The Trump administration is looking to target 'program integrity' within the Affordable Care Act marketplace with a new proposed rule, while also reducing funding for the ACA navigator program to $10 ...

The country's largest payers reported year-over-year increases in medical cost ratios. CVS Health reported the highest medical benefit ratio at 92.5%, driven by increased utilization, the unfavorable ...

A federal judge is allowing a lawsuit against UnitedHealth Group to partially move forward, which alleges the company used an artificial intelligence algorithm to wrongfully deny Medicare Advantage ...

The nation's largest payers have filed their fourth-quarter earnings reports, revealing which recorded the largest profits in 2024. 1. UnitedHealth Group: $14.4 billion Total net earnings in 2024 were ...

A bill to establish a single payer healthcare system in Massachusetts has been refiled in the state legislature, aiming to replace private insurers with a publicly funded program that guarantees ...

Payers are navigating through the second year of major Inflation Reduction Act changes. Beginning in 2025, Medicare beneficiaries have a maximum out-of-pocket limit of $2,000 annually. The change led ...

Blue Cross Blue Shield of Massachusetts has promoted Prem Somasundaram to CIO and named Dennis Charland Jr. as senior vice president of commercial and pharmacy sales. Mr. Somasundaram most recently ...

North Carolina has fined UnitedHealthcare $3.4 million following a four year investigation into the company's claims handling practices involving balance billing. The investigation focused on the ...

UnitedHealth Group and Amedisys have proposed selling a minimum of 128 home health and hospice facilities as part of their efforts to address competitive concerns arising from their $3.3 billion ...

Aetna has reversed course on a policy change involving reimbursement rates for services provided by nurse practitioners and nurse midwives. Originally set to take effect on April 1, the company said ...

Executives at two of the largest Medicaid managed care providers aren't expecting large federal funding cuts to the program. Joseph Zubretsky, CEO of Molina Healthcare, told investors he expects any ...

CalOptima Health, a Medi-Cal insurer in Orange County, Calif., is planning to offer coverage on the state’s ACA marketplace in an effort to improve continuity of care and expand access to more than 15 ...