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Each week we deliver news, information, and resources. Is there a focus you'd like to see? Share your insights with us at marketing@skygenusa.com.

News from the week of december 15, 2025

Deloitte 2026 Outlook: Why Traditional Health Strategies Will Fail in the Face of Regulatory Uncertainty (HIT Consultant) – Deloitte’s 2026 outlook highlights digital experiences and technology, scaling of AI and collaboration across industries as key strategies for health care organization success.
PwC 2026 Outlook: Health Services M&A Poised for Rebound as AI Becomes “Core Driver” of Value (HIT Consultant) – PWC predicts growth in health services deal value and volume in 2026 in their year-end report.
Medicare Advantage 2026 Spotlight: A First Look at Plan Premiums and Benefits (KFF) – A KFF brief provides an overview of premiums and benefits in Medicare Advantage plans available for 2026 and key trends over time.
AMA: A look at concentration in commercial insurance, MA markets (Fierce Healthcare) – The AMA calculates insurer market shares by locality, state and national reach for commercial, ACA and Medicare Advantage plans. It also looks at how concentration of payers is changing in these different markets.
More than 100 provider groups tell HHS to pull proposed HIPAA update (Fierce Healthcare) – Provider groups are joining industry representatives in opposition to a proposed HIPAA update designed to improve cybersecurity and other safeguards. The groups say the implementation timeline is rushed and does not allow for innovation.

News from the week of december 8, 2025

Dental Care in Medicaid Programs (ADA HPI) – The ADA’s Health Policy Institute’s new report on dental care in Medicaid finds that while benefits have expanded in most states, dentist participation in Medicaid and dental care utilization among beneficiaries have remained stagnant.
How Do Americans Experience Healthcare in Their State? (Gallup) – Polls from Gallup and KFF detail anxiety about health care costs with Gallup reporting that a record 47% of adults are worried about affording healthcare in the coming year.
The 2025 State of America’s Oral Health and Wellness Report (Delta Dental) –Delta Dental’s annual report on oral health finds that 67% of adults with dental benefits are likely to access preventive care while only 23% of those without coverage say they will seek out care.
Broker Fees and Direct Sales by Health Insurance Market (KFF) – KFF has updated their interactive dashboard with 2023 data illustrating average broker fees across different markets and states.
Medicare Advantage 2026 Spotlight: A First Look at Plan Offerings (KFF) – KFF provides an update on the Medicare Advantage landscape which shows slight declines in available plans across the states. The update also highlights the increase in the number of Special Needs Plans (SNPs).
Recent trends in commercial health insurance market concentration (Petersen-KFF) – The Petersen-KFF Health System Tracker finds competition in the individual market remains high while employer group coverage has become increasingly concentrated and more employers are shifting to self-funded plans, while another article questions the affordability of high deductible plans for workers.

News from the week of december 1, 2025

“Classic” Employer Benefits Are A Strong Draw For US Job Seekers Across Ages (Hiring Lab) – A recent survey from Indeed found workers across all ages value health insurance and paid time off. Vision and dental insurance had a strong showing in the top ten across all age groups. In a related report, The Business Group on Health highlights key issues in health benefits for employers.
States Reporting At Least One Medicaid Benefit Expansion, SFYs 2003-2025 (KFF) – New reports from KFF detail Medicaid benefit expansion efforts over the past 12 years and highlight how regulatory changes may impact Medicaid funding and decrease enrollment by suppressing usage by immigrants and other groups.
CMS proposes significant overhauls to Medicare Advantage star ratings metrics (Fierce Healthcare) – CMS is taking an active approach to Medicare Advantage programs by proposing an overhaul to the star ratings system and introducing the ACCESS Model to improve management of chronic diseases.
Poll: 1 in 3 ACA Marketplace Enrollees Say They Would “Very Likely” Shop for a Cheaper Plan If Their Premium Payments Doubled; 1 in 4 Say They “Very Likely” Would Go Without Insurance (KFF) – New polling highlights how ACA marketplace enrollees are reacting to large premium jumps, creating a good deal of uncertainty in the market.
IDOC Teams Up With Eyes On Eyecare to Release 2025 Optometrist Report (Vision Monday) – A new survey of optometrists provides insights into their practices, preferences, engagement with technology and long term goals.

