What’s New and What To Watch For in the Upcoming ACA Open Enrollment Period

It’s that time of year again: In most states, the Affordable Care Act’s annual open enrollment season for health plans begins Nov. 1 and lasts through Jan. 15. Current enrollees who do not update their information or select an alternative will be automatically reenrolled in their current plan or, if that plan is no longer available, ...

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California Insurer Experiments With Drug Giveaway, Bypassing Secret Fees

A major California health insurer is set to offer one of the world’s top-selling drugs for free in a bid to show the medicine can reach Americans affordably without going through the middlemen that typically control its flow.

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Even Political Rivals Agree That Medical Debt Is an Urgent Issue

While hot-button health care issues such as abortion and the Affordable Care Act roil the presidential race, Democrats and Republicans in statehouses around the country have been quietly working together to tackle the nation’s medical debt crisis.

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CMS To Increase Oversight On Exchange Brokers

The proposed rule comes after the CMS reported a growing number of complaints about ACA health plan applications submitted by brokers.

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CMS Proposes Risk Adjustment Changes, Broker Fraud Crackdown For 2026 Plan Year

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) released Oct. 4 would protect beneficiaries from shady broker behavior and modify the federal risk adjustment program, among other changes. Under the Notice of Benefit and Payment Parameters proposed rule (PDF) for the 2026 plan year, insurance agents could be held responsible for marketplace violations. ...

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GAO Wants CMS To Check Whether Hospitals’ Price Transparency Data Are Actually Usable

The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote in a Wednesday report. The Centers for Medicare & Medicaid Services (CMS) has required hospitals to post the prices for numerous ...

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This California Ballot Measure Promises Money For Health Care. Its Critics Warn It Could Backfire

Among the blitz of election ads flooding TV, social media and street corners, you won’t see any opposition to a ballot measure proposing to lock in billions of dollars to pay doctors more for treating low-income patients. But opponents of Proposition 35 have a warning even if they don’t have the money to pay for ads: The measure could ...

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CMS Readies Changes For 2nd Round Of Drug Price Negotiation Program

The Centers for Medicare & Medicaid Services (CMS) rolled out guidance Oct. 2 as stakeholders prep for the second round of the drug price negotiation program. Made possible through the Inflation Reduction Act, the federal government has praised the program, saying it drastically lowers the cost of lifesaving drugs. The negotiation period for the first ...

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UnitedHealth Report Calls Out Policy Changes To Accelerate Shift To Value-Based Care

The healthcare industry is making the push toward greater adoption of value-based care, yet it’s not a secret that progress has been slow-moving. With that backdrop, UnitedHealth Group has released its latest “A Path Forward” report, which is a biennial look at progress in the shift to value. The paper includes dozens of policy recommendations ...

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Obamacare Agent, Broker Activity Tackled in HHS Proposal

Proposed guidelines for operating Obamacare insurance exchanges in 2026 call for tightening protections against unauthorized actions by agents and brokers who help consumers enroll in coverage. The proposal, released Friday by the Centers for Medicare & Medicaid Services, sets standards for health insurers and ACA marketplaces, as well as requirements for agents, brokers, and others ...

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