker Link, Josh Slattery breaks down key carrier updates that will impact Medicare Advantage and Part D plans in 2026. Highlights include:

A new federal law is reshaping how healthcare is paid for and delivered in America.In this episode, Steve sits down with health policy expert Joe Mercer to unpack the details of the One Big Beautiful Bill Act. It's the most significant healthcare legislation since the ACA, with ripple effects across Medicaid, rural hospitals, and the ACA exchange.We cover:

In this episode, Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan, shares her experience testifying before Congress on the future of Medicare Advantage and highlights key policy changes needed to protect access, expand rural care, and ensure member choice in a rapidly evolving healthcare landscape.

State Rep. Jon Rosenthal discusses Texas Democrats' fight to prevent Republican redistricting. MTP challenges Lindsey Graham's lies. Financial insecurity is widespread.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

Over chips and salsa, Jana and Mark sit down with Medicare Advantage broker Kirsten Falls to demystify healthcare options for seniors and some disabled individuals. Feeling overwhelmed by Medicare choices? Kirsten's expertise and resources will help you navigate plans with confidence, ensuring your health and lifestyle needs are met. Tune in for a fun, informative chat

Get access now to 7 Figure Medicare University:Lifetime access:https://sevenfigureu.com/On this episode of the Seven Figures or Bust podcast, we dive into a major shift: a large Medicare Advantage carrier plans to cut prior authorizations by one-third. We break down what this change means for agents, clients, and the industry as a whole. Could this be the beginning of a more streamlined future in Medicare?Learn more about getting your own VA with Hire Heroes here: https://app.hireheroes.com/signup?fpr=christian43Join our free private Facebook group for insurance agents: https://www.facebook.com/groups/551409828919739/Welcome to the Christian Brindle channel brought to you by Christian Brindle & Christian Brindle Insurance Services. This channel is here for the sole purpose of bringing training, tips, success stories, and personal development from Christian Brindle. Christian is a published author, hosts the ever popular Everything Medicare Podcast, and made six figures in the Medicare business by the time he was 25 years old.

Federal legislation has been introduced that is intended to help the beleaguered 340B Health organization via an effort to ban pharmaceutical companies from restricting access to the drug pricing discount program of the same name, through community and specialty contract pharmacies.Reporting this lead story as well as other updates from Congress and the Trump Administration during the next live edition of Monitor Mondays will be Maureen Testoni, CEO for 340B Health and a frequent guest on the long-running broadcast. Testoni represents more than 1,600 hospitals and health systems participating in the 340B drug pricing program.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Thank you Mary B, Gayla Kunis, and many others for tuning into my live video! Join me for my next live video in the app.* Get Traditional Medicare. Here is why Medicare Advantage is a scam: We must discuss the reality that Medicare Advantage is a scam ad nauseum, as more and more Americans fall into the trap. [More]* Be a part of Politics Done Right's work on Radio Row at N… To hear more, visit egberto.substack.com

Thank you to everyone who tuned into my live video! Join me for my next live video in the app.* Plastics Cause Over $1.5 Trillion in ‘Health-Related Economic Losses' Per Year Globally: “Plastics are a grave, growing, and under-recognized danger to human and planetary health,” says a new study published in The Lancet. [More]* ‘Come and Take It': Texas Dems D… To hear more, visit egberto.substack.com

“Pandemics are a political choice. We will not be able to prevent every disease outbreak or epidemic but we can prevent an epidemic from becoming a pandemic,” says Dr. Joanne Liu, the former International President of Médecins Sans Frontières/Doctors Without Borders and a professor in the School of Population and Global Health at McGill University. You are in for a lot of that sort of frank and clear-eyed analysis in this episode of Raise the Line from Dr. Liu, whose perspective is rooted in decades of experience providing medical care on the frontlines of major humanitarian and health crises across the globe, as well as wrangling with world leaders to produce more effective responses to those crises and to stop attacks on medical facilities and aid workers in conflict zones. Firsthand accounts from the bedside to the halls of power are captured in her new book Ebola, Bombs and Migrants, which focuses on the most significant issues during her tenure leading MSF from 2013-2019.  The book also contains insights about the geopolitical realities that hamper this work, including lax enforcement of international humanitarian law, and a focus on national security that erodes global solidarity. Join host Lindsey Smith as she interviews this leading voice on our preparedness to meet the needs of those impacted by violent conflict, forced migration, natural disasters, disease outbreaks and other grave challenges. If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Rushab Sanghvi, American Federation of Government Employees (AFGE) General Counsel, joined the America's Work Force Union Podcast to discuss the union's legal battles against the Trump administration's anti-union policies.    Merrilee Logue, Executive Director of the National Labor Office at Blue Cross Blue Shield Association and Duncan Lawson, Director of Market Intelligence for Government Programs at BCBSA, joined the America's Work Force Union Podcast to discuss Medicare and Medicare Advantage.

In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down the latest payer market trends. They explore Humana's improved earnings outlook and strategic pullbacks, contrasted with UnitedHealth's rising costs, leadership turnover, and major challenges across multiple business lines.

In this episode, Dr. Joe Kimura, Chief Medical Officer at SCAN Health Plan, discusses how SCAN is leading innovation in Medicare Advantage through personalized care, data analytics, and strategic partnerships. He also explores the critical role of technology and member engagement in improving outcomes for a growing senior population.

In this episode, Scott Becker discusses the mounting challenges for UnitedHealthcare, including a Department of Justice investigation into its Medicare Advantage billing and a 50 percent stock drop over the past year.

In this episode, Stacey Richter discusses 'Three Surprising Ways Carriers Make Lots of Money' with Preston Alexander. The episode highlights how carriers leverage financial strategies—like using premium dollars as float, intracompany eliminations, and upcoding in Medicare Advantage—to enhance their profits.  The discussion emphasizes the importance for plan sponsors and policymakers to understand these tactics to better manage healthcare costs. Alexander advises collaborating with unbiased consultants who are experts in health plan design to navigate these complex financial dynamics effectively. === LINKS ===