Payer

Alabama has the highest average in-network denial rate for ACA insurers, while South Dakota has the lowest, according to KFF. 

Insurers on the ACA marketplace denied around one in five in-network claims in 2023, according to a report from KFF published Jan. 27. 

CMS proposed a payment bump for Medicare Advantage plans in 2026, and insurers are continuing to file challenges over star ratings. 

A Minnesota federal judge has given preliminary approval to UnitedHealth's agreement to pay $69 million to settle a class-action lawsuit alleging the company prioritized its business relationship with Wells Fargo over concerns that its 401(k) plan contained low-performing target-date funds.

Blue Cross and Blue Shield of Vermont is sounding the alarm about the escalating financial challenges facing the state's healthcare system, noting that "the cost surge was unrelenting through 2024."

Colorado's employee health plan will drop coverage in July for GLP-1s prescribed to treat obesity in an effort to cut costs, the Colorado Sun reported Jan. 23.

Almost every state has completed the unwinding of Medicaid continuous coverage, but the process is still causing problems for insurers. 

An Indiana lawmaker has reintroduced legislation that would cap all prior authorization rates at 1%, the Indiana Capital Journal reported Jan. 23. 

CMS' proposed Medicare Advantage rates for 2026 are moving in the right direction, but still "insufficient" to cover rising costs in the program, according to Elevance Health executives. 

Elevance Health posted nearly $6 billion in net income in 2024, according to the company's year-end earnings report published Jan. 23.