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CMS proposed a rule Oct. 23 that would require exchanges to verify eligibility before providing financial assistance to consumers. CMS…
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Blue Cross Blue Shield of Massachusetts and Burlington, Mass.-based Tufts Medicine are partnering on a new health plan for BCBS employees, as well as AI implementation to streamline prior authorization. The HMO, Tufts Medicine Alliance Network, includes access to Tufts…
There will be at least seven new carriers on ACA marketplaces in 2027, despite the continued pressures facing the wider market. Nationally, insurers have proposed a median 14% rate increase for 2027, the second straight year of double digit hikes.…
For most health plans, social risk lives inside care management, disconnected from strategy and the balance sheet. The result is avoidable utilization no one has quantified and spending no one has traced to a cause. As medical costs climb and…
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Optum is asking a Baltimore court to throw out Maryland’s $380 million fraud lawsuit over a failed Medicaid behavioral health claims system, calling the state’s allegations “a story that it knows is untrue.” In its Oct. 19 motion to dismiss,…
Medicare Advantage annual enrollment kicked off Oct. 15, and the ACA open enrollment period is around the corner. Employers are also navigating cost pressures, opening the door to innovative plans. Insurers have been primed to consider new health plans across…
About 40% of flexible spending account holders forfeited funds in 2024, averaging $404, according to an Oct. 15 brief from the Employee Benefit Research Institute. FSAs allow for pretax contributions and tax-free distributions on qualified medical expenses. The Bureau of…
Health plans are measured on member experience, security, quality and efficiency. Yet one capability quietly underpins all four: Knowing, with confidence, exactly who each member is. As member data spreads across digital and assisted channels, that confidence erodes. Duplicate records,…
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Molina Healthcare reported $38 million in net income for the third quarter of 2026, a 52% year-over-year drop from $79 million. The insurer attributed the decline mainly to a higher consolidated medical loss ratio, which was 92.9% in Q3, up…
The share of working-age Americans without health insurance has risen to 11.2% this year, according to the Commonwealth Fund’s Biennial Health Insurance Survey published Oct. 22. The survey is based on interviews with more than 9,300 adults conducted from May…
Covered employees on average contributed $7,471 toward their family coverage in 2026, 9% more than they did in 2025. KFF published its annual benchmark health benefits survey of employers on Oct. 22. Davis Research carried out fieldwork between January and…
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