Payer: Page 3
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Half of large employers plan to shift health plan costs onto employees: Mercer
Employers are looking for ways to manage costs, cover popular weight loss drugs and offer well-being and mental health options.
By Carolyn Crist • July 23, 2025 -
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10M people will lose insurance due to GOP policy law: CBO
The final tally from the nonpartisan budget scorekeeper estimates the law will decrease federal healthcare spending by $1.1 trillion over the next decade.
By Emily Olsen • July 23, 2025 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
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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ACA health plan premiums could spike in 2026: report
Insurers are requesting a median premium increase of 15% for 2026 as they grapple with policy uncertainty for plans on the exchanges, according to an analysis from KFF and the Peterson Center on Healthcare.
By Emily Olsen • July 22, 2025 -
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Humana refiles Medicare Advantage star ratings suit
Humana is taking a second bite at the apple to improve its sunken MA stars, filing an edited complaint with a Texas court on Monday. The insurer also announced plans to pare back its prior authorization policies.
By Rebecca Pifer • July 22, 2025 -
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States sue Trump administration over ACA eligibility, enrollment rule
The lawsuit argues the rule would drive up the number of uninsured and saddle states with increased healthcare expenses.
By Emily Olsen • July 21, 2025 -
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Sponsored by VeradigmThe next evolution of provider engagement: Why workflow integration matters
Discover how workflow integration is reshaping provider engagement and improving patient outcomes.
By Veradigm • July 21, 2025 -
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Civil monetary penalties against Medicare Advantage, Medicare drug plans rising, CMS data shows
Civil monetary penalties against payers for improperly delaying or denying coverage, hitting members with higher cost sharing than allowed and other issues have already surpassed $3 million this year.
By Rebecca Pifer • July 18, 2025 -
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Judge dismisses Humana’s Medicare Advantage star ratings suit
It’s a significant loss for the insurer, which sued the government late last year after its star ratings plummeted for 2025. Analysts estimate Humana could lose billions of dollars as a result of the decision.
By Rebecca Pifer • Updated July 18, 2025 -
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Trump administration to end Medicaid waivers for continuous enrollment, workforce training
On Thursday, CMS sent letters to states notifying them that it doesn’t plan to approve any new such waivers or extend existing ones in the administration’s latest curtailing of Medicaid.
By Rebecca Pifer • July 18, 2025 -
Permission granted by Elevance Health
Elevance cuts 2025 guidance as profit falls from higher ACA, Medicaid costs
The insurer attempted to reassure investors that it can operate through looming policy changes that appear set to worsen existing challenges. It was unsuccessful: Elevance’s stock fell 11% following the second quarter results.
By Rebecca Pifer • July 17, 2025 -
Ned Pagliarulo/Healthcare Dive
33 states pick up CMS program to pay for sickle cell gene therapies
States representing about 84% of Medicaid beneficiaries are participating in an initiative that enables the government to negotiate pay-for-performance deals with the manufacturers of products like Casgevy and Lyfgenia.
By Ben Fidler • July 16, 2025 -
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Medicaid cuts could have ‘far-reaching’ healthcare, economic impacts: study
Coverage losses linked to the massive tax and policy law could drive up excess deaths and preventable hospitalizations by 2034, according to the study in JAMA Health Forum.
By Emily Olsen • July 16, 2025 -
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CVS beats out UnitedHealth for CalPERS pharmacy benefits contract
The contract, though sizable, is likely immaterial to CVS’ earnings. But it moves the company in a positive direction as it struggles with recent challenges, an analyst said.
By Rebecca Pifer • July 16, 2025 -
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Medicare targets site neutrality, price transparency in hospital outpatient rule
The proposed rule would send an additional $8 billion to hospitals next year, but includes a number of other policies hospital groups have criticized.
By Sydney Halleman , Emily Olsen • July 16, 2025 -
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Most Medicare Advantage markets controlled by few insurers: KFF
UnitedHealthcare or Humana had the largest market share in two-thirds of U.S. counties, making up nearly 60% of total MA enrollment last year.
By Emily Olsen • July 15, 2025 -
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CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,’ MACRA
The sweeping regulation proposes notable changes to how Medicare pays physicians, but overall results in a modest bump to reimbursement in 2026.
By Rebecca Pifer • July 15, 2025 -
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Alignment Healthcare wins partial victory in Medicare Advantage star ratings case
A judge agreed that the CMS should recalculate the scores for one Alignment plan in Arizona. Now, all of the insurer’s MA members are in plans rated four stars or higher.
By Rebecca Pifer • July 10, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth names new chief of government programs, Medicaid unit
Longtime insurance executive Mike Cotton will helm the company’s Medicaid division, while Bobby Hunter is stepping up as CEO of government programs.
By Rebecca Pifer • July 10, 2025 -
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Insurer ownership of U.S. primary care practices is small but growing: study
The first-of-its-kind research suggests vertical consolidation is being driven by plans wanting to direct more Medicare Advantage members to in-house clinics.
By Rebecca Pifer • July 9, 2025 -
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CVS Omnicare ordered to pay $949 million in government fraud case
CVS plans to appeal the judgment, which comes after a jury ruled that its long-term care pharmacy benefits manager illegally charged Medicare, Medicaid and Tricare for prescription drugs for almost a decade.
By Rebecca Pifer • July 9, 2025 -
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Judge temporarily blocks megabill’s Planned Parenthood Medicaid funding ban
The restraining order prevents the Trump administration from enacting a provision of the massive tax and policy law that would cut Medicaid funding for Planned Parenthood.
By Emily Olsen • July 8, 2025 -
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Humana agrees to purchase bankrupt Florida provider The Villages Health for $50M
The insurer’s bid is preliminary and kicks off an auction for the debt-laden provider, which decided to pursue bankruptcy after discovering it owed Medicare hundreds of millions of dollars.
By Rebecca Pifer • July 8, 2025 -
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Molina cuts earnings guidance as costs rise in government programs
UnitedHealth and Centene both pulled their outlooks this year over elevated medical spending in Medicare Advantage and the Affordable Care Act respectively. Now, cost pressures are hitting their smaller peer.
By Rebecca Pifer • July 7, 2025 -
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Historic Medicaid cuts to come as Trump signs domestic policy bill
President Donald Trump passed the GOP's tax megabill into law on Friday, setting into motion $1 trillion in Medicaid cuts despite objections from hospitals, doctors, insurers and other stakeholders in the healthcare industry.
By Emily Olsen • July 4, 2025 -
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Optum Rx slashes reauthorization requirements for more drugs
The UnitedHealth-owned pharmacy benefit manager has removed reauthorization requirements for more than 140 drugs so far this year amid what it says is a push to improve patient access to critical medications.
By Susanna Vogel • July 2, 2025
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