News from the week of November 17, 2025

Employers brace for 6.7% increase in health benefits costs next year: Mercer (Fierce Healthcare) – New reports from Mercer, Families USA and Willis Towers Watson dive into the details of increases in health care costs and premiums and provide some recommendations for employers and payers to address these challenges.
With government reopened, healthcare orgs press lawmakers to act swiftly on ACA subsidies (Fierce Healthcare) – Lawmakers continue to debate ACA subsidies while a wide range of healthcare organizations urge action.
Integrated Care Plans Didn’t Boost Medicaid Enrollment for the Poorest Seniors (University of Pennsylvania) – A recent study found that that the expansion of integrated Medicare-Medicaid Plans (MMPs), created to streamline care for dual eligible individuals, has not increased Medicaid enrollment rates.
CMS issues guidance on Medicaid provider tax overhaul (Healthcare Dive) – CMS has started to outline how it will restrict state usage of Medicaid provider taxes, which will impact state’s ability to fund the program.
2026 Medicare Physician Fee Schedule Shows Increase for Doctors of Optometry (Vision Monday) – CMS recent Medicare final rule included a 2.5% payment increase for providers and other provisions related to telehealth, and MIPS for diabetes eye exams.

News from the week of November 10, 2025

Report: Payers need to do more to demonstrate value to plan sponsors (Fierce Healthcare) – A new report, finds payers should be aware of a growing interest in direct-to-consumer or direct-to-employer relationships as employers seek to cut costs. Payers can combat these trends by demonstrating their value in keeping members healthier.
Healthcare Consumer Experience 2025: Safety, AI, and Social Capital Redefine Trust (HIT Consultant) – A new study dives into the trends driving consumer experience in healthcare as expectations continue to evolve. Key pillars include building trust and eliminating friction points.
Medicaid Enrollment & Spending Growth: FY 2025 & 2026 (KFF) – KFF’s annual report on Medicaid enrollment and spending shows enrollment declined by 7.6% in 2025 and growth is expected to be flat in 2026. At the same time, total Medicaid spending increased by 8.6% in 2025 and state Medicaid spending increased by 12.2%. In addition, a majority of the states that responded to the survey say Medicaid budget shortfalls are likely and some are already implementing Medicaid spending cuts.
Participation in Medicare Advantage Risk-Based Provider Payments Shows Little Impact on Care Delivery (University of Pennsylvania) – As Medicare moves from fee-for-service to risk-based contracts designed to minimize costs and improve member health, a new study find these contracts do not meaningfully change how care is delivered.
Concerns Over Fairness, Access Rise as States Compete for Slice of $50B Rural Health Fund (KFF Health News) – As state leaders recently finalized applications for a piece of the $50B Rural Health Fund, some fear that funds will not be fairly distributed. In addition, while funding for test projects is welcome it won’t replace lost Medicaid funding.

News from the week of November 3, 2025

CMS highlights medical-dental integration in 2026 Medicare Physician Fee Schedule (ADA News) – CMS is getting praise for a new oral health–related quality improvement activity within the merit-based incentive payment system. To qualify, Medicare-participating physicians must complete training, implement a referral process and take at least one step to integrate oral health into their practice.
Managed care plans offer recommendations to CMS on rollout of Medicaid work requirements (Fierce Healthcare) – ACAP and MHPA are urging CMS to adopt recommendations that could help smooth the adoption of Medicaid work requirements by allowing insurers to deploy more modern communication methods, enable critical data sharing and other measures.
Assessing Marketplace Coverage for Parents and Children (Urban Institute) –A recent Urban Institute report underlines the importance of marketplace plans for families with children which now cover nearly 5 percent of parents and more than 3% of children. Another analysis by KFF finds that individual market premiums have become more similar to employer-sponsored premiums over time.
Understanding the Evidence: SNAP and Health (University of Pennsylvania) –The Leonard Davis Institute's recent blog post references six studies that highlight how the loss of SNAP can negatively impact heart-related deaths among adults younger than 65, diabetes prevalence and inpatient admissions.
KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown (KFF) – KFF’s latest Health Tracking Poll and an analysis of recent election results provide insights into public opinion on health care costs and the government shutdown.

