Category: Health Coverage

Daily articles posted on health insurance changes for all lines of business. Whether you are an agent or a small business owner you will be captivated in how much this industry is changing in the United States today.

Colorado’s Home Insurance Rules Echo the Affordable Care Act for Health Insurers

Nordstrom
Coloroda Home Insurance Reforms

Colorado is rolling out major reforms to its home insurance market, and if the changes feel familiar, there’s good reason. The state’s new legislation bears a striking resemblance to the Affordable Care Act (ACA) in how it aims to ensure fairness and hold insurers accountable. But unlike health insurance, where metrics like medical loss ratios are more stable, applying similar rules to home insurance opens up a whole new set of challenges. What’s the 75% Rule All About? Under the new law, Colorado home insurers are required to spend at…

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Will the $25 Billion Medicare Advantage Boost Benefit Patients or Insurers?

Marc
medicare advantage changes

Medicare Advantage Payments Surge: What It Means for 2026 and Beyond The Medicare Advantage landscape is undergoing a seismic shift with a better-than-expected payment increase announced for 2026. With rates set to climb by 5.06%, translating to a $25 billion boost, industry stakeholders are abuzz with speculation about its far-reaching implications. This announcement is a compilation of technical adjustments and recalibrated growth rates, but what does it mean for you, the taxpayer, and the broader healthcare ecosystem? A 5.06% Increase That Outruns Expectations The Centers for Medicare and Medicaid Services…

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Why UnitedHealth’s $2.1B Case Could Reshape Medicare Forever

Nordstrom
UnitedHealth Case Impact on Medicare

UnitedHealth’s Medicare Advantage Legal Battle Intensifies UnitedHealth Group, a titan of the healthcare industry, is involved in a high-stakes legal fight over allegations of upcoding within its Medicare Advantage program. At the heart of this controversy is an alleged $2.1 billion in over-payments that the company received by reportedly inflating patients’ health conditions to secure higher reimbursements from the federal government. While the legal battle has spanned over a decade, recent developments, including the Department of Justice’s (DOJ) unwavering commitment to take the case to trial, have reignited public and…

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Obesity Crisis Meets Policy Standstill as Trump Halts Medicare Expansion

Ester Adams
Medicare’s role in weight-loss drug coverage

Trump Administration Reverses Plans to Expand Medicare Coverage for Obesity Drugs The Trump administration has officially halted a Biden-era initiative that aimed to extend Medicare and Medicaid coverage to include obesity drugs, a move set to impact millions of Americans coping with obesity, disproportionately affecting seniors and lower-income groups. While supporters saw the proposed expansion as a progressive step towards tackling one of the nation’s most pressing health challenges, critics have raised concerns over the potential cost burden. Below, we untangle the implications of this decision, exploring its economic, medical,…

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AI in Health Insurance Claims Denials Sparks Controversy

G. Turner
Health Insurance Claims Denials

Artificial intelligence (AI) has revolutionized many industries, but its use in health insurance claims processing is stirring sharp debate. Health insurance giants like Cigna, Humana, and UnitedHealth Group are facing serious allegations over their use of algorithm-driven systems to deny claims at a staggering rate. With lives at stake and lawsuits piling up, the practice has raised deep ethical and legal concerns. The Allegations Against Industry Leaders The controversy largely centers on accusations that AI algorithms are being used to wrongfully deny claims, often in mere seconds. One lawsuit claims…

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Building Bridges in Healthcare and Insurance: How Collaboration Lowers Costs and Improves Care

Guest Author
Healthcare and Insurance

Sharing Expertise for Better Coverage and Outcomes Healthcare and insurance are deeply connected—both fields thrive on teamwork. When doctors, nurses, insurers, and pharmacists align their efforts, patients benefit from smoother care and fewer financial surprises. By combining clinical expertise with insurance knowledge, professionals create a system focused on cost-effective, high-quality outcomes. Insurance providers play a key role here. Whether connecting patients with in-network specialists or ensuring treatments align with coverage plans, collaboration helps avoid unexpected bills. Imagine a collaborating doctor working with insurers to pre-approve a surgery or medication. This…

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