Wakely Wire
April 16, 2026
New Insights
Whitepapers, briefs, press releases and more
Performance, Risk Reduction, and Strategic Implications for ACA Insurers in States with Reinsurance Programs
This whitepaper examines state reinsurance programs through a financial and actuarial lens. It focuses on how reinsurance improves insurer profitability, reduces earnings volatility, and changes the marginal financial impact of members with chronic and catastrophic conditions. Using spend-based and condition-level loss ratio analysis, we highlight how reinsurance transforms previously unbounded risk into manageable exposure and ... Continue reading
Summary of CY2027 Final Rate Announcement
The Centers for Medicare & Medicaid Services (CMS) recently released the Announcement of Calendar Year (CY) 2027 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, which finalizes important changes in plan payments, risk adjustment and other financial and regulatory requirements for 2027. Wakely summarizes key changes that will affect Medicare ... Continue reading
Who Paid, and Who Stayed? Early 2026 Enrollment Trends in the Individual Market
A new report from Wakely Consulting Group, an HMA Company, models changes to the 2026 ACA market enrollment due to the loss of federal subsidies. Findings suggest a larger drop in ACA marketplace enrollment – lower than some feared, but higher than the CBO analysis. Written By: Michelle Anderson, FSA, MAAAChia Yi Chin, ASA, MAAAMichael ... Continue reading
Wakely Analysis Signals Significant Enrollment Shifts in ACA Individual Market as 2026 Unfolds
OKEMOS, Mich., April 15, 2026 /PRNewswire/ — Wakely Consulting Group, an HMA Company, today released a new analysis of the Affordable Care Act (ACA) individual market that points to meaningful changes in enrollment, consumer behavior, and overall market morbidity as 2026 progresses. Drawing on data representing approximately 80% of the market, the findings highlight early indicators that could shape pricing, ... Continue reading
Week in Washington 4/16/26
New Wakely Estimates on 2026 ACA Enrollment Patterns Wakely released a new report on key trends in 2026 ACA market enrollment. Data collected by Wakely found that, on average, about 86% of individual market enrollees had paid their first January premium. Furthermore, Wakely estimated that enrollment could drop nationally from 17% to 26%. However, results ... Continue reading
Newsworthy Findings
CMS Proposes New Deadlines for Prior Authorizations for Drugs
Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The CMS is addressing that gap.
CMS Accepts More Than 150 Providers, Digital Health Firms for ACCESS Model
Participants will receive set reimbursement for managing Medicare beneficiaries’ chronic conditions, like diabetes, chronic kidney disease and hypertension.
California Judge Tosses Elevance’s Surprise Billing Suit in Win for Providers
It’s a major victory for controversial billing intermediary HaloMD, which cheered the court’s decision. Elevance said it plans to appeal.
More Insurance Claims Denials Are Being Overturned Upon Appeal, Study Finds
Study authors, who reviewed data from New York, said that rising overturn rates suggest that insurers’ claims reviews processes might not be working as intended.
Providers Back New Bipartisan Bill Eliminating Medicare Chronic Care Management Cost Sharing
The Chronic Care Management Improvement Act, introduced by Reps. Suzan DelBene (D-WA) and Mike Kelly (R-PA), would waive the 20% coinsurance Medicare beneficiaries currently pay for chronic care management services, which provider groups argue creates unnecessary barriers to care.
Bonus Article
Chicago Turns All Public School IDs into Library Cards to Boost Student Access
Just for Fun
Math Joke:
FSA stands for “Fellow of the Society of Actuaries.” Or, alternatively:
Prior Week
Q: Why did the angle get promoted?
A: Because it was always right.
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