Medi-Cal no longer covers GLP-1s for weight loss as of Jan. 1. Wegovy, Zepbound and Saxenda have been removed from the Medi-Cal Rx Contract Drugs List and are no longer eligible for coverage for weight loss or weight-loss indications. The…
Author: Jakob Emerson
Enhanced ACA premium tax credits expired Dec. 31, with congressional efforts to extend them stalled and no resolution in sight. The enhanced subsidies, introduced under the 2021 American Rescue Plan Act, increased subsidy amounts and expanded marketplace eligibility to households…
Alabama insurers issued the highest amount of medical loss ratio rebates to consumers in 2024, according to KFF. Under the ACA, if an insurer in the individual market spends less than 80% of premium revenues on clinical services and quality…
Delaware’s largest payer controls 93% of the state’s health insurance market, while Washington state’s largest insurer controls just 24%, according to KFF. The 2023 data was obtained from the “Health Coverage Portal TM,” a database maintained by Mark Farrah Associates. …
Health insurers face a wave of regulatory and policy changes in 2026, from the expiration of enhanced ACA premium tax credits to tighter prior authorization rules and new state coverage mandates. Here’s a rundown of major federal and state payer…
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Fitch Ratings has issued a “deteriorating” outlook for the U.S. health insurance industry in 2026, citing persistent medical cost pressures, regulatory uncertainty, and fallout from expiring ACA enhanced subsidies. The Dec. 30 report shared with Becker’s projects medical loss ratios…
State Medicaid agencies have made an estimated $289 million in improper capitation payments to managed care organizations on behalf of deceased enrollees since 2016, according to a series of audits from the HHS Office of Inspector General. The latest OIG…
Switching from Medicare Advantage to traditional Medicare was associated with increased mental health visits, along with a shift toward nurse practitioners and away from emergency and internal medicine specialists, according to a December study published in the American Journal of…
Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with contract losses.
By 2027, many people who get their health insurance through Medicaid will need to show they are working, pursuing an education or volunteering to remain eligible for their coverage. The new rules, passed as part of the “One Big Beautiful…