Payer

The ACA marketplace’s open enrollment period kicks off on Nov. 1, but HealthCare.gov and states have price previews already available. The shopping window will remain open until Jan. 15, 2026, but those assessing their coverage face uncertainty. The fate of…

Minnesota Gov. Tim Walz has paused payments for 14 high-risk Medicaid services for up to 90 days while a third-party audit is conducted. The state’s Department of Human Services has contracted with Optum, which will analyze Medicaid fee-for-service claims data…

UnitedHealth Group is projecting its Medicare Advantage enrollment will decrease by 1 million people in 2026.  That estimate is up from a 600,000-member decrease it projected in July. UnitedHealthcare CEO Tim Noel said on the company’s Oct. 28 earnings call…

Optum Health, UnitedHealth’s care services division, “strayed from the initial intent,” said Optum CEO Patrick Conway while discussing the unit’s performance during UnitedHealth Group’s Oct. 28 earnings call. However, he remained confident that the company can push the business forward.  Mr.…

Humana’s board of directors declared a $0.885 per share dividend to be paid on Jan. 30, 2026.  The dividend will be paid to all shareholders of record as of the close of business Dec. 26, according to an Oct. 28…

Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Broward Health, based in Fort Lauderdale, Fla., seeks a manager of managed care…

Improving member experience remains a top priority for payers — and for Medicare Advantage plans, it’s not just a goal but a business imperative. Member experience directly influences CMS Star Ratings, which in turn affect financial performance. At the heart…

The Cigna Group’s Evernorth division introduced a rebate-free pharmacy benefit model that it says will lower medication costs and simplify drug pricing. The model removes the traditional post-purchase rebate structure by applying negotiated drug discounts upfront, according to an Oct. 27…

The Cigna Group’s board of directors has declared a $1.51 per share cash dividend to be paid on Dec. 18.  The dividend will be paid to shareholders of record as of the close of business Dec. 4, according to an…

Today, the durable medical equipment management (DME) process can be fragmented, inefficient, and unreliable – leading to errors and delays that impact member health, inflate costs for health plans, and burden clinicians with administrative complexity. But what if the end-to-end…