News from the week of October 31, 2025

Insurers most often blamed for medical debt, but providers trusted to protect patient interests: survey (Fierce Healthcare) – A recent survey from the nonprofit, Undue Medical Debt finds a majority of voters blame payers for medical debt. The survey also looks at how debt is impacting respondents ability to access health care.
High volume of surprise billing disputes are ineligible for arbitration, insurers allege (Healthcare Dive) – A recent payer study alleges that PE-backed provider groups are flooding the Surprise Billing dispute system with ineligible claims that are nonetheless getting approved.
ROI from virtual care remains elusive, report shows (Healthcare IT News) – New research finds virtual care and digital health remain priorities for health system leaders, even though they are not seeing significant ROI from virtual care investments. Another study from PWC explores how people in different age groups utilize health technology.
The Vision Council Submits Comments to Department of Commerce About Possible New Tariffs on Optical Products and Equipment (Vision Monday) – Health industry groups are urging the US government to provide tariff exemptions for a wide range of medical products and equipment.
Multi-Sector, Community-Driven Partnerships: An Intentional Strategy to Advance Health Equity (National Academy of Medicine) – The National Academy of Medicine looks at two examples of multi-sector, community-driven partnerships designed to improve health outcomes.
The risks when dentists give pediatrics opioids (Dr. Bicuspid) – A new JADA article tackles the issues tied to prescribing opioids for pediatric dental care. The study shows 1 in 10 pediatric dental visits in which opioids were used were linked to overdose or persistent use with some requiring hospitalization after dental treatment.

News from the week of October 24, 2025

Workers and Employers Face Higher Health Insurance Costs (NY Times) –Rising health care costs, including a sharp rise in 2025 premiums and costs for consumers, are documented by a new KFF report, while a Families USA poll finds lowering healthcare costs is a top concern for voters.
H.R. 1 and Medicaid: What Healthcare Providers Need to Know About Upcoming Changes (HC Innovation Group) – A Foley & Lardner webinar takes a closer look at the impacts of the new federal budget law on providers and warns of the danger of a snowballing effect on state programs and the rest of the health care ecosystem while Kansas continues to expand Medicaid dental benefits in an effort to increase preventative care.
Officials Show Little Proof That New Tech Will Help Medicaid Enrollees Meet Work Rules (KFF Health News) – KFF investigated federal pilot programs in Louisiana and Arizona, which are designed to help Medicaid enrollees verify work requirements. They found very limited program information and little proof of success.
Optometry’s Expanding Scope: Bridging the Eyecare Gap (Vision Monday) – Optometrists are gearing up to expand the scope of their practices in several states which could help fill health care gaps due to shortages of eyecare professionals and increased demand due to an aging population.
Dentistry enters a “golden era” of oral health thanks to innovation and AI (Dental News) – A recent podcast hosted by the ADA’s Marko Vujicik looks at recent breakthroughs in technology, data-analytics, patient-centric care and new business models.

News from the week of October 17, 2025

Survey from Aflac shows more burnout, anxiety over health insurance (Aflac) – A recent Aflac survey finds employees are navigating burn-out and anxieties about the rising cost of health care and the KFF health tracker illustrates how employers are juggling cost sharing of health benefits. Employees are facing health care costs that are growing faster than wages and inflation.
ADA launches toolkit to support dentists in Medicaid participation (ADA) – The ADA has a new Medicaid toolkit and updated Medicaid fee schedules available for dentists to maximize efficiencies in their practices.
37 dental insurance reform laws passed in 2025 (ADA News) – The ADA reports that thirty-seven new dental insurance laws have been enacted across 18 states this year. Most of the activity was centered around dental loss ratios, virtual credit cards, assignment of benefits and provider credentialing process improvements.
How Medicaid cuts in the “Big Beautiful Bill” will impact dental practices (Dental Economics) – Dental Economics takes a closer look at how impending Medicaid cuts will impact dental practices including patient’s experiencing loss of coverage and confusion increased administrative burdens for office staff. These changes will make strong insurance workflows even more critical.
Medicaid-Covered Dental Visits during and after Pregnancy (RWJF) – A new study from the Robert Wood Johnson Foundation finds a marked increase in dental visits during and after pregnancy in states that extended Medicaid coverage at least one year postpartum while a KFF report looks at how children’s health access may be impacted by the recent changes to Medicaid.
Commonwealth Fund: Medicare member experience varies by state (Techtarget) – The Commonwealth Fund has published a study comparing Medicare Advantage member experience across the states and finds disparities in access to care, costs and red tape. Differing state healthcare policies are a key predictor of member experience. A closer look at Kentucky reveals where gaps lie.
No Real Choices: How Medicare Advantage Fails Seniors of Color (PNHP) – A study from Physicians for a National Health Program provides a critical look at how Medicare Advantage is serving communities of color while a STAT piece advocates for streamlining plan choices to help seniors better evaluate plan options.

