Insurance

Most Medicare beneficiaries perceived low health care burdens, but 1 in 4 Medicare Advantage enrollees with at least 6 chronic conditions experienced high administrative and financial burdens.

As value-based care mandates expand, a new survey highlights documentation burdens and burnout risks.

Democrats move to extend ACA subsidies as enrollment closes, leaving consumers uncertain about premiums, coverage, and alternative health options.

In analyzing 2025 Transparency in Coverage (TIC) files from national insurers, the authors found vast payer-level differences; overall, physician/outpatient data were more complete, and hospital inpatient data were less complete.

Patients with stage I to IIIA NSCLC had lower 2- and 4-year mortality in states that expanded Medicaid coverage.

As open enrollment continues, 77% of surveyed Americans were happy with their options for 2026 health care coverage, although cost concerns surfaced.

Connecting primary care providers and commercially insured adults to outpatient behavioral health services via a digital platform improved health outcomes and reduced medical costs.

With ACA subsidies ending in 2025, Ben Light explains how rising premiums may push individuals toward ICHRAs and reshape employer health coverage strategy.

A new study shows fee-for-service care is linked to higher odds of low-value surgery, suggesting salaried models may reduce unnecessary procedures.

New research shows immigrant children face higher odds of unmet medical needs as federal and state coverage rules narrow.

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

Medicare Advantage beneficiaries with mental health diagnoses see more nurse practitioners and fewer internal medicine and emergency medicine specialists after switching to traditional Medicare.

Shared savings reflects continued growth of long-term-care ACOs in Medicare’s value-based models.

The expansion of direct-to-consumer (DTC) pharmaceutical manufacturer models and the upcoming TrumpRx launch offer lower costs but create new complexities for patients.

Targeted financing, clinician recruitment, and telehealth expansion are needed to improve rural primary care.

Cuts to Medicaid could spell trouble for pediatric health, as millions of children rely on Medicaid to cover their hospital expenses.

Chronic Conditions Data Warehouse comorbidity data vary by insurance status. Analyses using these data that fail to account for insurance status are subject to information bias.

Experts say proposed pharmaceutical tariffs could raise drug prices, impacting patient access and health care budgets.

A vote on the House floor allowed for the government to reopen immediately, but the fight over the extension of ACA subsidies still goes on.

To mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The November issue features a conversation with Laurie C. Zephyrin, MD, MPH, MBA, senior vice president for achieving equitable outcomes at the Commonwealth Fund. This interview has been edited for length and clarity.

Utilizing the Health Insurance Disparities Index for assessment, the authors found that New York’s Medicaid health maintenance organizations (HMOs) outperformed Medicaid HMOs nationally in addressing health care disparities from 2019 to 2023.

Only 4% of NIH prevention projects target health disparities, revealing a major gap between equity research and real-world implementation.

The introduction of more stringent work requirements for those enrolling or renewing their Medicaid coverage can affect both children and adults.

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

Patients save most on outpatient surgeries at in-network sites, so Xiaoxi Zhao, PhD, emphasizes that transparency could help them make better cost choices.

UPMC's pilot program reveals how social determinants of health impact food access and blood sugar management, challenging traditional health care assumptions.

In-network ambulatory surgery centers are cheapest, while out-of-network hospital outpatient departments nearly double costs, says Xiaoxi Zhao, PhD.

As open enrollment begins November 1, 2025, millions are signing up under enhanced subsidies that are set to expire at the end of this year.

Individuals with both low incomes and health problems were more likely to gain employment when covered by Medicaid.

Kimberly Westrich, MA, discusses how patient engagement can revolutionize health care decision-making and break down barriers to accessing necessary medicines and care.