On Nov. 1, current Healthcare.gov enrollees in Illinois will move to state-based health insurance marketplace, Get Covered Illinois, for their 2026 coverage, according to a news release confirming CMS approval this summer. In 2023, Illinois passed a law instituting a…
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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…
The Office of Personnel Management announced 2026 federal worker health premiums this month, ahead of the open enrollment period. The health benefits season runs from Nov. 10 through Dec. 8. Shane Stevens, OPM’s associate director for healthcare and insurance, said…
Sens. Ron Wyden, Elizabeth Warren, Bernie Sanders and Raphael Warnock sent a letter Oct. 10 to Deloitte, Conduent, General Dynamics Information Technology and Gainwell Technologies probing how they determine Medicaid access. The letter comes amid broader legislation that enforces stricter…
CMS released its Medicare Advantage star ratings for 2026 on Oct. 9. Strong ratings, with five stars being the highest score, lead to plans earning quality bonus payments. Eighteen plans achieved a 5-star status, versus only seven last year. These…
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CMS shared its Medicare Advantage star ratings for 2026 on Oct. 9. Strong ratings lead to plans earning quality bonus payments, while plans that consistently underperform may encounter more oversight and a higher risk of contract cancellation. The number of…
The Rhode Island Executive Office of Health and Human Services proposed pulling back on Medicaid’s coverage of GLP-1s for weight loss, according to a budget document acquired by the Rhode Island Current. In April, the Trump administration said it will…
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…
West Virginia may have paid managed care organizations up to $32.4 million for ineligible Medicaid participants, according to an October audit report. The audit examined payments from 2019 to 2020 and was inspired by Louisiana audits involving Aetna. MCOs get…
The Medicare Part D market is entering 2026 amid a period of contraction and recalibration. Premiums are ticking down on average, but plan options are shrinking as major insurers reassess the profitability of standalone drug plans under the effects of…