Insurance and Payors
Expert articles and analysis related to insurance and payors.
AI Summary — Last 24 Hours
This week, significant tensions emerged in the health insurance landscape as payers increasingly demand results over mere access, particularly in behavioral health, which aligns with ongoing value-based care initiatives. The Medicare Advantage program is in the spotlight as a "dark money" group lobbies for higher payments, raising concerns about financial sustainability amidst estimates that the federal government will overpay these plans by $76 billion this year. Additionally, a new study indicated that hospital adoption of AI-enabled coding is linked to a multibillion-dollar increase in spending, triggering further scrutiny of payer strategies and their impact on costs in a rapidly evolving healthcare ecosystem. These dynamics highlight the need for a careful reassessment of payment models and their implications for ACOs and population health management moving forward. For deeper insights, see Payers Want More than Access and [Feds Will
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Payers, hospitals pan CMS' plan to bring non-network plans to ACA exchanges
Payers, hospitals pan CMS' plan to bring non-network plans to ACA exchanges  Fierce Healthcare
Evidence Shows ACA’s Mandated Benefits Alone Don’t Drive Up Costs. The Debate Continues.
The Affordable Care Act put in place a package of benefits that health insurance plans must cover. Critics contend this mandate has jacked up premiums. Evidence supporting that claim is mixed.
LT-Congress-ACAPremiumTaxCredits-091525.pdf - American Academy of Family Physicians | AAFP
LT-Congress-ACAPremiumTaxCredits-091525.pdf  American Academy of Family Physicians | AAFP
Coalition ad spotlights harmful corporate insurer policies driving up health care costs
Coalition ad spotlights harmful corporate insurer policies driving up health care costs  American Hospital Association
Quiz – How Well Do You Understand Your Health Insurance – Frameless
Health insurance is often complicated, but understanding the basics helps you make better decisions about your coverage and care. This 10-question quiz touches on some terms you may encounter.
New Investigation Underscores How Provider-Driven Abuse of No Surprises Act ‘Raises Costs for Everyone’
New Investigation Underscores How Provider-Driven Abuse of No Surprises Act ‘Raises Costs for Everyone’  AHIP
Study Suggests Wide Variation in Access to Primary Care Among Medicare Beneficiaries Living in Urban Locations
Health insurance bankruptcies ticked up in 2025
Health insurance bankruptcies ticked up in 2025Â Â Modern Healthcare
STAT+: How a Texas couple is getting rich off out-of-network medical bills
STAT investigates how a Texas couple cashed in on a new law that's supposed to protect patients from surprise medical bills.
Elevance Health drops as CMS threatens to block enrollment in Medicare drug plans
Elevance Health drops as CMS threatens to block enrollment in Medicare drug plans  MSN