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…
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California Gov. Gavin Newsom has signed a bill into law allowing the state’s Department of Managed Health Care to waive prior authorizations for services or prescriptions that payers approve at least 90% of the time. Senate Bill 306 also requires…
Sixty-five percent of U.S. voters believe Democrats should accept a continuing resolution to end the government shutdown instead of holding out for extended ACA funds, according to a Harvard CAPS-Harris Poll. The survey ran Oct. 1-2, gathering results from 2,413…
The Maryland Department of Health is streamlining three Medicaid waiver programs overseen by the Developmental Disabilities Administration into a single program, according to an Oct. 6 news release. The unified waiver program aims to help those with intellectual and developmental…
It was Tuesday at 3pm, and Michael, a health plan compliance officer, paced around his office in frustration. A new state law mandated a fundamental change in reporting data related to claims reimbursement policies. The deadline was looming, and his…
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The American Hospital Association critiqued the Medicare Payment Advisory Commission’s initial assessment of Medicare Advantage enrollment changes and its effect on hospital finances, according to an Oct. 3 letter from Molly Smith, AHA’s group vice president of public policy. MedPAC…
Sentara Health Plans will not offer Medicare Advantage, MA prescription drug HMO, or C-SNP plans in Virginia, North Carolina and Florida in 2026. “These products are no longer financially sustainable in the current environment. Industry-wide headwinds and market dynamics, including…
A shareholder of UnitedHealth Group has put forward a proposal calling for the appointment of an independent chairperson for the company’s board that is separate from the CEO position, Bloomberg reported Oct. 3. Earlier this year, UnitedHealth named its board…
As many major insurers scale back on Medicare Advantage, some players are exiting the market entirely. Here’s a look at the insurers that are fully backing out: Editor’s note: This is not an exhaustive list. It will continue to be…
Ochsner Health Plan will no longer offer Medicare Advantage plans in 2026. The insurer, part of Jefferson, La.-based Oschner Health, has around 6,000 total MA members, per CMS enrollment data. The majority of members are enrolled in an HMO plan,…