Payer Policy Updates

An organization representing Medicare Advantage insurers is asking CMS to pause any policy changes to the program not required by law in 2026. 

A group representing large employers is suing to block the implementation of a rule that would more strictly enforce requirements for insurers to cover mental health care. 

HHS has rescinded a proposal to require ACA plans to cover over-the-counter contraceptives, Politico reported Jan. 14. 

CMS will implement policies meant to crack down on fraud in the ACA marketplace. 

Nevada has received federal approval to implement public health insurance plans on its ACA exchange, becoming the third state to do so after Colorado and Washington. 

CMS is proposing a more generous increase in payments to Medicare Advantage plans in 2026 than in previous years. 

A new California law went into effect Jan. 1 that prohibits payers from making coverage decisions based solely on artificial intelligence algorithms. 

Two major Medicare changes signed into law in the Inflation Reduction Act will take effect in 2025. 

CMS will sunset the Medicare Advantage Value-Based Insurance Design Model at the end of 2026, citing "unprecedented" costs to the Medicare trust fund. 

CMS has moved the deadline to enroll in federally facilitated marketplace coverage from Dec. 15 to Dec. 18 for benefits that begin in the new year.