Timely Health Plan News and Commentary
A single health insurer controls at least half of the commercial health insurance market in 15 states, and a Blue Cross Blue Shield company is the largest insurer in 43 of 50 states and the District of Columbia, according to the latest American Medical Association (AMA) study of insurer competition. In Alabama, Blue Cross and Blue Shield of Alabama holds 84% of the market.
Cigna is leaving the ACA individual market in all 11 states where it sells Marketplace plans for 2027, and several other insurers are pulling out of individual states, from UnitedHealthcare in Georgia to Molina in Florida, Illinois and Ohio, according to KFF’s tracking of insurer participation and state regulators.
Health insurers are returning about $759 million to customers in 2026 under the Affordable Care Act's medical loss ratio rule, less than half the $1.64 billion they paid in 2025, according to a preliminary KFF estimate based on insurer filings. … [Continue reading]
Workers can set aside up to $3,500 in a health flexible spending account (FSA) in 2027, up $100 from this year, under inflation adjustments the IRS released November 5. The FSA carryover limit rises to $700, and health savings account (HSA) limits … [Continue reading]
ACA Marketplace sign-ups fell in 41 states for 2026, with North Carolina down 21.9% and Ohio down 19.5%, according to final Open Enrollment data from the Centers for Medicare & Medicaid Services (CMS). Nationally, 23.1 million people picked a … [Continue reading]
Nearly 68 million Medicaid enrollees, 78.2% of the program, got their care through a comprehensive managed care plan in 2024, according to federal enrollment data from the Centers for Medicare & Medicaid Services (CMS). Counting dental, … [Continue reading]
People with Medicare in 29 states will have fewer Medicare Advantage plans to choose from in 2027 than they had this year, according to state fact sheets from the Centers for Medicare & Medicaid Services (CMS). Wyoming drops from 14 plans to 8, … [Continue reading]
Medicare Advantage plans denied 65.3% of requests for long-term care hospital stays in June 2024, the HHS Office of Inspector General (OIG) found in a data brief released this year. Aetna, Humana and UnitedHealth Group each denied more than 70% of … [Continue reading]
Insurers selling Affordable Care Act (ACA) plans on HealthCare.gov denied 18.7% of the in-network claims they received in 2024, according to federal data analyzed by Health Plan News. That is 84.5 million denied claims out of 451 million, and the … [Continue reading]
CVS Health plans to split into two publicly traded companies. Aetna, the CVS Caremark pharmacy benefit manager, CVS Specialty, Oak Street Health and Signify Health will stay together under the CVS Health name. The roughly 9,000 CVS stores, the mail … [Continue reading]
UnityPoint Health is bringing in Omega Healthcare as a strategic partner as the nonprofit health system works to improve its financial and operational performance without losing sight of patient care. … [Continue reading]
Blue Cross and Blue Shield of Illinois is putting more than $4.4 million behind community programs across the state, with 121 nonprofit organizations receiving 2026-2027 Blue Impact grants. … [Continue reading]
A Monday Hearing Sets the Stage Luigi Mangione, the 28-year-old accused of fatally shooting UnitedHealthcare CEO Brian Thompson on a Manhattan sidewalk in December 2024, is scheduled to appear in federal court on Monday. The hearing comes ahead of … [Continue reading]
A hospital admission can feel stressful even when you already have health insurance. Many families assume that a policy automatically removes every upfront payment, but hospital billing and claim approval often follow a step-by-step process. A … [Continue reading]
BioOra Limited and Cincinnati Children’s Hospital Medical Center have announced a strategic partnership that could reshape how paediatric leukemia is treated. The collaboration centers on Atla-cel, a third-generation CAR-T (Chimeric Antigen Receptor … [Continue reading]
One in Three Americans Losing Sleep Over Healthcare Bills—And the Numbers Keep Getting Worse A new national survey from Imagine360 paints a clear picture: healthcare costs are no longer just a budget issue. They are now a daily stressor affecting … [Continue reading]
Blue Cross Blue Shield of Michigan has agreed to sell its wholly owned subsidiary, AF Group, to Enstar Group in a transaction backed by investment firm Sixth Street. The move marks a major shift for both organizations and signals a new chapter for … [Continue reading]
Taikang Pushes a New Approach to Insurance and Aging in China China is aging at a pace that transforms how society works, spends, and plans. A report from WallstreetCN highlights a difficult truth: retirement and long life are becoming the rule, not … [Continue reading]
Millions of Americans are opening enrollment notices and doing a double take. ACA marketplace premiums for 2026 are climbing fast. In many cases, the jump feels less like inflation and more like a cold splash of water. … [Continue reading]
Blue Shield of California Promise Health Plan just dropped $80,000 to fund medical assistant training scholarships in San Diego County. The investment targets students joining the Laura Rodriguez Medical Assistant Institute (LRMAI), a program run by … [Continue reading]
Hold Onto Your Wallets: Health Insurance Costs Are Going Bonkers If you buy health coverage through the Affordable Care Act (ACA) marketplaces, you might want to sit down. A new report from ValuePenguin by LendingTree is sounding the alarm. It’s … [Continue reading]
Medical malpractice cases aren’t simple, and most patients don’t know where to begin when something goes terribly wrong. The right law firm makes all the difference in securing justice, accountability, and answers. Some firms take on headline-making … [Continue reading]
Novo Nordisk just pulled a move that every patient paying cash for GLP-1 treatment will notice. The company is rolling out an introductory self-pay price of $199 per month for Wegovy and Ozempic starter doses, and cutting ongoing self-pay pricing to … [Continue reading]
Kay Van Wey Launches AdvoKAYte Podcast to Expose Failures in American Healthcare The American healthcare system has met one of its sharpest critics once again, and she now has a microphone. Attorney Kay Van Wey, known nationwide for her long track … [Continue reading]
Wellcare Opens 2026 Medicare Enrollment Season With New Choices for Florida Seniors Wellcare, the Medicare brand of Centene Corporation, has announced the start of the 2026 Medicare Annual Enrollment Period for Florida. From October 15, 2025 … [Continue reading]
BAYADA Introduces AI-Driven Home Care Model That Reduces Senior Falls and Hospital Visits BAYADA Home Health Care has rolled out a new approach that blends predictive monitoring, clinical oversight, and daily data review to help seniors stay safe … [Continue reading]
Fidelis Care Awards $130,000 in Maternal Health Grants Across New York Funding Focused on Postpartum Care and Maternal Mental Health Fidelis Care, a statewide health plan serving more than 2.4 million members in New York, has awarded $130,000 in … [Continue reading]
How Americans Can Slash Prescription Costs Without Risking Their Health Medication Costs Force Hard Choices Prescription drugs are becoming a financial strain for millions of Americans. Rising costs are leaving families to choose between paying … [Continue reading]
Highmark Health and Abridge Partner to Transform Clinical Documentation and Prior Authorization Highmark Health has announced a wide-scale collaboration with Abridge, a Pittsburgh-based developer of AI technologies for healthcare, to integrate … [Continue reading]
Fidelis Care Urges Families to Prepare Kids for a Healthy School Year As summer wraps up and backpacks start appearing by the door, Fidelis Care is reminding New York families that a smooth start to the school year begins with a focus on health, … [Continue reading]