Non-Network Plans Could Thrive
Non-network plans have been approved as qualified health plans on the Exchanges under a new rule and a number of prominent healthcare companies, including Sidecar Health, may offer such plans in the future. Non-network plans do not hold contracts or negotiate prices with hospitals and doctors, but outline for enrollees how much they will pay for specific services. Usually, such prices are based on average local prices.
The Trump administration has argued that such plans encourage innovation and lower costs. Opponents argue that such plans will boost costs for other enrollees if such plans end up as benchmark plans in the Exchanges. Further, they say healthier people could be attracted to such plans and increase risk in more comprehensive ones. Last, they also say such plans could end up being expensive for many due to limited benefits.
States do have the choice to approve the offering of such plans on the Exchange in their states. To qualify under the new regulation, non-network plans must demonstrate that a sufficient range of providers accepts the plan’s benefit amount as full payment.
Additional article: https://www.modernhealthcare.com/insurance/mh-cms-aca-exchanges-non-network-plans/
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#exchanges #trump #regulation #healthplans
https://www.beckerspayer.com/payer/aca/non-network-insurer-eyes-aca-exchange-as-cms-clears-the-way/
Jefferson Health Records Loss
Philadelphia-based Jefferson Health recorded an operating loss of $252.6 million through the third quarter of fiscal 2026, compared to an operating loss of $29.3 million during the same period last year.
#healthplans #healthsystems #margins
KFF Issues Two Briefs
Healthcare policy group, KFF published two important issue briefs today. One covers the medical frailty exemption from Medicaid work requirements. The other covers healthcare affordability for those enrolled in Medicare. Many seniors and the disabled have low income and modest savings. Therefore, healthcare costs account for a large share of income.
Additional article: https://www.kff.org/medicaid/medically-frail-exemptions-for-medicaid-work-requirements-key-issues-to-watch-for-in-upcoming-cms-guidance/
#medicaid #medicare #healthcare #affordability
https://www.kff.org/medicare/key-facts-about-health-care-affordability-for-people-with-medicare/
— Marc S. Ryan
