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Sept. 10, 2025
| This week’s payer news for healthcare leaders
2026 will mark the fourth consecutive year of substantial health benefit cost growth, signaling “mounting pressure on employers’ healthcare budgets.”
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The guidance is meant to give states more time to meet requirements laid out in the One Big Beautiful Bill Act.
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The healthcare behemoth expects to have roughly 78% of its MA enrollees in plans rated four stars or higher, a key cutoff for valuable bonuses in the privatized Medicare program.
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As consolidation transforms healthcare, tensions between insurers & providers intensify over reimbursement rates and care access policies. Examine the complex dynamics of these critical industry relationships in
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In June, CVS sent a mass text to pharmacy customers in Louisiana urging them to contact their representatives to oppose a PBM reform bill. That may have been illegal, two Republican congressmen say.
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Implementing work requirements should be a “multi-year project,” researchers said, but states have just until next year to prepare.
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The findings throw cold water on allegations from hospital groups that MA plans contribute to shrinking margins.
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The model will now run for one additional year and require providers to assume more downside risk.
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Roughly 150,000 individual and group MA members will be affected by the plan exits, as will some 400,000 Part D enrollees.
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The move will give more Americans a coverage alternative with low monthly premiums come November’s open enrollment, but could come at the expense of people who remain in standard Affordable Care Act plans.
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The decade-long case alleged that Aetna and Optum Health conspired to pass along administrative costs to patients by disguising them as medical codes.
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Doctors told the CMS that more patients need access to the procedure, with one calling it the start of a new era in hypertension management.
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