The Massachusetts Division of Insurance has renegotiated lower rates — projecting $72 million in premium savings — with insurers in the state’s merged individual and small employer market. The negotiations included Blue Cross Blue Shield of Massachusetts HMO Blue, Harvard…
ACA
CalOptima Health, the public Medi-Cal insurer for Orange County, Calif., will soon begin selling individual plans on the state’s ACA marketplace, Covered California, for the 2027 plan year. CalOptima will offer coverage in Orange County and is the only new…
A federal judge has paused eight provisions of CMS’ 2027 ACA marketplace rule, blocking a slate of eligibility, verification and plan design changes just days before they were set to take effect July 20. Judge Brendan Hurson of the U.S.…
A newly proposed federal bill would create a government-run public health insurance option sold on the ACA exchanges and permanently extend the enhanced premium subsidies that lapsed at the end of 2025. The Medicare-X Choice Act, introduced July 15 by…
Insurers estimate that they will pay more than $759 million in medical loss ratio rebates across commercial markets in 2026. KFF’s preliminary analysis is based on insurer-reported financial data from market database Health Coverage Portal TM. The ACA established an…
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CMS lacks adequate safeguards to stop agents and brokers from enrolling individuals into ACA coverage or switching their plans without consent, according to a report from the Government Accountability Office published July 13. More than 19 million people were enrolled…
The traditional group health plan is in crisis, with commercial insurance costs reaching record highs as factors like specialty medication spend, stop-loss insurance and behavioral health utilization continue to compound. Naturally, employers nationwide have been turning to an array of…
Payers owe a combined $11.2 billion in ACA risk-adjustment charges for 2025, CMS said at the end of June. Risk adjustment transfers funds within a state’s individual or small group market from insurers whose members have lower risk to insurers…
Enrollment in ACA marketplace plans fell in 49 of the 50 states plus D.C. between February 2025 and February 2026, according to CMS data published in late June. Ohio, Oklahoma and Arizona posted the steepest year-over-year declines, each shedding roughly…
Three federal lawsuits are forming a tapestry of litigation related to the future of the ACA marketplace. In recent years, CMS has pitched rules focused on promoting marketplace “integrity” by tightening eligibility, altering enrollment periods and narrowing subsidy access, to…