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.
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 ...
Hospitals are facing more hurdles in using the 340B drug pricing program as shifts in insurance coverage make it harder to maintain access to discounted drugs. Health systems are increasingly running into regulatory and legislative barriers to the program that allows safety-net providers to buy deeply discounted drugs from manufacturers. A Corewell Health hospital in ...
The Trump administration has promoted its new TrumpRx website as a way for consumers to get the lowest prices in the world for prescription medications, drawing on voluntary pricing agreements with drug manufacturers aimed at securing “Most Favored Nation” prices for American consumers. A KFF analysis, however, finds that consumers who buy brand-name prescription drugs ...
Autumn Daniels is no stranger to migraine headaches, which have troubled her since childhood. The migraine tormenting the 32-year-old in April was even worse than usual. After a week of piercing head pain, she went to an urgent care center near her home in Champaign, Illinois, and received an injection of Toradol, a non-steroidal anti-inflammatory ...
The Trump administration plans to cancel enrollment in Affordable Care Act plans for more than 760,000 people as part of its crackdown on fraud, waste and abuse. The Centers for Medicare & Medicaid Services announced on Tuesday that it would cancel 315,000 “unauthorized enrollments” covering that population, a move the agency said will return $2.2 ...