Uninsurance Rate Holds Flat in 2025
The Centers for Disease Control and Prevention (CDC) reports that the uninsurance rate remained flat in 2025. This was despite the continuing insurance losses in Medicaid and the Exchanges.
Last year, 28 million or 8.3% of Americans were uninsured – just up 0.1% from 2024. More people are likely to lose coverage due to coming healthcare spending cuts.
#uninsured #healthcare #coverage
https://www.healthcaredive.com/news/uninsurance-rate-steady-2025-cdc/821488/
Elevance Health Gets Another Sanction Reprieve
Elevance Health has gotten yet another reprieve from deep sanctions over its handling of risk adjustment in Medicare Advantage (MA). The Centers for Medicare & Medicaid Services (CMS) said the company has made progress in complying with regulations and must fulfill additional key steps by June 30 or face the sanctions.
Additional article: https://www.fiercehealthcare.com/payers/cms-set-suspend-enrollment-elevance-healths-medicare-advantage-plans
(Some articles may require a subscription.)
#medicareadvantage #regulations #sanctions #radv #riskadjustment #elevancehealth
https://www.modernhealthcare.com/insurance/mh-elevance-medicare-advantage-enrollment-cms
United To End Many Children’s Auths; Mass Sues Over Alleged Fraud
Massachusetts is suing UnitedHealthcare, alleging that it defrauded the state’s Medicaid program, MassHealth, of at least $100 million. Massachusetts’ Attorney General alleges United misclassified enrollees to garner higher levels of reimbursement.
At the same time, the nation’s largest insurer said it will drastically cut down its prior authorization requirements for pediatric care.
Additional articles: https://www.fiercehealthcare.com/payers/massachusetts-ag-sues-unitedhealthcare-over-alleged-medicaid-fraud and https://www.modernhealthcare.com/legal/mh-massachusetts-unitedhealthcare-medicaid-fraud-lawsuit/ and https://thehill.com/policy/healthcare/5901791-unitedhealthcare-prior-authorization-changes/
(Some articles may require a subscription.)
#unitedhealthcare #fwa #priorauthorization
https://www.fiercehealthcare.com/payers/unitedhealthcare-nix-nearly-two-thirds-pediatric-prior-auths
Payers Groan About New No Surprises Disputes Rule
While a new No Surprises Act (NSA) dispute resolution rules offers some relief, payers are saying that the Trump administration missed an opportunity by not cracking down on provider abuse of the dispute resolution process. Analyses show that providers win the lion’s share of awards and that prices set by the arbitrators are now considerably higher than pre-NSA. In addition, a small number of providers have consistently abused the process, some of whom are alleged to have illegally and fraudulently put cases through the process for awards.
#nsa #nosurprisesact #providers #healthplans
https://www.healthcaredive.com/news/surprise-billing-idr-final-rule-insurers-lash-out/821407
— Marc S. Ryan
