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Medicare Advantage, ACA exchanges, and more: How Oscar plans to use Alphabet's $375M investment

August 16, 2018

Oscar Health Co-founder and CEO Mario Schlosser says a recent $375 million investment from Google parent company Alphabet will allow the insurer to "continue to build a member experience that lowers costs and improves care, and to bring Oscar to more people—deepening our expansion into the individual and small business markets while entering a new business segment, Medicare Advantage, in 2020."

New Mexico insurer sues CMS over rule to reinstate risk-adjustment payments

August 14, 2018

The lawsuit, filed by New Mexico Health Connections, contends that CMS violated the Administrative Procedure Act when it issued a final rule to reinstate $10.4 billion in payments to exchange insurers under the Affordable Care Act's risk-adjustment program.

CMS proposes methodology to calculate exchange insurers' 2018 risk-adjustment payments

August 13, 2018

CMS says under a newly proposed rule it intends "to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula."

Some insurers are planning to lower their premium rates for 2019

August 3, 2018

Insurers in many states are seeking single-digit premium rate increases for health plans sold on the Affordable Care Act's exchanges—and some are even seeking premium decreases, marking a significant change from several years of double-digit rate increases.

Senate Democrats want to rescind Trump's short-term health plan rule. Here's their plan.

August 3, 2018

Senate Democrats plan to introduce a resolution of disapproval that would repeal the Trump administration's final rule on short-term health plans, which they argue "would raise premiums and reduce plan choices for individuals with pre-existing conditions."

Lawsuit claims Trump admin is violating Constitution by 'undermining' ACA

August 2, 2018

Four cities in a lawsuit claim that President Trump and his administration are violating the Constitution by not ensuring the Affordable Care Act is "faithfully executed."

HHS just finalized Trump's rule on short-term health plans. Here's what it does.

August 1, 2018

The Trump administration's final rule will again allow insurers to sell short-term health plans that are valid for up to 12 months and will allow enrollees to renew the plans for up to three years.

KFF: US residents who don't get subsidies are dropping individual health plans

August 1, 2018

New Kaiser Family Foundation data show total enrollment in individual health plans decreased by about 12% from the first quarter of 2017 to the first quarter of 2018—and all of the decline occurred among individuals who had been enrolled in individual health plans that did not qualify for the Affordable Care Act's subsidies.

CMS approves reinsurance programs in two more states

July 31, 2018

Wisconsin Gov. Scott Walker says, under his state's reinsurance program, premiums for individual health plans in the state are expected to be 11% lower than they would have been if the state was not able to implement the program, while Maine officials project that premiums for individual health plans in the state will be about 9% lower than they would have been without its new reinsurance program.

Two states are looking to restructure exchange coverage. Here's how.

July 30, 2018

Alabama and Illinois so far are the only two states that have indicated they will seek CMS' permission to redefine the essential health benefits individual and small-group insurers in the states must cover for the 2020 coverage year, and the states appear to be approaching the changes in drastically different ways.

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