Oscar Health expects between 250,000 and 300,000 of its marketplace members to be retroactively disenrolled in connection with CMS program integrity initiatives and fraud, waste and abuse enforcement, the insurer disclosed Aug. 7. The expected disenrollments represent roughly 8% to…
ACA
A federal judge has thrown out a False Claims Act lawsuit accusing Sentara Health Plans of fraudulently inflating ACA marketplace premiums in Virginia after multiple large insurer competitors left the market in 2017. Chief U.S. District Judge Elizabeth Dillon found…
Not all CMS data is telling the same story when it comes to ACA enrollment in Texas. As of January, nearly 4.2 million Texans had selected ACA plans for 2026, up from nearly 4 million in 2025. That marked the…
Cox HealthPlans, the insurance arm of Springfield, Mo.-based CoxHealth, will stop selling ACA marketplace plans directly starting in 2027, instead partnering with insurer Oscar Health to offer marketplace coverage. The new Oscar plans will be built around CoxHealth’s network of…
The ACA individual market risk pool is getting smaller and sicker, with risk scores rising 6.3% even as enrollment fell 12% through April, according to a July report from Wakely. The analysis drew from data representing nearly 80% of individual…
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ACA insurers are pitching a median rate increase of 15% for 2027, the second year in a row of double-digit premium hikes, according to a July 8 Peterson-KFF Health System Tracker analysis that was updated Aug. 3. The tracker reviewed…
A coalition of 22 states are suing to block key pieces of CMS’ 2027 ACA marketplace rule, arguing the changes will push consumers into “barebones” coverage and revive provisions a federal court previously struck down. The complaint, filed July 31…
King of Prussia, Pa.-based Universal Health Services is seeing almost no offset from commercial coverage as patients drop off the ACA exchanges, CFO Steve Filton said on the for-profit system’s July 28 earnings call. Responding to an analyst question about…
The expiration of the ACA’s enhanced premium tax credits appears to be playing out positively for several insurers, while some of the nation’s largest hospital operators are absorbing a wave of newly uninsured patients who continue to seek care. The…
HHS and CMS appealed a Maryland federal court’s decision to vacate parts of CMS’ 2025 “Marketplace Integrity and Affordability Rule,” according to July court filings. In the case — which has the city governments of Columbus (Ohio), Baltimore and Chicago, as well as…