ACHP Urges “Better Of” Approach for Star Year 2027
In a letter sent to the Centers for Medicare and Medicaid Services (CMS), the Alliance of Community Health Plans (ACHP) requested that CMS continue its hold harmless methodology for 2027 Medicare Advantage (MA) Star Ratings.
The non-profit plan trade group asked that CMS calculate the “better of” the 2025 measurement year original ratings and a version that removes measures affected by Clover Health’s litigation.
The letter appears purposefully ambiguous on what the second scenario would be – CMS’ view used in SY 2026 or other possibilities that could result from lawsuits. Overall, the proposal makes sense.
Additional article: https://achp.org/wp-content/uploads/ACHP-re-Clover-Litigation_Request-to-Apply-the-2026-Hold-Harmless-Methodology-to-the-2027-Medicare-Advantage-Star-Ratings_July-27-2026.pdf
#medicareadvantage #stars #quality #cms
Centene Reports Q2 Results, Raises Guidance
Centene reported $1.1 billion in profit for Q2 2026 compared with a loss a year ago. First half 2026 profits were $2.6 billion, compared with 1H 2025’s $1.05 billion. Revenues in Q2 2026 were $53.6 billion, up from $48.7 billion in Q2 2025. Centene is continuing to focus on margin restoration in their overall business, but especially the Exchanges. Centene also announced that its individual coverage health reimbursement arrangement (ICHRA) business has grown to around 50,000 members, two and a half times larger than a year ago.
In other news, UnitedHealth Group reported on July 16 strong Q2 2026 results, with $112.0 billion in revenue, with $5.48 billion in net income.
Additional articles: https://www.fiercehealthcare.com/payers/centene-boosts-2026-guidance-it-posts-11b-q2-profit and https://www.healthcaredive.com/news/centene-cnc-q2-2026-guidance-hike-aca-medicaid/826286/ and https://www.beckerspayer.com/payer/ichra/centenes-ichra-membership-hits-50000/ and https://www.modernhealthcare.com/insurance/mh-centene-earnings-guidance-outlook-2026/
(Some articles may require a subscription.)
#healthplans #margins #centene
Premium Stabilization in PDP Will Expire
The Medicare Part D Premium Stabilization Demonstration will end next year, a risky move as midterms are a few weeks after open enrollment season begins in Medicare. The Centers for Medicare and Medicaid Services (CMS) conducted the demonstration in 2025 and 2026 after the Biden administration and a Democratic Congress pushed through some misguided program changes in Part D in 2022. We shall see if premiums will surge or not. More to come on this issue for sure.
(Some articles may require a subscription.)
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-cms-medicare-part-d-subsidy-expire/
#medicare #partd #medicareadvantage #pdp
Wakely Sees Increasing Risks In Exchange
A Wakely analysis says early 2026 data show that individual market enrollment declined 12.0% while normalized relative risk increased 6.3% compared with the same period in 2025. Wakely says healthier members may be leaving the market once enhanced premium tax credits expired and premiums rose. Major disenrollments are also occurring due to affordability issues as the months go by in 2026.
#exchanges #coverage #affordability
https://www.wakely.com/blog/emerging-2026-aca-data-enrollment-drops-12-as-relative-risk-rises-6-3/
— Marc S. Ryan
