Industry Updates
This broad category includes articles concerning health insurance costs, carrier and health plan news, changing benefits technology, and surveys by the Kaiser Family Foundation and others on employee benefits.
The Trump administration has finalized a new model that aims to bring its most-favored nation pricing approach to Medicare Part B. Called the Global Benchmark for Efficient Drug Pricing, or GLOBE, Model, the program will begin on Jan. 1 and run through March 31, 2032. The model deploys an alternative approach to calculating drug inflation ...
The Medicare Advantage company exits are piling up. At least 11 health insurance companies that sold individual Medicare Advantage plans this year are abandoning the program for 2027 amid cost and regulatory challenges, company and federal data reveal. That compares to seven carriers that quit Medicare Advantage in 2026. Almost all of the insurers that ...
New research from the Employee Benefit Research Institute (EBRI) finds that substantial differences in reimbursement for the same physician-administered medications based on where treatment is provided could add billions of dollars annually to the cost of employment-based health coverage. The research, titled “Location, Location, Location: Spending Differences for Physician-Administered Outpatient Medications by Site-of-Treatment,” found that hospital ...
A proposal to tax California’s billionaires has fractured Democratic politics, repelled some of the state’s richest residents and exploded into a costly battle that’s overshadowing even the gubernatorial election. Known as Proposition 40, the ballot measure is also dividing the very industry it’s supposed to help. The healthcare-workers union behind the initiative, which would authorize ...
Amye Joseph says America’s political polarization has made it an “interesting time” in her Tennessee household. She and her husband, Charlie, have been married 35 years. She’s a Republican. He’s a Democrat. But their shared disenchantment with profit-driven healthcare has provided a unifying target: pharmacy benefit managers, known as PBMs. The Josephs’ frustration is focused ...
The Trump administration is projecting significant declines in premiums for Medicare Advantage plans in 2027. The Centers for Medicare & Medicaid Services said Monday that it expects weighted MA premium costs to decline by more than 16% in 2027 compared to 2026, with Medicare Advantage prescription drug premiums set to decrease by 38% year-over-year. The ...
Vendors insist their AI-assisted coding tools can correct years of under-documentation, but insurers say the tools are driving up healthcare costs for patients.
Hospitals’ increasing use of artificial intelligence for patient coding has increased the frequency of inpatient stays classified as medically complex—boosting the bills sent to payers despite no apparent changes in the care being delivered, according to a new claims analysis from the Blue Cross Blue Shield Association. The association found that the share of medically ...
Private-sector employers in the United States are facing much higher health insurance costs but struggling to hold their benefits packages together. The Bureau of Labor Statistics painted that picture today in a new batch of National Compensation Survey employee benefits data. The average cost of health benefits for a single employee at a private-sector employer ...
Medicare Advantage insurance companies anticipate another year of enrollment declines, the Centers for Medicare and Medicaid Services announced Monday. Insurers project Medicare Advantage membership will fall from 36.3 million this year to 34 million in 2027, CMS said in a news release. Companies made a similar prediction for the 2026 plan year that failed to ...