Payer: Page 2
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CMS issues guidance on Medicaid provider tax overhaul
The agency has started to lay out how it’ll implement restrictions on the arrangements, which are used by states to finance their share of Medicaid funding, enacted in the One Big Beautiful Bill Act.
By Emily Olsen • Nov. 17, 2025 -
Courtesy of UnitedHealth Group
Optum Health names new CEO
Krista Nelson replaces Dr. Patrick Conway, who was appointed as CEO of UnitedHealth’s healthcare delivery unit in June. Conway will stay on as CEO of the company’s broader health services division.
By Susanna Vogel • Nov. 17, 2025 -
Explore the Trendline➔
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TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
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Medicare premiums set to rise 10% next year, CMS says
The Part B premium hike could have been worse, the Trump administration said. Still, it’s likely to pressure the pocketbooks of millions of seniors, and could drive more into Medicare Advantage plans.
By Rebecca Pifer • Nov. 17, 2025 -
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Sponsored by ZelisHow health plans can boost Star Ratings with smarter member engagement
Struggling with Star Ratings? Discover how smarter engagement can turn scores around.
Nov. 17, 2025 -
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Historic government shutdown ends, leaving ACA subsidies in limbo
The House passed a stopgap funding bill and President Donald Trump signed it late Wednesday, reopening the government without a clear path forward on preserving enhanced subsidies for ACA plans — Democrats’ chief demand.
By Rebecca Pifer • Nov. 13, 2025 -
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Health insurers in government programs can’t seem to turn a profit
Major payers with a presence in the ACA, Medicare or Medicaid posted an average operating margin of -1.4% in the third quarter. The market “continues to be challenging,” complicating margin recovery plans, one expert said.
By Rebecca Pifer • Nov. 12, 2025 -
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Democrats introduce bill to repeal Medicare prior authorization pilot
Lawmakers argue the CMS innovation center pilot, which will implement AI-backed prior authorization for some services in six states, will add red tape and limit access to care.
By Emily Olsen • Nov. 10, 2025 -
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Congress inches towards ending shutdown with no extension of ACA subsidies
The Senate overcame a key procedural hurdle on Sunday after eight Democrats broke with their party to back a measure freeing the government from the longest funding lapse in history.
By Rebecca Pifer • Nov. 10, 2025 -
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Sponsored by ZelisHow flexible technology is redefining healthcare compliance
Composable tech is transforming healthcare—faster compliance, smarter savings, scalable growth.
By Serkan Kutan, Chief Technology Officer, Price Optimization, at Zelis • Nov. 10, 2025 -
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CMMI to launch model to lower Medicaid drug spending
Under the model, set to start next year, the CMS will negotiate lower prices for Medicaid programs linked to those paid in select other countries.
By Emily Olsen • Nov. 7, 2025 -
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Novo, Lilly cut deal with Trump to lower prices of obesity drugs
The agreement will make Wegovy and Zepbound available to some Medicare enrollees for $245 per month, and starter doses of pill versions, once approved, for $149 monthly.
By Jonathan Gardner • Nov. 6, 2025 -
Alamy
Cigna’s new chief medical officer starts as other execs depart the company
Dr. Amy Flaster, Cigna Healthcare’s chief medical officer since last year, is stepping up as CMO of the whole enterprise. At the same time, Cigna’s chief health officer and a business improvement executive are hitting the road.
By Rebecca Pifer • Nov. 6, 2025 -
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Humana confident in Medicare Advantage growth despite plan generosity muddling margin recovery
The Medicare giant likes what it’s seen in the first two weeks of open enrollment. But there are steps it can take if membership growth starts getting out of hand, executives said.
By Rebecca Pifer • Nov. 5, 2025 -
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Legislators object to proposed CMS payment changes for diabetes tech
In a letter to CMS Administrator Dr. Mehmet Oz, diabetes caucus leaders raised concerns that the agency’s proposals will reduce access to glucose monitors and insulin pumps.
By Elise Reuter • Nov. 4, 2025 -
Alamy
UnitedHealthcare pays Optum doctors more than other doctors: study
Researchers said the results suggest UnitedHealth may be sidestepping government rules meant to keep a lid on exorbitant payer profits. UnitedHealth said the study was “flat-out wrong.”
By Rebecca Pifer • Nov. 4, 2025 -
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Health groups urge passage of bill to ease Medicare pay cuts for tests
More than 30 organizations, including AdvaMed and the American Clinical Laboratory Association, are pushing for a permanent legislative solution to stop looming Medicare payment cuts for diagnostic tests.
By Susan Kelly • Nov. 3, 2025 -
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Medicare finalizes controversial cut to specialty care next year
The CMS finalized the Medicare physician fee schedule for 2026 on Friday, one day before the statutory deadline. It includes an overall payment hike and a few policies that are deeply unpopular with specialists.
By Rebecca Pifer • Updated Nov. 4, 2025 -
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Federal ACA enrollment kicks off without action on subsidies
Millions of Americans are facing steep price hikes for Affordable Care Act coverage while Congress dithers over the issue. Experts say there’s not as much time to act as legislators may believe.
By Rebecca Pifer • Nov. 1, 2025 -
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Cigna’s 2026 pharmacy profits could be dampened by transition to rebate-free model
Overall, Cigna expects earnings to grow next year after posting a solid third quarter. But investments in a new PBM model and discounted contracts for some big clients could lower Express Scripts’ profitability, executives said.
By Rebecca Pifer • Oct. 30, 2025 -
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Voters blame insurers for medical debt: poll
More than 60% of respondents said insurance companies are most at fault for medical debt, compared with just 9% who blamed hospitals, according to a survey by nonprofit Undue Medical Debt.
By Emily Olsen • Oct. 29, 2025 -
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CVS hikes 2025 guidance despite goodwill impairment charge on healthcare delivery
The healthcare giant beat Wall Street expectations in the third quarter, but reported a net loss after recording a $5.7 billion charge linked primarily to decelerating clinic growth at Oak Street Health.
By Emily Olsen • Oct. 29, 2025 -
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Centene posts $6.6B loss on massive value writedown
The goodwill impairment charge is meant to realign Centene’s value on its own books with its value in the market, which has plummeted this year. Still, Centene upped its earnings outlook for 2025.
By Rebecca Pifer • Oct. 29, 2025 -
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National payers OK on price transparency compliance: Turquoise Health
The company has started to score insurers on their success in making rate data available online. Large payers tend to do better than their smaller peers.
By Rebecca Pifer • Oct. 29, 2025 -
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UnitedHealth maps path back to Wall Street’s good graces
The healthcare giant beat Wall Street expectations in the third quarter and raised its 2025 earnings guidance, albeit modestly.
By Rebecca Pifer • Oct. 28, 2025 -
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Surprise Billing
High volume of surprise billing disputes are ineligible for arbitration, insurers allege
Plans found 39% of claims submitted to independent dispute resolution last year were actually ineligible for the process, but arbiters themselves caught only 17% of improper cases, according to AHIP and the BCBSA.
By Rebecca Pifer • Oct. 27, 2025
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