California Attorney General Rob Bonta has reached a $34 million settlement to resolve claims that the Aliera Companies and its subsidiaries, along with Sharity Ministries, (formerly Trinity Healthshare) sold and operated sham health plans in violation of state law. The…
Author: Jakob Emerson
Wellmark Blue Cross and Blue Shield has filed a lawsuit against Iowa’s insurance commissioner, challenging the enforcement of a newly enacted state law that regulates pharmacy benefit managers and the administration of prescription drug benefits. The lawsuit, filed on Oct.…
CMS Administrator Mehmet Oz, MD, discussed some of the biggest issues facing the Medicare Advantage program at an Oct. 15 industry conference. During his first six months on the job, CMS has already overseen policy moves to streamline prior authorization…
Commercial insurance prices were 78% higher in hospital outpatient settings compared with ambulatory surgical centers in 2024, according to a Health Affairs study published in October. The analysis, led by researchers at Brown University, examined 2024 pricing data for UnitedHealthcare,…
Blue Shield of California is conducting a third round of layoffs this year, with 150 more employees being laid off in December. The nonprofit insurer laid off 138 employees in September and 113 employees in May. The majority of the…
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The Medicare open enrollment period runs from October 15 to December 7, setting insurers’ 2026 membership and revenue trajectories as beneficiaries select Medicare Advantage and Part D coverage. The 2026 cycle is unfolding amid a projected MA enrollment decline, lower…
Michigan Gov. Gretchen Whitmer signed legislation Oct. 7 that aims to preserve the state’s Medicaid funding by maintaining its Insurance Provider Assessment tax. The new law instructs the state to request a waiver from CMS to continue the tax on…
The No Surprises Act is succeeding in protecting patients from unexpected medical bills, but insurers and provider groups remain divided on what is driving rising costs tied to the Independent Dispute Resolution process and how regulators should respond. Since the…
CMS released Medicare Advantage star ratings on Oct. 9, showing an average score of 3.65 for 2026, compared to 3.92 last year. Plans were evaluated by the agency across 40 quality criteria spanning outcomes, experience, access, operations, and pharmacy. Plans…
Republican lawmakers are reviving proposals that failed to make it into the sweeping One Big Beautiful Bill Act, turning their focus to a trio of measures that could reshape how employers offer health benefits through Individual Coverage Health Reimbursement Arrangements,…