Cities and County Sue Over Exchange Rule
A group of cities and a county are suing the Trump administration over the just-finalized Affordable Care Act (ACA) Exchange rule for 2027. The parties argue that elements of the regulation — such as multi-year catastrophic plans, higher out-of-pocket caps and non-network plans as qualified health plans — are unlawful. The lawsuits say they should not be implemented.
(Article may require a subscription.)
#exchanges #aca #obamacare
https://www.modernhealthcare.com/politics-regulation/mh-hhs-lawsuit-aca-exchange-rule-2027
KFF Covers 2026 MA Enrollment And Benefits
Healthcare policy group KFF has a number of briefers on Medicare Advantage (MA) enrollment and benefits. Some key highlights across the three briefers:
- 55% of Medicare beneficiaries are in MA.
- 23% of MA enrollees are in Special Needs Plans (SNPs).
- The average MA in-network limit is $5,421 in 2026, But nearly one in five enrollees face in-network limits higher than $7,000.
- In 2026, three quarters (75%) of enrollees in individual MA plans with prescription drug coverage pay no premium other than the Medicare Part B premium.
- Nearly all Medicare Advantage enrollees are in plans that offer vision, dental, and hearing benefits, while fewer are offered over-the-counter benefits, meals, remote access technologies, transportation, and bathroom safety devices.
Additional articles: https://www.kff.org/medicare/medicare-advantage-in-2026-enrollment-update-and-key-trends/ and https://www.kff.org/medicare/medicare-advantage-out-of-pocket-limits-variation-and-trends/
#medicareadvantage
Clover MA Star Lawsuit Fallout
A good Modern Healthcare article on the uncertainty created by a federal court ruling throwing out Clover Health’s 2026 Star Ratings. Cover challenged on the grounds that the Centers for Medicare and Medicaid Services (CMS) did not have the authority to include some measures and did not properly notice more. In total, 20 measures included in Star are now in question. See my blog on the topic here: https://www.healthcarelabyrinth.com/clover-wins-lawsuit-and-throws-medicare-advantage-stars-program-into-turmoil/
(Article may require a subscription.)
#stars #quality #cms #medicareadvantage
https://www.modernhealthcare.com/insurance/mh-clover-health-medicare-advantage-star-ratings
— Marc S. Ryan