News from the week of October 10, 2025

KFF Health Tracking Poll: Public Weighs Political Consequences of Health Policy Legislation (KFF) – A recent KFF Health Tracking Poll shows nearly 80% of adults support extending the enhanced tax credits for plans purchased through the ACA Marketplace. In addition, a strong majority say higher premiums would significantly impact their finances, with 4 in ten saying they would go without health coverage if premiums doubled.
Medicaid enrollees at risk of disenrollment report multiple chronic conditions: study (Healthcare Dive) – A recent JAMA study found that a large number of Medicaid beneficiaries likely to be impacted by new work requirements, suffer from three or more chronic conditions. For Medicaid recipients between 50 and 64 years old, more than 66% were impacted by multiple chronic conditions.
A Look at Variation in Medicaid Spending Per Enrollee by Group and Across States (KFF) – KFF breaks down total Medicaid (state and federal shares) spending per enrollee for full-benefit Medicaid enrollees by eligibility group and state. As expected, the highest spending rates were among seniors and people with disabilities.
ADA pushes back against payer downcoding on multisurface restorations (ADA News) – The ADA and state of California are warning payers to work with providers on any network fees or downcoding of procedures.
Why one DSO incorporated virtual dental care (Dr. Bicuspid) – One DSO is integrating after hours virtual-first emergency dental care to help relieve stress on staff and improve patient care.

News from the week of October 3, 2025

How an ACA Premium Spike Will Affect Family Budgets, and Voters (KFF) – The ongoing federal government shutdown highlights potential impacts of the expiration of tax credits on ACA premiums, the uninsured rate, healthcare spending and employer-based benefits.
Government Shutdown Watch: Impacts on the Industry, Vision Care and More (Vision Monday) – The vision industry is closely watching developments in Washington as the shutdown could not only hit those practices that serve Medicaid and ACA patients, but could also be impacted by staffing reductions at the FDA and customs.
CMS: Average MA premiums are set to decline for 2026 plan year (Fierce Healthcare) – Medicare Advantage enrollment and premiums are set to decline in 2026 and as some insurers reduce their footprint people in some areas will have to revert to traditional Medicare. At the same time special needs plans are seeing strong growth.
The State of the U.S. Dental Economy (ADA HPI) – The ADA’s Health Policy Institute’s Q3 report on The State of the U.S. Dental Economy shows dental practices continue to be impacted by decreases in demand and higher prices.
2025 State of America’s Oral Health and Wellness Report (Delta Dental) –
Delta Dental is out with their 2025 State of America’s Oral Health and Wellness Report. Only 36% of adults surveyed rated their oral health as good or excellent.
Participation in Medicaid child dental care continues to decline in Georgia, audit finds (Georgia Recorder) – A new report sharply criticizes Georgia’s Department of Community Health for failing to follow through on recommendations from a 2021 state audit detailing declines in Medicaid child fee for service dental care utilization in Georgia. This new report showed that this trend continues to worsen with only a 28% participation rate in 2024. Reimbursement rates for providers in this program is below rates offered in the managed care program.

