In 2025, major U.S. health insurers face financial and operational setbacks while smaller, focused payers achieve significant growth by leveraging market-specific strategies and managing costs effectively, reshaping the Medicare Advantage and ACA markets.
Colorado's Journey of Care introduces a dedicated value-based palliative care model targeting Medicare Advantage and special needs plans with interdisciplinary services and telehealth support.
The HHS Office of Inspector General identifies $17 billion in potential cost savings by improving program efficiency and compliance in healthcare programs.
Rep. Spartz introduces the SMART Health Care Act to reduce Medicare and Medicaid waste, address hospital overbilling, enhance rural healthcare access, and reform the 340B drug program.
CMS's GUIDE Model is reshaping Medicare dementia care with home-based solutions, virtual nursing, and new respite care reimbursements to improve patient outcomes and reduce costs.
Explore Humana's detailed prior authorization requirements for medical services and medications, including timelines, appeal rights, and Medicare member guidance for coverage approvals.
New Medicare Part D rules in 2025 cap oral cancer drug costs at $2,000 annually and introduce a voluntary monthly payment plan to improve affordability for patients.
Updates on U.S. healthcare budget reconciliation delays, Medicaid policy debates, Medicare Advantage lawsuits, HHS budget for FY 2026, and new NIH research initiatives shaping insurance and healthcare regulation.
Ozarks Community Hospital highlights financial challenges in rural healthcare due to lower Medicare Advantage reimbursements and the value of nonprofit status in accessing grants.
Summary of Medicare payment reductions used to fund Medicaid expansion under ACA, highlighting impact on hospital financial stability and Medicare's long-term obligations.
