L.A Care Health Plan is the largest Medicaid managed care organization in the U.S. with nearly 2.4 million enrollees, according… ...

Texas emerged as a standout in the 2026 ACA open enrollment period, attracting about 206,000 new enrollees — the highest in the country — according to preliminary data published Jan. 28 by CMS.

Network Health, a Wisconsin-based insurer owned by Froedtert ThedaCare Health, grew 37% during this past annual enrollment period to 126,000 total Medicare Advantage members, its second consecutive ...

This February, BCBS Michigan shared how it will cut reimbursement by 50% for nonpreventive evaluation/management services with modifier 25 that were billed on the same day as procedure codes with ...

Navigating GLP-1 coverage for weight loss has been a sore spot for insurers and employers. These drugs — alongside other specialty drug spending — have been behind price hikes going into 2026. Still, ...

Minnesota filed a lawsuit against CMS and HHS, as well as their respective leaders, Mehmet Oz, MD, and Robert F. Kennedy Jr., regarding $243.8 million in deferred Medicaid funds, according to March 2 ...

The Wasteful and Inappropriate Service Reduction initiative from CMS will take effect next year, adding prior authorization requirements to traditional Medicare. Providers in Arizona, Washington, New ...

Excellus BlueCross BlueShield ended 2025 with a 1.4% operating loss totaling $108 million, as medical and drug claims climbed 16% year over year to nearly $7 billion. The insurer said March 5 the ...

UnitedHealth Group reported only 10 subsidiaries in its U.S. Securities and Exchange Commission filings for 2025, down from thousands in 2024. “UnitedHealth Group is focused on making it easier for ...

Major insurers are retrenching their Medicare Advantage strategies as federal cost‑containment measures and rising medical expenses squeeze profitability. Amid the growing financial pressures the ...

UnitedHealth’s Optum has launched Optum Real, a real-time claims system designed to streamline the claims and reimbursement process by providing instant coverage validation for providers. “Optum Real ...

Effectuated ACA enrollment has increased 13% since 2024 and nearly 93% of enrollees qualify for enhanced premium tax credits, according to an August report from CMS. Total effectuated enrollment as of ...