News from the week of September 26, 2025

Benefits advisors will switch carriers for digital innovation (BenefitsPro) –BenefitsPro has written about the findings in SKYGEN’s recent 2026 Pulse Report: Broker Perspectives. The report focuses on the perspectives of brokers, their role in shaping dental and vision benefits and communicating with employers and individuals.
WTW: Half of Employers Exceeded Their Healthcare Budgets in 2024 (MedCityNews) – A recent survey finds that more than half of employers were over budget on health care spending in 2024. Employers are looking at making bold changes to control costs and improve health including scrutinizing vendors, putting their health coverage out to bid, adopting alternative plan designs and leveraging AI.
States Are Cutting Medicaid Provider Payments Long Before Trump Cuts Hit (KFF) – KFF reports that states are already cutting Medicaid provider payments months before the Trump administration’s Medicaid cuts take effect. North Carolina, for example, has announced a minimum 3% reduction in pay for all providers who treat Medicaid patients.
Medicare Advantage plans to share provider directories under CMS final rule (Healthcare Dive) – A new CMS final rule will require MA plans to publish their provider directors for 2027 open enrollment on Medicare Plan Finder.
Bipartisan bill introduced to speed up Medicare Advantage payments to providers (Fierce Healthcare) – A new bill aims to address Medicare Advantage payment delays by giving plans 14 days to pay electronic, in-network claims and a 30-day requirement for paper or out-of-network claims for 95% of clean claims.
Bridging the gap: Bringing menopause to the dental chair (Delta Dental) – A new reports finds women over 40 want menopause-specific dental benefits.

News from the week of September 19, 2025

PwC Report: The $1 Trillion Opportunity to Reinvent Healthcare (HIT Consultant) – A new report from PwC predicts a fundamental transformation of the healthcare system away from fragmented, infrastructure-heavy models toward a digital-first and personalized system that also removes administrative burdens from providers.
ADA submits comments in DOJ review of state laws affecting competition (ADA News) – The ADA has submitted comments to the DOJ on what they feel are anti-competitive state insurance laws impacting dental as well as recommending changes to how limited dental services in Medicare are managed.
Federal watchdog report on Georgia's Medicaid program raises concerns about administrative costs (AP News) – A federal watchdog report finds that Georgia’s Medicaid work requirements program is paying out more in administration costs than in benefits and a recent KFF podcast looks at how states plan to implement Medicaid work requirements.
Medicaid and CHIP Monthly Enrollment (KFF) – KFF has published Medicaid and CHIP enrollment figures by state through May 2025 illustrating that while CHIP numbers have stayed fairly consistent, Medicaid enrollment continues to fall off post COVID.
One in three young adults skip the dentist, and that's a problem (Medical Xpress) – A Tufts researcher finds young adults between 18 and 35 years old were most likely to report not having visited a dentist in the past year, often citing cost and lack of insurance as key factors.

News from the week of September 12, 2025

Penn Dental on Cedar bridges medicine and dentistry, lightens ER demands (Penn Today) – A co-location of Penn Dental and Penn Medicine is prompting greater collaboration between health professionals and is lessening the strain on the nearby emergency department as dental cases can be quickly redirected to the dental clinic.
Medicaid must improve network adequacy standards, ADA council says (ADA News) – A new ADA report finds only seven states are meeting Medicaid network adequacy criteria and provides recommendations that the organization could adopt to help bridge this gap.
CMS pauses MA supplemental benefit notification rule (Becker's Payer) – CMS is delaying a Medicare Advantage rule that would have required plans to send an annual mid-year notification to members about unused supplemental benefits.
2024 Uninsured Rate Held Steady, as ACA Marketplace Enrollment Offset Medicaid Declines (KFF) – The uninsured rate remained steady at 8% in 2024 according to KFF analysis of Census Bureau data. Medicaid declines were offset by increases in private and marketplace coverage. They also report that roughly half of adults with ACA coverage are small business owners, employees or self-employed.
In the Fallout From Trump’s Health Funding Cuts, States Face Tough Budget Decisions (KFF Health News) – States are assessing making cuts to state programs, providing extra assistance to nonprofits and other budget decisions based on the administrations cuts to health funding.

