Category: News

Noah Tong

December 17, 2025

Some very big health insurance companies and a bevy of startups are striving to win over employers vexed by rising health benefit costs with new plan designs.

Alternative health plans such as variable copayment plans that favor certain in-network providers and individual coverage health reimbursement arrangements, better known as ICHRAs, may appeal to businesses that expect healthcare costs to continue accelerating and are reconsidering their employee benefits. A significant share of employers has adopted these models already.

Alex Kacik

December 10, 2025

The Federal Trade Commission sent a letter this fall to some of the largest for-profit health systems and staffing firms, including HCA Healthcare, Tenet Healthcare Corp. and Universal Health Services, warning them to ensure any employment contracts aren’t restricting competition and access to care.

In September, the FTC said it sent warning letters to several large healthcare employers and staffing firms but did not specify the number or the recipients. The agency recently disclosed the 19 companies to Modern Healthcare in response to a Freedom of Information Act request.

November 20, 2025

By Nona Tepper

Promising signs for “public option” health plans sold on state health insurance exchanges spell bad news for providers, who say they’re squeezed by low reimbursements.

Colorado and Washington are the only states that have government-sponsored — but privately administered — public options on their marketplaces. Nevada is set to join them soon and other states may follow. Public option enrollment climbed on Connect for Health Colorado and Washington Healthplanfinder during the open enrollment period that ended Jan. 15, the states reported.

October 31, 2025

Bridget Early

Doctors who treat Medicare beneficiaries are getting a 2.5% raise next year under a regulation the Centers for Medicare and Medicaid Services issued Friday.

The 2026 Medicare Physician Fee Schedule final rule implements provisions from the tax law President Donald Trump enacted in July, which mandated a pay hike and reversed a multiyear trend of reimbursement cuts. CMS also spells out its plans for an “efficiency adjuster” that will reduce some payments, a lower back pain and heart failure payment model, and new flexibilities for telehealth coverage.

“The actions we are taking will improve seniors’ access to high-quality, preventive care that will help them to live longer, healthier lives,” CMS Administrator Dr. Mehmet Oz said in a news release.

October 24, 2025

Nona Tepper

Elevance Health has notified healthcare facilities they face penalties for assigning out-of-network clinicians to its members.

Starting Jan. 1, hospitals and other inpatient and outpatient facilities must ensure that all providers involved in care for members of Elevance Health’s Anthem Blue Cross Blue Shield commercial plans in 11 states are under contract with the insurer, Anthem said in a notice.

Facilities that don’t comply may be assessed administrative penalties equivalent to 10% of the allowed amounts payable under the claims in question, and may be terminated from Anthem networks. Facilities are not permitted to pass the cost of administrative penalties on to patients.

October 23, 2025

By Nona Tepper

Major health insurance companies are expanding where they sell exchange plans for 2026 despite uncertainty over rising costs and federal policy.

The biggest unknown is how Congress will deal with the enhanced exchange subsides that drove record enrollment in recent years but are scheduled to expire at the end of 2025. The issue is at the center of the showdown between the Republican congressional majority and the Democratic minority that led to the government shutdown that began Oct. 1.

Still, most exchange carriers are entering new states and counties for the 2026 plan year. The open enrollment period spans Nov. 1-Jan. 15 in most states.

October 15, 2025

Jeffrey Young

Medicare will hold claims for telehealth and hospital-at-home services while Congress is at an impasse over funding the government and renewing key healthcare programs, the agency said in a notice Wednesday.

The legal authorities for fee-for-service Medicare to cover telehealth and hospital-at-home care expired Oct. 1. CMS has instructed Medicare billing contractors to hold claims for services performed on or after that date, the agency said in the notice.

Congress failed to extend these programs amid the stalemate over fiscal 2026 government spending, which led to a shutdown that began Oct. 1.

August 26, 2025

Alex Kacik

Concierge and direct primary care practices are gaining traction among physicians, employers and patients increasingly frustrated with traditional care pathways.

The growth of these practices, where patients pay membership fees in exchange for increased access to physicians, is a symptom of Medicare and Medicaid reimbursement that has not kept pace with inflation, advisers, doctors and policy experts said. Growing care backlogs, coding and documentation tasks that take doctors away from patients and seemingly ever-rising health insurance premiums are also contributing, they said.

September 11, 2025

Lauren Dubinsky

Hospitals could see another popular procedure move to ambulatory surgery centers if it is reimbursed by the Centers for Medicare and Medicaid Services.

Cardiac ablations are among a larger group of procedures CMS is considering adding to the list of procedures they would cover at ASCs and industry groups have advocated for their inclusion for years. Currently, the agency only reimburses the procedures in hospital and hospital outpatient settings.

September 10, 2025

Caroline Hudson

Kaiser Permanente and Renown Health signed an agreement to form a joint venture to operate a health plan and ambulatory care services in Nevada.

As part of the deal, Kaiser would acquire a majority stake in Renown’s insurance arm, Hometown Health, which has more than 73,000 members. Kaiser plans to start offering health plan coverage in northern Nevada as Kaiser Permanente Nevada with an open enrollment period late next year, according to a Wednesday news release.