New & Notable
High health costs force small employers to up cost-sharing
As small businesses struggle to keep up with rising healthcare costs, many have increased cost-sharing for their workers in both single and family coverage.
Lawmakers promote access to direct primary care in Medicaid
While Medicaid programs can use waivers to implement direct primary care, a law that is under consideration in the Senate would make it easier for states to take this approach.
5 pillars that underpin payer population health strategies
The healthcare system faces many challenges, but by focusing on these five pillars, payers can establish holistic and effective population health strategies.
CMS suggests public payer weight loss drug coverage changes
Amid suggestions around prior authorizations and AI use, CMS introduces a policy that would expand weight loss drug coverage in Medicare Advantage, Medicaid and Part D plans.
Insights
Insights is the research division of Xtelligent Healthcare Media. Our work aims to leverage Xtelligent’s diverse readership of healthcare professionals across various sectors of the industry to understand real-world challenges and identify effective solutions.
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Latest News
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Top 5 Medicare Advantage payers by footprint in 2025
The five Medicare Advantage payers with the largest footprint in 2025 made their case to beneficiaries by positioning themselves on affordability, quality and access to care.
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ACA open enrollment for 2025: What you need to know
CMS pursued proven outreach strategies for ACA open enrollment 2025, sought to lower costs for consumers, and announced that the number of ACA plans had increased.
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HHS seeks to secure PrEP, birth control coverage
A proposed rule supports birth control coverage for FDA-approved therapies and devices with no prescriptions or cost-sharing and clarifies the exceptions process for enrollees.
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Medicare Advantage growth persists ahead of open enrollment
Medicare Advantage growth continues, spurred on by high quality of care, lower costs and better access to care.
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CMS, HHS update Medicare drug price negotiation process
The next Medicare drug price negotiation cycle might see new parameters around the negotiation platform and more talks around patient experience and pharmacy concerns.
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Top health insurance trends based on quality measures
The 2024 NCQA Health Plan Ratings revealed quality measure performance trends that could guide payers’ decisions on major topics like health equity and diabetes care going forward.
Features
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Understanding Medicare vs. Medicaid vs. CHIP
Medicare, Medicaid and CHIP are very influential in the healthcare industry at large, often steering trends in value-based care, social determinants of health and health equity.
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Key MA quality bonus payment program outcomes, concerns
Understanding the quality bonus payment program is critical to appreciating Medicare Advantage and discussing the calls for reform.
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What are the differences between Medicare Parts A, B, C, D?
Medicare includes four different segments that each insure a wide variety of services and supplies for enrollees.
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Data, technology strategies boost payer patient education
Analytics platforms, omnichannel engagement tools, telehealth, and other technological and data advancements have been pivotal to successful payer patient education.