News from the week of September 5, 2025

Dental workforce transitioning to younger, female dentists (ADA HPI) – The ADA’s Health Policy Institute has a new dentist workforce report that shows growth in the numbers of new dentists entering the workforce is more than compensating for retirements. The report also looks at practice ownership and Medicaid enrollment trends and illustrates how dental practice expenses have increased while revenue has decreased.
New Test Could Help Detect Children’s Vision Issues Earlier (Optik Now) – A new vision screening has the potential to detect vision problems in children who are too young to read existing vision charts.
Status of State Medicaid Expansion Decisions (KFF) – KFF’s Medicaid expansion report has been updated to include information on new legislative actions related to work requirements, Medicaid expansion trigger laws and other initiatives.
Preparing for the ‘Big Beautiful Bill’: How Digitization Can Streamline Medicaid Eligibility & Social Care Delivery (HIT Consultant) – Strengthening digital workflows for eligibility, referrals and care coordination can help minimize the impact of new Medicaid work requirements on members, providers and payers.
The Substantial Costs Of The No Surprises Act Arbitration Process (Health Affairs) – A new report finds that the arbitration process established under the No Surprises Act is proving costly. Researchers from Georgetown University estimate that between 2022 and 2024, the IDR system cost $5 billion to manage including additional payments from plans to providers, internal costs for payers and providers and additional administrative fees.
Health Care Costs for Workers Begin to Climb (NY Times) – A large survey of employers finds companies are expecting sharp increases in health care costs and possible decreases in benefits in 2026. In addition, a second study finds that new retirees will need $17,000 more in savings for total retirement health care costs than was needed in 2022.

News from the week of August 22, 2025

Chase study: How small businesses are thinking about health benefits in an uncertain economic environment (Fierce Healthcare) – Two recent surveys illustrate concerns among employers related to the rising costs of health benefits and their plans to minimize impacts through cost-sharing, changes in plan design and other strategies.
How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State? (KFF) – KFF revisits the impact of the federal budget reconciliation law using updated CBO estimates of uninsured people. This report illustrates how the projected increase of 14 million uninsured people will be reflected across Medicaid, ACA and other areas on a state level.
J.D. Power: Medicare Advantage headwinds impacting member satisfaction (Fierce Healthcare) – J.D. Power’s annual Medicare Advantage study found a drop in customer satisfaction tied in part to policy changes impacting benefits, as well as higher out-of-pocket costs and deductibles and prior authorization concerns.
The Vision Council’s Webinar Provides Updates on the Latest Tariffs, Outlines Their Impact on the Optical Industry (Vision Monday) – The Vision Council is providing guidance on keeping abreast of the latest tariff rules and impacts on glasses and other optical imports.
Dr. Bicuspid dental survey results (Dr. Bicuspid) – A recent survey of dentists finds costs, staffing shortages, the overall economy and patient spending top their list of concerns. 63% of respondents also expressed significant worry about dental insurance reimbursement levels.

News from the week of August 15, 2025

Prior Authorization Process Policies in Medicaid Managed Care: Findings from a Survey of State Medicaid Programs (KFF) – A recent KFF survey of state programs looks at Medicaid prior authorization standards related to decision timeframes, electronic denial notices and access to external medical review.
Medicaid Cuts in the One Big Beautiful Bill Act Leave 3 in 10 Young Adults Vulnerable to Losing Health Care Access (Urban Institute) – The Urban Institute delves into how young adults may be disproportionately vulnerable to losing health care access due to the impact of Medicaid cuts in the new federal budget. .
Many Americans Still Lack Health Insurance, U.S. Census Bureau Finds (Vision Monday) – A recent update from the U.S. Census Bureau based on data through 2023 finds a growing number of American’s under 65 lack health insurance.
Trump Administration Scraps Research Into Health Disparities (New York Times) – Rollbacks of federal funding for health disparity-related research are hurting efforts to identify causes of poor health in minority communities, low-income and rural areas, and among Americans with disabilities.
Probiotics, diet changes may improve gum disease (Dr. Bicuspid) – A recent study found patients with periodontitis benefited from taking probiotics and following an anti-inflammatory diet.
New Edition of CORE’s ‘Contact Lens Update’ Explores Impact and Potential of Artificial Intelligence (Vision Monday) – The Centre for Ocular Research & Education’s (CORE) latest issue focuses on how AI is being incorporated into tools to enhance fitting accuracy, streamline workflows, and personalize treatment for contact lenses.

