New & Notable
ACA Marketplace deductibles increased by over $1K: KFF
The expiration of enhanced premium tax credits is increasing ACA Marketplace deductibles as enrollment hits an all-time low, KFF reports.
CMS finalizes major changes to ACA exchanges, including greater access to catastrophic plans
The Trump administration continues to open the doors to the cheap, high-deductible coverage, to the worry of insurance experts and stakeholders in the healthcare industry.
— Healthcare Dive
ACP calls for Medicare Advantage transparency overhaul
The American College of Physicians urged overhauls to Medicare Advantage that would promote transparency, access to care and healthcare affordability.
Feds hold states to the fire over Medicaid fraud as CA loses $1B
The White House wants proof that states are aggressively pursuing Medicaid fraud, threatening to stop funding if they don't take it seriously enough.
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Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
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Latest News
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CMS accelerates Medicare coverage for breakthrough medical devices
The agency and FDA announced a new Medicare coverage pathway for certain breakthrough medical devices that cuts the reimbursement timeline from 1+ years to months.
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CMS benches BALANCE Model for Medicare
The federal agency announced an indefinite delay to the Medicare Part D portion of the upcoming model that would expand coverage criteria for GLP-1s.
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UnitedHealthcare eliminates prior authorization for rural providers
In addition to scrapping prior authorization, UnitedHealthcare said it will speed up payments and create more community-based care models for rural providers.
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Mental health parity remains elusive in 43 states
In-network mental healthcare is harder to get in most states than physical healthcare, potentially due to disparate provider reimbursement rates.
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Payers face faster prior authorization approvals under CMS proposal
Under the proposed rule, affected payers would need to respond to urgent prior authorization requests for drugs within 24 hours and to standard requests within 72 hours.
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Digital member experience improves for health plans, gaps remain
A recent JD Power survey showed that, although the digital member experience is improving for health plans, there's room to grow for onboarding and patient education.
Features
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5 healthcare pros on the trends defining primary care
The 2025 Payer + Provider Virtual Summit explored AI, value-based care and community-based partnerships, offering strategies on how to promote primary and preventive care.
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How payers can regain consumer trust via personalized care
Creating personalized health plans is central to regaining consumer trust. To do that, payers must outline safeguards for member data and create seamless experiences.
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With trust low and costs high, do payers stand to lose members?
Healthcare payers might see fewer enrollments as members face higher prices for a product they don't trust or see as high value.
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Breaking down the ABCs of rising alternative health plans
More employers are seeking alternative health plans, like AHPs and ICHRAs, to bend the cost curve, but education is key to navigating their growing popularity.