Payer: Page 3

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    Humana could end 2026 as the largest Medicare Advantage insurer

    Humana is nabbing MA members while UnitedHealthcare sheds lives. That leaves the companies neck and neck when it comes to MA enrollment, though Humana’s growth is a gamble at a time of elevated medical spending.

    By • Feb. 11, 2026
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    Cigna to lay off 2,000 workers worldwide

    Cigna’s layoffs follow other recent downsizing announcements from health insurers looking to cut costs during an era of heightened medical spending.

    By • Feb. 10, 2026
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    CMS proposes sweeping ACA exchange rule

    The CMS said the regulation should remove barriers to more affordable health plans like catastrophic coverage, as enrollment on the exchanges falls following the expiration of stronger financial assistance. 

    By • Feb. 10, 2026
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    CVS holds 2026 guidance steady as turnaround plan bears fruit

    The healthcare giant outperformed to close out 2025, and expects its finances to improve further this year. Still, proposed Medicare Advantage rates could be an issue moving forward.

    By • Feb. 10, 2026
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    Centene swings to loss but predicts stabilization in 2026

    Centene outperformed in the fourth quarter, while predicting earnings growth in 2026 — a rarity among managed care companies’ generally dour outlooks.

    By • Feb. 6, 2026
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    Cigna posts ‘low-drama’ fourth quarter following major FTC settlement

    Cigna is hoping the settlement it reached with regulators paired with recent legislation will mollify calls to reform PBMs — without affecting Express Scripts’ profitability.

    By • Feb. 5, 2026
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    Express Scripts reaches ‘landmark’ settlement with FTC in insulin suit

    The agreement includes sweeping changes for Cigna’s PBM, including no longer preferring expensive drugs over cheaper equivalents on standard formularies and reshoring its controversial rebate aggregator.

    By • Updated Feb. 4, 2026
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    One-quarter of Medicaid doctors don’t actually treat Medicaid patients: study

    The new research published in Health Affairs adds to concerns about low physician participation in the safety-net insurance program, especially among mental health practitioners.

    By • Feb. 4, 2026
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    Trump signs funding bill with PBM reforms, hospital-at-home and telehealth extensions

    The funding package ends a partial government shutdown and enacts several healthcare policies, including preserving telehealth flexibilities in Medicare through 2027.

    By • Feb. 4, 2026
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    Genetic testing takes greater share of Medicare Part B test spending: OIG

    Spending on the tests, which analyze genetic material from both people and pathogens, rose 20% year over year in 2024, the analysis found.

    By Susan Kelly • Feb. 4, 2026
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    CMS presses ahead on accelerated Medicare Advantage audits

    The agency quietly released a memo updating MA plans on how it’s approaching risk adjustment data validation audits after a Texas judge’s ruling last year threw the expanded reviews into doubt.

    By • Feb. 4, 2026
  • A tan and black monument sign with bold orange "Optum" lettering and the address "11000 Optum Circle" sits on a grassy lawn with low shrubs in front of a large, modern office building with glass windows and beige panels. Bare trees and a cloudy sky are in the background.
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    Prices rise at surgery centers acquired by Optum: study

    The full financial impact of the price hikes could exceed $67 million each year in two dozen markets, according to the new study published in Health Affairs.

    By • Feb. 3, 2026
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    Medicare Advantage prior authorization requests rise in 2024: report

    Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Almost 8% of those requests were partially or fully denied.

    By • Feb. 3, 2026
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    Humana deploys AI support tool for call centers

    Agent Assist, developed with Google Cloud, summarizes conversations between workers and beneficiaries while highlighting relevant information, like enrollees’ benefit and eligibility details.

    By • Feb. 3, 2026
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    Telehealth flexibilities, hospital-at-home waivers lapse amid partial government shutdown

    The Senate passed a spending package Friday, but the measure is still awaiting House approval. House Speaker Mike Johnson said the partial shutdown should be brief.

    By • Feb. 2, 2026
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    Sponsored by Elavon

    As self-pay increases, healthcare leaders look to retail for inspiration

    Rising costs, low reimbursement, and staffing shortages challenge small medical practices. Learning from the retail industry can help them stay profitable.

    Feb. 2, 2026
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    CMS finalizes rule cracking down on Medicaid provider taxes

    The rule puts limits on states levying higher taxes on Medicaid businesses. The CMS argues the tax arrangements allow states to shift costs onto the federal government, but providers say they’re integral for covering the cost of care.

    By • Jan. 30, 2026
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    Healthcare industry outlook for 2026: Providers, insurers, IT companies look to stability

    Companies are hoping to reshore finances and double down on efficiency initiatives this year as several policy sea changes threaten to upend the industry.

    By Healthcare Dive staff • Jan. 30, 2026
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    Labor Department wants to strong-arm PBMs into being more transparent with employers

    The DOL proposed a rule that would force pharmacy benefit managers to share a broad range of pricing and compensation information with their employer clients, calling it the most significant proposed PBM reform in decades.

    By • Jan. 30, 2026
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    Opinion

    The healthcare claims system is ready for transformation. Here are 5 ways to prepare in 2026.

    Artificial intelligence could rework the claims and reimbursement process, allowing faster decision-making, reduced errors and billions in savings, according to an Optum executive.

    By Puneet Maheshwari • Jan. 29, 2026
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    Medicaid contractors strike deals with CMS to help states execute work requirements

    Ten Medicaid systems vendors have agreed to provide low- or no-cost services to states over the next two years. The Trump administration said the agreements would save $600 million.

    By • Jan. 29, 2026
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    ACA enrollment backslides to 23M in 2026

    That’s down 5% from last year. But it’s not the nosedive some market watchers predicted, and a handful of states — notably, Texas — saw robust growth.

    By • Jan. 28, 2026
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    Deep Dive

    Health insurers brace for impact in 2026

    Profits will start to tick up after reaching trough levels. Washington will play nice. M&A and AI adoption will accelerate. We asked experts to look into their crystal balls on what the coming year means for a beleaguered industry.

    By • Jan. 28, 2026
  • A sign reading 'Elevance Health 220 Virginia Ave' in front of a large office complex on a clear day.
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    Elevance expects lower revenue, earnings, membership in 2026

    This year should see improvements in Medicare Advantage and Affordable Care Act plans but continued pressure in Medicaid, Elevance executives warned investors.

    By • Jan. 28, 2026
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    CMS official defends flat Medicare Advantage rate proposal for 2027

    Medicare director Chris Klomp said the Trump administration is “massively” in support of MA as health insurers cry foul over the meager rate update.

    By • Jan. 27, 2026