News from the week of August 8, 2025

Health Provisions in the 2025 Federal Budget Reconciliation Law (KFF) – KFF has published an in-depth report and implementation timeline on the health care provisions in the new federal budget across Medicaid, ACA, Medicare and Health Savings Accounts.
New Medicaid Federal Work Requirements Mean Less Leeway for States (KFF Health News) – States will need to solve new administrative challenges for their Medicaid programs including new work requirements which may conflict with plans that the states are developing. In addition a recent study shows expanded continuous Medicaid eligibility for children helped reduce children’s unmet health care needs, expanded continuity of coverage, and decreased administrative burdens for families.
Integrated Medicare Advantage Plans Cut Dropout Rates for Dual-Eligible Individuals (University of Pennsylvania) – A recent study found that members enrolled in Fully Integrated Dual-Eligible Special Needs Plans (FIDE-SNPs) had the lowest disenrollment rate—8.1% by 2022—among enrollees of all Medicare Advantage plan types.
Many tech companies have made a play for healthcare. Samsung believes it has a winning approach (Fierce Healthcare) – Samsung continues to make a push to expand its role in the healthcare space with a focus on affordability and accessibility.
Trump administration launches health data sharing initiative (Healthcare Dive) – CMS announced that more than 60 companies will participate in a new government-sponsored Health Tech Ecosystem which plans to focus on adoption of a health data sharing framework as well as further development of digital health tools.
Deep Staff Cuts at a Little-Known Federal Agency Pose Trouble for Droves of Local Health Programs (KFF Health News) – KFF details the impacts of cuts to the Health Resources and Services Administration which provides grants and support to local health programs including telehealth initiatives and assistance for programs training students to become dentists and other healthcare providers in underserved areas.

News from the week of August 1, 2025

How does the One Big Beautiful Bill affect dentists? (ADA News) – Analysis by the ADA and NADP on the new federal budget’s impact on dental reveal areas where payers and providers might be able to help minimize impacts on patients.
Federal Budget Reconciliation Law Implementation Timeline for Key Medicaid, Medicare, and Marketplace Provisions (Families USA) – Families USA has published a detailed timeline for the implementation of many of the new provisions in the new federal budget bill that will impact Medicaid, Medicare and ACA plans.
Medicare Advantage in 2025: Enrollment Update and Key Trends (KFF) – KFF provides an update of the Medicare Advantage market in 2025. Key findings show the growing gap on spending per individual beneficiary between traditional Medicare and Medicare Advantage. This year payments average 20% more person, resulting in an additional $84 billion in federal spending. A second report looks at premium and benefit design trends..
Bipartisan Bill Seeks to Establish Parity Between MA & Traditional Medicare Payments (MedCity News) – Congress is also looking at ways to improve the Medicare Advantage program by closing the gap in provider payments between traditional Medicare and Medicare Advantage.
RFK Jr. plans to remove all members of US Preventive Services Task Force: WSJ report (Fierce Healthcare) – RFK Jr. is expected to remove all members of the US Preventive Services Task Force which provides dental and vision preventive care guidance.
KFF Health Tracking Poll: Public Finds Prior Authorization Process Difficult to Manage (KFF) – KFF takes the pulse of the public regarding the prior authorization process.

