Internal CMS Memo Shows Growing Exchange Falloffs
NOTUS obtained an internal Centers for Medicare and Medicaid Services (CMS) memo that says more Americans are dropping out of Exchange coverage than usual. The memo says more than one in five people who enrolled in health insurance through the federal Exchanges during open enrollment and in the weeks following were dropped from coverage for failing to pay their first month’s premium. This rate is significantly higher than the rate from last year, which was 12%.
The administration attributes most of the drop to efforts to root out fraud. That could be some of it, but companies also report dropping enrollment since January due to non-payment. Premiums surged when enhanced subsidies lapsed. This occurred for those subsidized as well as more generally as companies increased rates across the board to mitigate an anticpated increase in risk and surging utilization costs.
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#exchanges #coverage #healthcare
https://www.notus.org/healthcare/aca-healthcare-dropped-insurance-numbers-subsidies
Bill Would Bar PBMs And Pharmacies Owned By Same Entity
A bipartisan group of congressional lawmakers reintroduced a bill aimed at barring companies from owning both a pharmacy benefits manager (PBM) and retail pharmacies. Those that own them now would have to divest. Arkansas has implemented a similar law at the state level. Tennessee just passed a similar bill.
#pbms #pharmacies #healthplans
Plans Stockpiling Cash
Given the tricky healthcare climate and more headwinds to come on the policy and coverage front, a number of health insurance companies are bolstering their reserves. This includes UnitedHealth Group and Elevance Health, among others.
See my blog today on 2025 and Q1 2026 margins of major players: https://www.healthcarelabyrinth.com/health-plans-stocks-soar-so-is-all-well/ .
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#healthplans #margins
https://www.modernhealthcare.com/insurance/mh-unitedhealth-elevance-alignment-reserves-earnings/
— Marc S. Ryan
