October 22, 2026

The CMS has proposed a rule that aims to improve the accuracy of Medicare Advantage (MA) plans' provider directories, reforming how pharmacy benefit managers are paid. The MA directory changes should give the 36 million seniors in the privatized Medicare program more reliable information about what doctors and hospitals are covered by an MA plan when seeking out services or choosing between carriers.

The HHS and CMS recently announced that agents and brokers who didn't help people sign up for ACA plans for 2026 would be forbidden from registering for 2027. About 19,000 agents and brokers will be prevented from registering because of the pause, according to CMS. Now, the HHS is being taken to court over the policy by The National Association of Benefits and Insurance Professionals (NABIP), which represents more than 100,000 licensed agents, brokers and benefits professionals in the U.S.

Inaccurate provider directories are the primary barrier to mental health access. But federal laws mandating accuracy haven’t fixed the problem as psychologists typically work solo without staff to handle scheduling. The CMS is proposing stricter oversight and a national directory, but accurate listings can’t solve access if the underlying supply doesn’t exist.

While most major insurers retreat from the ACA, Centene and Oscar are expanding with Oscar aggressively adding 140 new counties, Centene adding 55 (though offset by exits from Delaware and New Hampshire). They’re betting that competitors’ departures will leave profitable gaps, even as the market shrinks: enrollment has cratered post-subsidy, double-digit rate increases loom, and fraud crackdowns add uncertainty. Both are banking on personalized, condition-specific plans for chronic disease and early-retiree transitions to drive growth.

Rising hospital costs, prescription drug spending, and broader healthcare inflation are contributing to higher premiums and forcing businesses to balance comprehensive coverage with affordability. The findings underscore growing concerns about the sustainability of employer-sponsored insurance, particularly as workers face higher out-of-pocket expenses and employers grapple with escalating benefit costs.