health-insurance
Every record this desk has filed under health-insurance, newest first, each with the number of sources it can still show you.
CMS proposes verifying key eligibility information before paying Marketplace premium assistance
A CMS proposal scheduled for Federal Register publication October 27 would withhold advance premium tax credits and cost-sharing reductions while certain eligibility discrepancies remain unresolved, subject to exceptions. It would also require annual confirmation of specified information and create an early verification period beginning August 1, 2027, for 2028 coverage. This is a proposed rule, not a new requirement taking effect today.
Also filed underaffordable-care-acteligibilitypremium-tax-creditsrulemaking
GAO reports private health insurance was generally more concentrated in 2024 than in 2011, with three or fewer insurers holding at least 80 percent of each market's enrollment in most states
The Government Accountability Office reported October 16 that enrollment in private health insurance generally grew more concentrated from 2011 through 2024. By 2024, three or fewer insurers held at least 80 percent of a state's enrollment in 45 of 51 large-group markets, 47 small-group markets and 36 overall individual markets, and in 49 of the 51 ACA individual exchanges, which sit inside the individual market. The report makes no recommendations and does not measure premiums.
Also filed undergaomarket-concentrationaffordable-care-acthealth-care
Final health-price rule adds telephone access in 2027 and changes the files insurers must publish
A final rule published October 6 adds telephone access to health-plan cost information for plan years beginning on or after January 1, 2027. It also restructures public price files and moves their updates from monthly to quarterly. The published effective date is December 7, 2026; separate file requirements begin March 6 and September 6, 2027.
Also filed underprice-transparencyfederal-registerhealthcare-pricinghhs
Medicare's open enrollment starts October 15, and the numbers that matter this fall are not the averages
CMS projects the average Medicare Advantage premium will fall to $12 a month in 2027, and says about eight in ten enrollees can keep their plan at the same or a lower premium. Those are averages. What decides one person's year is the plan's change letter, the drug benefit's new limits, and two blanks an agent who sells for more than one company must fill in before talking about benefits. Open enrollment runs October 15 to December 7.
Also filed undermedicareopen-enrollmentprescription-drugsconsumer-protection
When someone else can click 'I agree' in your name, the record stops proving that you agreed. This week's federal records show who finds out last: the person named on it, often from a tax form.
On August 31 federal officials canceled about 315,000 HealthCare.gov marketplace policies covering more than 760,000 people. The rule that followed describes them this way: enrolled through an agent or broker, no verified citizenship or immigration documents, no claims, and nobody the insurer could reach. On September 24 a federal judge sentenced a man whose scheme filed more than 500 pandemic unemployment claims in 27 states under at least 375 stolen identities, and the FTC asked whether the ad tools that platforms sell help impersonators find people. These records share one shape. Someone acted in another's name without them, and the paperwork could not tell the difference. CMS says a victim may first learn of it from a Form 1095-A at tax time, and the Labor Department says the same of the 1099-G. Fixes keep arriving long after the harm, because the evidence that justifies them arrives late. The defense is to read your own records at the source before someone else's paperwork does. A checklist for before November 1 follows.
Also filed underconsentidentity-theftimpersonation-scamsconsumer-protectionopen-enrollment
CMS canceled about 315,000 HealthCare.gov policies covering more than 760,000 people on August 31. Its new broker rule describes them as broker-assisted enrollments with unverified citizenship or immigration documentation, no identified claims and no consumer contact, and says CMS's additional preventive controls will not be fully operational before Open Enrollment opens November 1.
On August 31 the Centers for Medicare & Medicaid Services canceled approximately 315,000 Plan Year 2026 policies covering more than 760,000 people in the federal Marketplace. CMS's September 22 fact sheet says the cancellations followed confirmation that the enrollments were unauthorized, and that CMS expects about $2.2 billion in advance premium tax credits to be returned. The interim final rule published September 23 (CMS-9872-IFC, 91 FR 60317) describes the same policies as enrolled with agent or broker assistance, without verified citizenship or immigration documentation, where insurers could identify no claims and could not reach the consumer. The rule, effective September 22, bars agents and brokers who had no 2026 Exchange agreement from registering for Plan Year 2027 until February 1, 2027. It cites more than 624,000 confirmed complaints of unauthorized enrollment or plan switching from 2023 through 2025, and says CMS's additional preventive controls will not be fully operational before Open Enrollment opens November 1. Comments are due November 21. None of the documents says how the people whose coverage was canceled were told, or how anyone canceled in error gets coverage back.
Also filed undercmsacamarketplaceinsurance-brokersconsumer-protectionfederal-register
About 4.4 million people with ACA marketplace coverage are in plans that cover abortions beyond the federal exceptions, GAO counted. The law requires a separate $1-a-month charge for that coverage, and GAO found two of 13 insurers it checked were not billing it the ways CMS allows.
GAO's September 15 report, requested by members of Congress, counts which 2026 ACA marketplace plans cover abortion services beyond the cases where federal funding is allowed, and checks how insurers keep that money separate as the law requires. In the 50 states and D.C., 1,719 of 6,655 plans (26 percent) covered them, in 19 jurisdictions, and about 4.4 million enrollees (about 24 percent) were in such plans in June. No plan in the 25 states that restrict this coverage offered it. All 15 insurers GAO surveyed charge the required minimum of $1 per enrollee per month, and those that shared estimates put the actual cost below 50 cents. Two of 13 insurers that bill enrollees directly did not use one of the billing methods CMS regulations allow, and one insurer had no required segregation plan for one state. CMS told GAO it does not collect those plans because the law does not require it to. GAO made no recommendations and does not find that federal funds paid for abortions.
Also filed undergaoacamarketplacecmsabortion-coverage
A record appears here because it carries health-insurance in its own tags. If a record you expected is missing, it was filed under a different subject — the full list is on the topics index.