Regional Nonprofit Insurers See Largest Dip In Operating Margins
Smaller insurers were also found more susceptible to Medicaid cuts, a report found. Meanwhile, 29 states see at least a 20% increase in insurance rates from the top insurers. Also in the news: Medicare drug prices, Medicare Advantage, and more.
Threatened by shrinking operating margins, regional nonprofit insurance companies are falling behind their larger competitors, according to a new report. In 2024, 71% of regional nonprofit insurers ended the year with an operating loss, according to an analysis published Wednesday by HealthScape Advisors, a division of the consulting company Chartis. By comparison, 53% posted operating losses in 2023, and just 22% did in 2020. (Tong, 9/25)
People who receive insurance through the top marketplace plan in most states can expect sticker shock this fall, according to data聽compiled by the office of Sen. Maria Cantwell. Cantwell, D-Wash., who鈥檚 urging congressional leadership and President Donald Trump to find a way to extend expiring health care subsidies, on Thursday issued a snapshot report on rate聽increase requests from insurers across the country. In 29 states, rates for the top marketplace insurer are expected to聽increase at least 20 percent next year, according to the data. (Raman, 9/25)
In Medicare news 鈥
Advertisement: 0:15AstraZeneca has asked the Supreme Court to hear its case challenging the Medicare Drug Price Negotiation Program created through the Inflation Reduction Act (IRA). According to the Supreme Court鈥檚 docket, AstraZeneca鈥檚 petition was filed on Sept. 19. The company has asked the court to consider 鈥渨hether the IRA implicates an interest of pharmaceutical manufacturers that is protected by the Due Process Clause.鈥 (Choi, 9/25)
Humana will not pay third-party marketers for enrolling new members in many of its wider-network Medicare Advantage products for 2026. The company will not pay agents and brokers for signing up new members for 288 plans across 46 states and the District of Columbia, according to a notice Humana sent to agents and brokers on Monday. About 80% of these plans are PPOs. (Tepper, 9/25)
A federal court has tossed a rule outlining how auditors must review Medicare Advantage insurance companies for overpayments, adding uncertainty to the federal government鈥檚 plan to audit every plan annually. On Thursday, Judge Reed O鈥機onnor, of the U.S. District Court for the Northern District of Texas in Fort Worth, vacated the 2023 Medicare Risk Adjustment Data Validation, or RADV, rule, on the grounds that regulators violated the Administrative Procedure Act of 1946. (Tepper, 9/25)
Supplemental benefit vendors are bracing for another challenging year as Medicare Advantage insurers discontinue plans and downscale the perks they offer members. Health insurance companies such as UnitedHealth Group subsidiary UnitedHealthcare and Elevance Health have announced they will eliminate unprofitable plans and pare back supplemental benefits in 2026 as they seek to restore profit margins amid high spending and stricter regulation. (Tepper, 9/25)
The Centers for Medicare and Medicaid Services has revamped and extended a hospital and primary care value-based care model intended to align payment incentives across payers and providers. CMS announced it is expanding and modifying the Achieving Healthcare Efficiency through Accountable Design, or AHEAD, model it unveiled in 2023, and adding new geography-based elements that could shake up how fee-for-service Medicare enrollees receive care. (Early, 9/25)
