Alabama insurers issued the highest amount of medical loss ratio rebates to consumers in 2024, according to KFF. Under the ACA, if an insurer in the individual market spends less than 80% of premium ...

Enhanced ACA premium tax credits expired Dec. 31, leaving millions of marketplace enrollees facing higher premiums in 2026. Congressional efforts to extend the subsidies have stalled, with neither a ...

Delaware’s largest payer controls 93% of the state’s health insurance market, while Washington state’s largest insurer controls just 24%, according to KFF. The 2023 data was obtained from the “Health ...

Medi-Cal no longer covers GLP-1s for weight loss as of Jan. 1. Wegovy, Zepbound and Saxenda have been removed from the Medi-Cal Rx Contract Drugs List and are no longer eligible for coverage for ...

Health insurers face a wave of regulatory and policy changes in 2026, from the expiration of enhanced ACA premium tax credits to tighter prior authorization rules and new state coverage mandates.

Health Care Service Corp.’s Blue Cross and Blue Shield of Texas filed a lawsuit against medical billing company Zotec Partners Dec. 18, alleging “abuse” of the No Surprises Act’s independent dispute ...

Mail-order pharmacies owned by UnitedHealth and Humana dispensed Medicare prescription refills earlier and more frequently than industry peers, according to an analysis of federal prescription data ...

Insurers are publishing incomplete price transparency data, with hospital inpatient information particularly sparse, according to a study published in the American Journal of Managed Care in December.

The payer-provider relationship is continually evolving. Becker’s connected with 13 health plan leaders to find out which part of that relationship they would change. Like what you see here? Join us ...

CMS’s proposed Medicare Advantage rule for 2027 includes more leeway for hemp coverage. Hemp has low concentrations of tetrahydrocannabinol, as defined by the Agriculture Improvement Act of 2018.

Nearly 5.8 million people have enrolled in ACA marketplace plans for 2026 coverage, outpacing last year’s enrollment figures at the same point in the open enrollment period, according to new data ...

Nearly half of health plan coverage denials that reached independent medical review were overturned between 2019 and 2023, with significant variation by state, according to a Health Affairs study ...