Insurance & Payors
Expert articles and analysis related to insurance & payors.
AI Summary â Last 7 Days
In the past week, tensions regarding care accessibility have intensified, particularly with rising concerns over prior authorization processes that may disrupt patient care, as seen in a Massachusetts case where approvals delayed necessary prescriptions. Concurrently, the Trump administration's health leadership, including HHS Secretary Robert F. Kennedy Jr. and CMS, has faced mounting pressure to address the financial strain on older adults due to the expiration of enhanced ACA premium tax credits, which disproportionately affects those aged 50 to 64. Notably, these issues are compounded by the rising costs associated with hospital care in the ACA market, as reported by Aetna, which has prompted discussions around the effectiveness and pricing strategies of commercial payers, impacting overall care delivery models in value-based care systems.
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How Will the Loss of Enhanced Premium Tax Credits Affect Older Adults?
Adults ages 50 to 64 are disproportionately affected by the expiration of ACA enhanced premium tax credits because they make up a large number of Marketplace enrollees and premiums rise with age. Our ...
Even Patients Are Shocked by the Prices Their Insurers Will Pay â And It Costs All of Us
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To Avoid Care Disruptions, Know When the Clock Runs Out on Your Prior Authorization
A Massachusetts woman knew the medicine her doctor prescribed required preauthorization, but she didnât realize the approval had an expiration date. It took nearly three weeks of phone calls and paper...
âKind of Morbidâ: Health Premiums Threaten Their Nest Egg. A Terminal Diagnosis May Spare It.
Chaz and Jean Franklin were facing a sevenfold increase in their health premium payments with the expiration of enhanced federal subsidies for Affordable Care Act plans at the end of 2025. Then Jean r...
New York secures more than $2.5 million from EmblemHealth over ghost networks
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Real world experience with insurers pushing back on copay cards
As reported by Kaiser Health News: The value of drugmakersâ copay cards has become more unpredictable as insurers try to restrict their use. Many insurance plans, for instance, do not count the money ...
Hasta los pacientes se sorprenden por los precios que sus aseguradoras estĂĄn dispuestas a pagar, un costo que al final pagamos todos
La inflación médica ha superado de manera constante la inflación general durante años, y las facturas de muchos procedimientos breves y de rutina llegan a decenas de miles de dólares.
STAT+: Aetnaâs ACA hospital prices, and a new Cigna deal
The health insurer paid higher prices for hospital care than some rivals in the ACA insurance market.
5 studies scaring ASC leaders
From widening commercial price gaps and declining Medicare surgeon pay, five studies are raising questions about the financial and structural pressures facing ASCs. The studies quantify shrinking sur...