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Half of States Have Chosen Benchmark Insurance Plan: Report
A little more than six months before open enrollment begins, 24 states and Washington, D.C., have chosen a benchmark plan that will determine what health insurers must cover in health plans sold in the state exchanges and individual and small-group markets, according to a new study from the Commonwealth Fund.
In the rest of the country, the snapshot suggests, the federal government will model the minimum benefits on the largest small-group plan sold in the state. Under the Patient Protection and Affordable Care Act, individual and small-group plans must offer an “essential health benefits” package. The core set of benefits must cover 10 broad categories, such as emergency services, maternity and pediatric care, prescription drugs, and mental health and substance-abuse services. HHS issued a final rule in February on essential benefits for 2014 and 2015 and will revisit the provisions for the 2016 benefit year.
Read the full story: http://bit.ly/ZI2Sj3
Source: ModernHealthcare.com
AI Meets Medicare: Inside CMS’s WISeR Model With Sanjay Doddamani, MD, MBA, Part 2
August 5th 2025In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on the future of value-based care and the promise—and limits—of AI-enabled innovation, reflecting on challenges like rising Medicare costs and patients’ growing financial burdens.
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Trump Directs Pharma Companies on Cutting Drug Prices Under Most-Favored-Nation Order
July 31st 2025President Donald Trump has sent letters to pharmaceutical companies, aiming to compel them to lower drug prices in the US to match the lowest prices offered in other developed nations, a move that could significantly reduce costs and disrupt the current system of pharmacy benefit managers.
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