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Insurance articles
A Popular Law Capped What Seniors Pay for Drugs. The Cost Didn't Vanish. Ending This Subsidy Shows Where It Went.
CMS is ending a subsidy that masked a cost the 2022 out-of-pocket cap created. Ending it doesn't remove the cost, it moves it back onto premiums.
A Bank Lost $600,000 to Fraud. Its Insurer Paid $100,000. The Policy Covered All of It.
The insurer agreed the loss was covered, then characterized it into the smaller sublimit. That fight, not a denial, is where most cyber claims get decided.
Iowa Banned Spread Pricing. An Audit Suggests PBMs Just Moved It to a Different Timescale.
A state auditor found one PBM collected about $100 million in back-end value from Iowa Medicaid over three years, through a mechanism the ban didn't anticipate.
Insurers Promised to Fix Prior Authorization. The Fine Print Excludes the Drugs People Depend On.
Insurers pledged 90 days of continuity when patients switch plans. Humana says that pledge doesn't cover drugs, and a patient was hospitalized because of it.
You Can Lose Your ACA Subsidy Without Your Income Changing at All
A verification rule can suspend tax credits over a database mismatch, while the full premium comes due, and it has nothing to do with affordability.
Should Medicaid Pay Your Rent? California Says Yes, and the Waiver Expires This Year
California has spent nearly $12 billion routing Medicaid money into housing and food. Republicans call it waste. The real question is what Medicaid is for.
Medicaid's New Work Rule Doesn't Require Anything of Employers. It Will Still Land on Their HR Desks.
There's no employer mandate in the rule, but the proof enrollees need has to come from payroll, on a 30-day clock.
Medicare Just Proposed Killing an Entire Health-Tech Business Model
CMS's 2027 rule would bar reimbursement for remote patient monitoring by third-party vendors. The fraud was real, but the remedy targets a structure, not a behavior.
Medicare Advantage Denied Their Rehab Care, Then Reversed Almost Every Appeal. That's the Business Model.
Insurers overturned 95% of appealed skilled nursing denials, and 97% of the ones a UnitedHealth AI contractor issued.
U.S. Health Care Spending Will Hit $6 Trillion in 2026. Here's What the Number Hides.
The number that matters is buried in an assumption the government's own actuaries had to make about the recent coverage cuts.
The AMA Owns the Codes Medicare Requires. Two Investigations Want to Know Why.
A doctors' lobby owns the code set Medicare requires and licenses it back to the industry for hundreds of millions a year.
The Spiral Is Not a Prediction. It Is in the Filings.
2027 ACA rate filings show insurers pricing in roughly four points of premium increase purely because the risk pool is getting sicker.
Two Hours a Year, a Thousand Dollars a Month
AI scribes save physicians about two hours a year and generate about $1,004 more revenue per provider per month.
The Subsidy Fight Is an Argument About the Invoice, Not the Bill
Enhanced ACA subsidies lapsed and premiums for subsidized enrollees more than doubled. Congress is fighting over who pays the bill, not why it's so large.
Two Levers, One Direction
UnitedHealth just audited the program regulators are investigating and gave it a 97%. Meanwhile, insurers keep suing their way to better quality scores.