Payer

Following the annual enrollment period for 2026, 56.1 million people — up from 54.6 million in 2025 — are enrolled in Medicare Part D, which includes standalone prescription drug plans and Medicare Advantage plans with prescription drug coverage, as of…

Providence Health Plan recorded a $102 million net loss in 2025, driven by rising medical and pharmacy utilization and a drop to a 3.5 Medicare Advantage star rating, but the Oregon-based health plan is projecting a return to financial stability…

Texas emerged as a standout in the 2026 ACA open enrollment period, attracting about 206,000 new enrollees — the highest in the country — according to preliminary data published Jan. 28 by CMS. Meanwhile, nationwide enrollment fell to nearly 23…

Medicare beneficiaries had about 60 million telehealth visits per year between 2021 and 2023, according to a February study published in Annals of Internal Medicine.  Co-author and University of Utah assistant professor Terrence Liu, MD, broke down the findings March…

The Republican-controlled House Committee on Energy and Commerce sent letters March 3 to ten states — California, Colorado, Massachusetts, Maine, Nebraska, New York, Oregon, Pennsylvania, Vermont and Washington — requesting information on fraud, waste and abuse, as well as integrity…

This February, BCBS Michigan shared how it will cut reimbursement by 50% for nonpreventive evaluation/management services with modifier 25 that were billed on the same day as procedure codes with global periods of zero, 10 or 90 days. However, the…

Novant Health, a 19-hospital system headquartered in Winston-Salem, N.C., has partnered with the North Carolina State Health Plan — which is administered by Aetna — to expand access to “no-cost surgical care” for hundreds of thousands of plan members across…

Eli Lilly has launched Employer Connect, a platform that offers employers a direct route to offer Zepbound coverage to workers at a list price of $449 per month, bypassing traditional pharmacy benefits. The platform pairs employers with more than 15…

CMS reported a record of nearly 47,000 comments on its Medicare Advantage payment proposal for 2027. The insurer-backed Better Medicare Alliance, an MA advocacy group, hosted an executive summit March 3, featuring CMS Director of Medicare and Deputy Administrator Chris…

In recent months, payers across the country have tried tightening policies to get a better grip on evaluation/management coding. While payers often say the policies aim to control costs or combat fraud, these more restrictive policies are often met with…