CMS proposes excluding chart reviews from MA risk scoring in 2027 payment rule

The proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses. Regulators also proposed a flat rate update for 2027, prompting anger from insurers.

By Rebecca Pifer Parduhn • Jan. 27, 2026

UnitedHealth revenue climbs in 2025, though profit continues to fall

The healthcare behemoth posted its lowest profits since 2018 last year, largely thanks to continued Medicare Advantage challenges. Executives warned how regulators’ “disappointing” rate update might further contract MA.

By Rebecca Pifer Parduhn • Jan. 27, 2026

No Surprises disputes increasing even as arbiters catch up, CMS says

The agency released new data on independent dispute resolution in the first half of 2025. Roughly 1.2 million cases were filed in that period, mostly by the same private equity-backed providers.

By Rebecca Pifer Parduhn • Jan. 26, 2026

CVS accused of shutting out rival pharmacy hubs in House Judiciary investigation

The company’s massive pharmacy benefit manager changed its rules and weaponized audits to ensure independent pharmacies couldn’t work with competing pharmacy service companies, House Republicans said.

By Rebecca Pifer Parduhn • Jan. 26, 2026

The case for transparent pricing: Making pharmacy benefits work for health plans

CVS Caremark TrueCost® is the industry’s first pricing model that gives insight into drug-level costs.

By CVS Caremark • Jan. 26, 2026

Why cover GLP-1s? They’ll lower employer healthcare costs, study says

While the medications may be pricey, a multi-year study by Aon found consistent use correlates with lower medical cost growth and fewer hospitalizations for cardiovascular events.

By Caroline Colvin • Jan. 23, 2026

Insurance CEOs’ no good, very bad day on the Hill

The chief executives of UnitedHealth, CVS, Cigna and Elevance were pilloried for care denials, vertical consolidation and sky-high executive compensation during two House hearings Thursday.

By Rebecca Pifer Parduhn • Jan. 23, 2026

Express Scripts considering settlement in FTC insulin price lawsuit

The antitrust agency paused its lawsuit against the pharmacy benefit manager while the two discuss a proposed consent agreement.

By Emily Olsen • Jan. 23, 2026

Small business health insurance coverage at risk as costs rise, EBRI finds

Even as overall employer-based coverage increased in the U.S., small companies pulled back.

By Ginger Christ • Jan. 22, 2026

Congress eyes tackling healthcare consolidation

“I think there’s common ground here,” one Republican congressman said during a House Budget Committee hearing. Squaring up against healthcare monopolies would be a major pivot for the GOP.

By Rebecca Pifer Parduhn • Jan. 22, 2026

UnitedHealth pledges to return ACA profits to customers

The announcement came one day before CEO Stephen Hemsley testified on healthcare affordability in front of two congressional committees.

By Rebecca Pifer Parduhn • Jan. 21, 2026

Healthcare False Claims settlements reached record $5.7B in 2025

The healthcare fraud settlements under the False Claims Act last year more than tripled the amount from 2024.

By Sydney Halleman • Jan. 21, 2026

Medicare Advantage overpayments will total $76B this year: MedPAC

The findings are “very depressing,” one commissioner said. Still, it’s a smaller sum than in 2025, thanks to the continued phase-in of a new risk adjustment model.

By Rebecca Pifer Parduhn • Jan. 16, 2026

MedPAC steps away from advocating doctor pay be tied to inflation

The advisory group wants Congress to approve a 0.5 percentage point increase for doctors in Medicare next year. But some commissioners dissented over MedPAC’s about-face on underlying payment reform.

By Rebecca Pifer Parduhn • Jan. 16, 2026

Trump unveils healthcare affordability plan

The “Great Healthcare Plan” is vague, but would send money directly to ACA enrollees and entrench Trump’s drug pricing deals.

By Rebecca Pifer Parduhn • Jan. 15, 2026

Kaiser affiliates to pay $556M to resolve Medicare Advantage fraud allegations

The Justice Department claims some Kaiser health plans submitted invalid diagnostic codes to reap higher reimbursement from Medicare. It’s the largest settlement linked to MA upcoding to date, according to one law firm.

By Sydney Halleman • Jan. 15, 2026

Utilization, intensity drove US health spending to $5.3T in 2024: CMS

The U.S. spent 7.2% more on healthcare in 2024. Most of the acceleration was because of greater use and intensity of medical goods and services, not growth in healthcare prices, CMS actuaries said.

By Rebecca Pifer Parduhn • Jan. 14, 2026

UnitedHealthcare to pilot accelerated MA payments to rural hospitals

The insurer will cut its MA payment timelines in half for select providers in Oklahoma, Idaho, Minnesota and Missouri in an effort to provide relief to rural hospitals.

By Sydney Halleman • Jan. 14, 2026

Lilly, Novo test direct-to-employer approach that could cut out PBMs and lower costs

The GLP-1 giants are the first to try out this new model, but more companies may follow. 

By Kelly Bilodeau • Jan. 14, 2026

ACA signups lag as enrollment deadline nears

Some 22.8 million people have signed up for Affordable Care Act plans through early January, slower than last year’s pace but more robust than some experts predicted. Still, the CMS data paints an incomplete picture of the market.

By Rebecca Pifer Parduhn • Jan. 13, 2026

UnitedHealth ‘aggressively’ gaming Medicare Advantage, Senate investigation finds

Staffers for Sen. Chuck Grassley, R-Iowa, dove into 50,000 pages of documentation from UnitedHealth for the new report, which accuses the company of maintaining a workforce dedicated to upcoding.

By Rebecca Pifer Parduhn • Jan. 12, 2026

Powerful PBM lobby names new CEO

David Marin will become president and chief executive of the Pharmaceutical Care Management Association effective Jan. 30.

By Rebecca Pifer Parduhn • Jan. 9, 2026

House votes to revive enhanced ACA subsidies

The House voted 230-196 to extend the financial assistance, which lapsed on Dec. 31, for three years. The measure is not expected to pass the Senate.

By Rebecca Pifer Parduhn • Jan. 8, 2026

UnitedHealthcare raises bar for doctors to get paid for radiology services

The change runs counter to the company’s broader efforts to pare back red tape for physicians amid widespread discontent with health insurers.

By Rebecca Pifer Parduhn • Updated Jan. 9, 2026

Time’s up: Enhanced ACA subsidies expire

The expanded tax credits are officially dead after lawmakers failed to secure an extension before the end-of-year deadline. There’s still a chance, though a small one, that they could come back in 2026.

By Rebecca Pifer Parduhn • Jan. 1, 2026