The U.S. Government Accountability Office found significant fraud risk in the ACA application process, according to a Dec. 3 agency report. Auditors applied for coverage under fictitious identities to test marketplace enrollment controls. The marketplace approved coverage for the four…
Author: Elizabeth Casolo
Aetna is bundling pharmacy prescriptions and medical procedures into a single clinical review, according to a Dec. 4 news release. Providers previously had to submit two prior authorizations, but, as of November, providers only have to file one medical review,…
The Trump administration introduced plans to lower obesity drug costs for Medicaid and Medicare, but commercial insurance coverage of GLP-1s remains a concern. “There is some speculation that this initiative will help create downward pressure for drug manufacturers to lower…
Angle Health raised $134 million in series B funding to scale its benefits platform, according to a Dec. 3 news release. The company secured a mix of debt and equity, with total funding reaching nearly $200 million. Portage led the…
A Massachusetts federal judge issued a preliminary injunction temporarily preventing Medicaid cuts to certain nonprofit reproductive health and abortion service providers for 23 plaintiff jurisdictions, according to a Dec. 2 ruling. The judge found the cuts, part of the One…
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Seventy-seven percent of Americans who reviewed their health plan choices for 2026 “felt good” about their options, according to a Dec. 3 eHealth survey. The health insurance marketplace surveyed more than 1,500 adults nationwide in November. Medicare beneficiaries reported the…
Health insurance ranks as the top deciding factor as Americans consider a career move, according to a survey from Talker Research on behalf of Oscar Health. The survey, published Dec. 2, assessed 2,000 Americans’ opinions of employer health insurance. Read…
The North Carolina Department of Health and Human Services launched a health plan specifically tailored for Medicaid-enrolled children, youth and young adults, dubbed Healthy Blue Care Together, Dec. 1. The statewide health plan — formed in partnership with Blue Cross…
Curative raised over $150 million in series B funding, bringing its valuation to $1.275 billion, according to a Dec. 2 news release. The startup, formerly a COVID-19 testing company, offers health insurance plans with no out-of-pocket costs — as long…
Bethesda, Md.-based Aledade secured a $500 million senior secured credit facility from Ares Commercial Finance, according to a Dec. 1 news release from the primary care network. The credit facility has the potential to increase to $650 million. It will…