Coverage, quality, and the economics of how care gets paid for.
We aren’t killing the problem that fax created. We are migrating it into a format that carries a higher expectation of automated processing — without yet having solved the underlying challenge that made automation hard in the first place. The post Don’t Celebrate the Wrong Win: What CMS-0053-F Actually Changes appeared first on MedCity News .
Uninsured patients made up about 1 in 4 of the more than 20,000 gunshot wound inpatient hospitalizations in Florida from 2018 to 2024, an analysis of state data by KFF Health News and The Trace found. They also had shorter hospital stays than those with any form of coverage.
Margaret Hvatum ended up in the hospital after her insurer denied coverage of a medicine she relies on to boost her immune system. Hvatum got entangled in the preapproval process, which the insurance industry has vowed to improve.
CMS is recalculating some 2026 Medicare Advantage Star Ratings after a court ruled it improperly calculated Clover Health’s rating, a decision that could boost payments for a small number of insurers. The post CMS Recalculates Star Ratings — Again appeared first on MedCity News .
For seniors, the change in policy will dramatically expand access to a revolutionary medication. But there are also significant risks. The post A Bridge to Nowhere? Medicare’s GLP-1 Coverage Expansion Requires A More Holistic Approach To Weight Management appeared first on MedCity News .
KFF Health News journalists made the rounds on national media last week to discuss topical stories. Here’s a collection of their appearances.
The Medicare Cost Cap Act seeks to create a $5,000 cap on out-of-pocket costs for traditional Medicare beneficiaries. The post New Bill Led by Democrats Aims to Cap Medicare Out-of-Pocket Costs appeared first on MedCity News .
Amid a flurry of traditional IPOs this spring, Talawar Therapeutics is taking a different path to the public markets via a merger with a special purpose acquisition company.
If your doctor prescribes a GLP-1 medication for weight loss but your insurance won’t cover it, you have options.
The state’s campaign to end school vaccine requirements is dead for now. The reasons could offer insights into similar efforts’ chances in other states.
The payment by Elevance Health to the Centers for Medicare & Medicaid Services comes as the agency threatened to bar new enrollments in the company’s plans.
The American Diabetes Association Expresses Concern Over Rhode Island’s Decision to Eliminate Medicaid Coverage of Obesity Treatments mcarmody Thu, 06/25/2026 - 19:39 Advocacy News The American Diabetes Association Expresses Concern Over Rhode Island’s Decision to Eliminate Medicaid Coverage of Obesity Treatments ARLINGTON, Va. June 25, 2026 The Rhode Island General Assembly’s Fiscal Year 2027 (FY 2027) budget adopted a policy change that limits Medicaid coverage of glucagon-like peptide-1 (GLP-1)-based medications to only individuals with type 2 diabetes. Beginning October 1, 2026…
Utilization — not cost growth — continues to accelerate spending, government actuaries said. Spiking prescription drug spending, including on GLP-1s, is especially acute.
[Sponsored] Give us a few minutes of your time for our survey and we’ll make it worth your while! The post How Are Payers and Providers Thinking of AI and Cybersecurity? appeared first on MedCity News .
A program in rural eastern Kentucky is receiving opioid settlement funding to address substance use disorders, housing, hunger, and other challenges.
Some Senate Democrats want to cap the amount beneficiaries in traditional Medicare have to pay toward care, but the move is expected to draw GOP opposition for potentially adding billions to Medicare costs.
Priority Health is partnering with Garner Health to steer members to high-quality physicians and reduce healthcare costs for employers. The post New Partnership Aims to Lower Out-of-Pocket Costs, Even Eliminate Them In Some Cases appeared first on MedCity News .
As a federal court mulls a case that could result in significant restrictions on a pill used in most abortions, providers say they have alternatives to preserve access even in states with bans in place.
Massachusetts passed laws and joined lawsuits to protect access to gender-affirming care for minors. But faced with the Trump administration’s threats, some hospitals voluntarily stopped care. Families are outraged.
Being a caregiver can start long before you go to a doctor appointment with a loved one or move your parents into your house. The HealthQ team explores how embracing the role matters — and how the recognition and support that come next can ease a difficult season of life.
Medicare is testing the use of artificial intelligence to preapprove several healthcare services. Federal health officials say prior authorization can help reduce fraud and contain costs. But doctors and patients describe the trial as “horrendous” and full of red tape so far.
Apogee Therapeutics brings AbbVie a long-acting antibody ready for Phase 3 testing in atopic dermatitis, also called eczema. This therapy’s pipeline in a product potential includes respiratory conditions such as asthma — as a monotherapy and as part of novel drug combinations. The post AbbVie’s $11B Apogee Acquisition Brings an Eczema Drug With an Edge appeared first on MedCity News .
“Government has to intervene, because healthcare is run like an unregulated utility,” Indiana’s GOP governor says of the state’s effort to regulate hospital prices.
This cross-sectional study compares trends in insurance coverage and out-of-pocket medical spending from 2014 to 2024 among US adults aged 19 to 65 years with and without visual impairment.