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All articles tagged with #insurers

Medicare pauses BALANCE GLP-1 pilot as transitional coverage extends through 2027
health1 month ago

Medicare pauses BALANCE GLP-1 pilot as transitional coverage extends through 2027

The Trump administration indefinitely delays the BALANCE pilot that would have let private Medicare drug plans cover GLP-1 weight-loss medicines, after insurers voiced concerns, while a transitional program will cover the drugs through 2027 with Medicare bearing the cost and no requirement for plans to take on financial risk. This means $50 co-pays won’t count toward deductibles or out-of-pocket max for the time being. The Medicaid portion of the initiative continues, with states able to apply by July 31, and analysts see the move as buying time to reassess BALANCE while keeping access available for beneficiaries.

via Axios|
#balance#glp-1#health
Capitol Hill to grill five health-insurance CEOs over soaring premiums
politics4 months ago

Capitol Hill to grill five health-insurance CEOs over soaring premiums

Five major health insurers’ CEOs (UnitedHealth Group, CVS Health, Cigna Health, Elevance Health, and Ascension) are set to testify before House Energy and Commerce and Ways and Means committees as Republicans blame rising premiums on the system and the expiration of enhanced ACA subsidies; with no quick fix in sight and Congress stalled on extending subsidies, the hearings will probe root causes of higher costs, including the ACA’s impact, while insurers argue premiums reflect overall care costs and provider prices rather than their pricing alone, and Trump’s plan is not the focus of this round.

via NBC News|
#aca-subsidies#congress#healthcare
Medicare Advantage 2026 Ratings: Winners, Losers, and Industry Insights
healthcare7 months ago

Medicare Advantage 2026 Ratings: Winners, Losers, and Industry Insights

The 2026 Medicare Advantage star ratings remained stable overall, with some insurers like Elevance and Centene improving, while others like Humana and Aetna saw declines. Clover Health experienced a significant drop below 4 stars, potentially impacting its earnings. The ratings influence insurer revenues and strategies, with some plans adjusting their offerings to maintain or improve their scores amid regulatory and market pressures.

via Healthcare Dive|
#2026#healthcare#healthcare-quality
Insurers' Stance on Kids' Vaccine Coverage Without Government Recommendations
health10 months ago

Insurers' Stance on Kids' Vaccine Coverage Without Government Recommendations

Major insurers are uncertain about whether they will continue to cover childhood vaccines if the CDC's Advisory Committee on Immunization Practices (ACIP) stops recommending certain vaccines, following a recent review of the vaccination schedule and changes in committee membership led by Robert F. Kennedy Jr. Only Blue Shield of California confirmed it would maintain coverage, while others are monitoring the situation. The review and political shifts have raised concerns about the future of vaccine coverage and public health policy.

via WIRED|
#acip#child-immunizations#health
"Harvard Study Reveals Troubling Truth About Florida's Insurance Market"
insurance-market2 years ago

"Harvard Study Reveals Troubling Truth About Florida's Insurance Market"

A recent study led by researchers at Harvard University, Columbia University, and the Federal Reserve Board warns that smaller, lower-quality insurers are replacing major private home insurers that have left Florida, leading to a crisis in the state's home insurance sector. These new insurers are found to be less financially stable and may not meet the minimum requirements set by government guidelines. The exodus of bigger private companies from high-risk areas in Florida has led to a reliance on approximately 50 small insurers, all rated by a single company, Demotech Inc., whose ratings differ significantly from those of other rating agencies. The situation has been exacerbated by factors such as excessive litigation, widespread fraud, and the increased risk of severe weather events due to climate change.

via Newsweek|
#financial-stability#florida#insurance
"Uncovering Hidden Fees: How Insurance Companies Profit at Patients' Expense"
health-insurance2 years ago

"Uncovering Hidden Fees: How Insurance Companies Profit at Patients' Expense"

A little-known data firm called MultiPlan helps health insurers maximize profits by negotiating lower payments for out-of-network claims, leaving patients responsible for the remaining balance. This practice has resulted in patients receiving unexpected bills amounting to tens of thousands of dollars, despite having insurance coverage. MultiPlan and insurers typically receive a percentage of the "savings" on each claim, creating a financial incentive to recommend lower payments. Confidential pricing and fee data, as well as insurance statements, have shed light on the extent of these hidden fees and the impact on patients.

via The New York Times|
#health-insurance#hidden-fees#insurers
"California's Wildfires: Can Insurance Commissioner Ricardo Lara Attract Insurers with a New Plan?"
insurance2 years ago

"California's Wildfires: Can Insurance Commissioner Ricardo Lara Attract Insurers with a New Plan?"

California's Insurance Commissioner, Ricardo Lara, is facing the challenge of luring insurers back to the state after major companies like Allstate, Star Farm, and Farmers Insurance limited or stopped coverage due to the growing risk of wildfires. Lara's plan involves requiring insurers to write policies in fire-prone areas in exchange for faster decisions on rate requests. However, insurers may demand rate increases of up to 40% to accommodate the higher risk. The situation reflects a business model unprepared for environmental disasters, leaving homeowners in a difficult position.

via KTLA Los Angeles|
#california#climate-change#insurance
Insurer Restrictions Cause Delays for US Diabetes Patients Seeking Ozempic
healthcare2 years ago

Insurer Restrictions Cause Delays for US Diabetes Patients Seeking Ozempic

Some patients with type 2 diabetes in the US are facing difficulties in getting reimbursed for drugs like Ozempic as insurers tighten coverage restrictions to discourage doctors from prescribing the medication for weight loss. This trend has led to a decline in US prescriptions, causing delays and disruptions for diabetes patients. Insurers are implementing prior authorization requirements, forcing patients to try other drugs before being allowed to access newer medications. The high cost of these medications and the paperwork burden on physicians are additional challenges. Patients and doctors are preparing for potential changes in coverage terms in January.

via Yahoo News|
#diabetes#glp-1-drugs#healthcare
Insurers' Tightened Coverage of Ozempic Causes Delays for US Diabetes Patients
healthcare2 years ago

Insurers' Tightened Coverage of Ozempic Causes Delays for US Diabetes Patients

Some patients with type 2 diabetes in the US are facing difficulties in getting reimbursed for drugs like Ozempic as insurers tighten coverage restrictions to discourage doctors from prescribing the medication for weight loss. This trend has led to a recent decline in US prescriptions, causing delays and disruptions for diabetes patients. Insurers are implementing prior authorization requirements, forcing patients to try other drugs before being allowed to access newer medications. The average number of weekly Ozempic prescriptions has dropped by over 6% since the third quarter of this year. Patients and doctors are preparing for changes in coverage terms in January, which may further impact access to these medications.

via Reuters|
#diabetes#glp-1-drugs#healthcare