April 9, 2026

As a result of the higher rates, the federal government will pay MA plans an additional $13 billion in 2027, up from the roughly $700 million increase originally projected. The primary driver of this change was CMS’s decision to abandon proposed updates to the risk adjustment model, which would have required insurers to rely more heavily on recent data for member diagnoses and spending. While CMS did not move forward with those updates, it did finalize a policy restricting payments for diagnoses not supported by a corresponding patient encounter.

While prior authorization is a valuable tool for preventing unnecessary procedures, it is widely disliked by providers, who say it slows the delivery of care and contributes to administrative burden. In response, major insurers pledged last summer to voluntarily scale back prior authorization requirements. As part of that effort, payers have also committed to standardizing data and submission requirements for electronic prior authorization, with the goal of answering at least 80% of electronic requests in real time by 2027.

Aetna’s is getting sued by Pennsylvania-based health system, Jefferson Health, over new “downcoding” policy that may violate Medicare rules via the reduction of reimbursement for inpatient hospital stays. While Aetna states the purpose of the policy is to approve payment for inpatient hospital stays sooner, providers claim the policy allows for lower payments than contractually agreed upon for hospital stays.

ICHRAs are emerging as a growing opportunity for insurers and employers by shifting from traditional group insurance plans to defined contributions, helping control costs as group enrollment declines. Adoption is rising quickly, especially among large employers; growth is challenged by instability in the ACA individual market, rising premiums and regulatory uncertainty. Overall, ICHRAs represent a broader shift toward consumer-driven coverage, requiring insurers to adapt to strategies, tools, and engagement models.

As of late March 2026, the United States had recorded about 1,575 measles cases, including major active outbreaks in states such as South Carolina and Utah, highlighting how quickly the disease can spread when vaccination rates decline, according to the article.