KFF study: A look at growing enrollment in Medicare Advantage special needs plans

Enrollment in Medicare Advantage (MA) has climbed steadily over the past decade, and of late a key area of focus in this market has been around special needs plans, or SNPs. Anew reportfrom KFF finds that these SNPs now account for 21% of all MA enrollees, up from 13% in 2018, the year they became a permanent part of the MA program. Enrollment in SNPs has grown from 2.6...

Here's how Medicaid work requirement disenrollments will dent hospital operating margins

A new Commonwealth Fund analysis estimates U.S. hospitals’ annual operating margins will drop by 12.5% to 14.2% in 2027 should mandatory Medicaid work requirements take effect. Compared to current law, Medicaid expansion state hospitals’ collective 3.6% operating margin would drop between 0.4 percentage points and 0.5 percentage points with the change. That reflects a...

Nonprofit hospitals delivered $149B total community benefit in 2022: AHA

A new review of tax forms released by the American Hospital Association (AHA) suggests nonprofit hospitals and health systems increased their collective total community benefit by $49 billion—nearly 50%—from 2017 to 2022. The review, released Wednesday and conducted with Ernst & Young on behalf of the lobbying group, tallied $149 billion spent on areas like health professional...

Hospitals aren’t the only ones stepping back from Medicare Advantage

Medicare Advantage reimbursement fights between hospitals and insurers has contributed to a dizzying and ever-changing environment for older adults to navigate each enrollment period. Now, that environment is experiencing more upheaval as the nation’s largest insurers pull back from Medicare Advantage markets to protect profit margins amid new federal cost-containment measures and rising...

HHS to step up enforcement of information blocking rules amid interoperability push

The Department of Health and Human Services’ investigation unit and health IT offices are stepping up enforcement of information blocking committed by providers, health IT developers and health information exchanges, the department announced Wednesday. The news comes as Trump’s HHS is trying to improve the flow of patient health information by securing voluntary commitments...

The 340B program, explained

More than three decades ago, Congress created the 340B program to help safety-net hospitals and clinics​​ expand resources and care for underserved communities. By requiring pharmaceutical companies to offer deep discounts on outpatient drugs, the program has become a hallmark resource to help health systems support vulnerable patients. In recent years, however, the program hasdrawnscrutiny from federal lawmakers as several...

Employers brace for a 9% cost increase in 2026: Business Group on Health survey

Compounding healthcare costs may force some employers to take a hard look at the benefits they're offering to employees, according to a new survey. The Business Group on Healthreleased its annualdeep dive into employers' healthcare strategies Tuesday and found that these firms are bracing for median cost increase of 9% in 2026, following two years of increases that outpaced...

New CMS data suggest future ACA market turmoil as feds crack down on fraud

The Centers for Medicare & Medicaid Services (CMS) this week released new data fueling a narrative of rampant broker fraud on the Affordable Care Act (ACA) exchanges. Plans received data finding 23% of enrollees did not have a claim in 2019. That number jumped sharply to 35% last year. Before the pandemic, the data were largely consistent across three categories: members on...

CMS pitches GLP-1 coverage ‘experiment’ for Medicare, Medicaid

CMS is proposing a five-year experiment that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1s for weight management on a voluntary basis, according to an Aug. 1 report from The Washington Post.  Ozempic, Wegovy, Mounjaro and Zepbound would be included in the program, along with Eli Lilly’s oral GLP-1, Orforglipron, if it’s approved next year.