CMS is expanding eligibility for catastrophic health coverage on the ACA marketplace in 2026. The agency issued new hardship exemption guidance on Sept. 4 aimed at individuals projected to be ineligible for advance premium tax credits or cost-sharing reductions due…
Payer Policy Updates
The California and Texas medical associations are urging Cigna to rescind a new policy they say will increase administrative burdens and create a barrier to appropriate reimbursement. Beginning Oct. 1, Cigna’s new Evaluation and Management Coding Accuracy policy will review…
Aetna is rolling out new claims cost control measures under its Claim and Code Review Program, beginning Sept. 1. The new claims editing policy applies to commercial, Medicare and student health members, the company said in June. Aetna may trigger…
HHS and CMS are establishing a panel of experts tasked with providing recommendations on how to “improve how care is financed and delivered” across Medicare, Medicaid, the Children’s Health Insurance Program and the ACA’s exchanges. Members of the Healthcare Advisory…
The U.S. Office of Personnel Management will end coverage of gender transition-related surgeries and hormone treatments under the Federal Employees Health Benefits and Postal Service Health Benefits programs, beginning in 2026. In an Aug. 15 letter to carriers, OPM said…
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Iowa will implement work requirements for its Medicaid expansion program beginning Jan. 1, 2026, Radio Iowa reported Aug. 19. Under the recently signed One Big Beautiful Bill Act, states will have to establish Medicaid work requirements for certain individuals, beginning…
New Hampshire Gov. Kelly Ayotte has signed legislation banning surprise ground ambulance billing and establishing reimbursement rates insurers must pay for services. Beginning Jan. 1, 2026, ambulance providers — whether in-network or out-of-network — will be prohibited from billing patients…
Aetna is rolling out a new inpatient reimbursement policy for its Medicare Advantage and Special Needs Plans, effective Nov. 15. “Our goal is simple: We want to help you get reimbursed faster for inpatient admissions that are initially denied. You’ll…
The Trump administration has no current plans to require payers to provide coverage for in vitro fertilization services, despite a campaign pledge to do so, The Washington Post reported Aug. 3. Five things to know: 1. During his 2024 presidential…
New Hampshire Gov. Kelly Ayotte has signed a bill that requires insurers to notify the state’s insurance department at least 90 days in advance before discontinuing a line of business, including Medicare Advantage plans. The bill specifically mandates that insurers…