News from the week of July 25, 2025

U.S. adults associate these dental problems with poor health (Dr. Bicuspid) – A recent study found a connection between self-reported overall health with key measures of poor oral health, providing additional support for including oral health in routine health checkups. In addition, a Gallup study finds that adults who visited a dentist in the past year are more likely, than those who have not, to report better overall health.
Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States: Enacted Reconciliation Package (KFF) – A new KFF analysis attempts to predict how the federal Medicaid spending reductions will impact each state. The exact results could vary depending on how each state approaches these program changes.
State Medicaid programs face 'big, beautiful' time crunch (The Hill) – State Medicaid programs are scrambling to try to comply with Medicaid work requirements, spending cuts and other measures which will start to take effect in just 16 months. CMS has also alerted states that it won’t extend or grant new Section 1115 Medicaid waivers which were used for continuous eligibility and efforts to strengthen dental and other care.
Medicare Will Not Expand on Dental Payment Examples in 2026 (Medicare Advocacy) – CMS has announced that they will not be expanding the scope of medically necessary dental care for additional clinical conditions under Medicare in 2026.
A ‘bastardized’ program: GOP lawmakers eye Medicare Advantage reform (Healthcare Dive) – A congressional hearing this week brought criticism and calls for reform of Medicare Advantage. Lawmakers called out high denial rates, prior authorizations and high costs of the program.
PWC Report: US Medical Cost Trend to Remain Elevated at 8.5% in 2026 (HIT Consultant) – PWC reports that persistent inflation and regulatory changes are helping sustain high medical cost trends.

News from the week of July 18, 2025

The State of the U.S. Dental Economy: Latest Data from Q2 2025 (ADA HPI) – The ADA’s HPI new quarterly report on the dental economy expands the previous provider economic survey to include consumer dental spending, dental practice economics, and the state of the dental job market. The report shows dentists’ confidence in the dental care sector overall, as well as their own particular practice are at new lows. In addition, consumer dental spending is up 3% through May while prices for dental equipment and supplies have increased 5% since the beginning of 2025.
Mercer survey: Employers may make a return to healthcare cost-shifting strategies (Fierce Healthcare) – A recent analysis by Mercer found that while employers have avoided shifting increased healthcare costs to workers, they may be ready to change course.
With New Tariffs Scheduled to Take Effect in August, Optical Industry Braces for Increases (Vision Monday) – The optical industry is assessing the impact of additional looming tariffs.
A Closer Look at the $50 Billion Rural Health Fund in the New Reconciliation Law (KFF) – KFF explores what is known about the $50 billion rural health fund that was a last minute addition to the recent federal budget. Half of the funds are said to be distributed equally to approved state programs and the remaining funds will be distributed to approved programs.
Medicaid insurers could be cleared to text enrollees under Trump’s work requirements law (Fierce Healthcare) – The new Medicaid work-reporting requirements in the federal budget may clear the way for insurers to text enrollees.
Dentists say it’s time to stop handling anesthesia alone (Dr. Bicuspid) – A patient death is bringing a push to require a two-provider approach for dental anesthesia, pairing a clinician focused on dentistry with another licensed professional to oversee anesthesia.
ADA urges revisions to NCOIL dental loss ratio model to improve transparency, patient care (ADA News) – The ADA is requesting key changes to the dental loss ratio model to exclude charitable contributions and broker commissions from the calculations since these expenditures do not directly benefit policyholders.

News from the week of July 11, 2025

Federal Medicaid Cuts Threaten State Dental Benefits (CareQuest) – A new report looks at the impact of Medicaid cuts on state dental benefits for adults. Based on the experience in several states impacts included a drop in oral health care for those impacted by the cuts and an increase in ER usage for dental care which increased costs.
Gum disease, decay, missing teeth: Why is mental illness linked to poorer oral health? (Medical Xpress) – Research has shown people with serious mental illness are four times more likely than the general population to have gum disease.
In Plain Sight: Examining America’s Eye Health Challenge and How to Solve It (Versant Health) – A recent report finds a disconnect between vision health needs and consumer understanding of the urgency of receiving preventive vision care.
Navigating the Policy Fog: Healthcare Organizations Adapt to Unprecedented Uncertainty in 2025 (KLAS Research) – KLAS surveyed health systems and other providers to find out how they are approaching the current financial pressures and rapidly changing regulations.
Some states rebrand Medicaid to reduce stigma. That's confusing recipients (NPR) – Cuts to Medicaid are revealing some members are unaware that they are receiving Medicaid benefits due to rebranding that was done to reduce stigma for many of these programs.
CMS sued over Trump administration's ACA final rule (Fierce Healthcare) – CMS is being sued by several cities and health care organizations over a recent ACA final rule that they say will cause nearly 2 million Americans to lose coverage in 2026. In addition, several states are suing the administration for sharing health data with DHS in order to facilitate deportations.

News from the week of June 27, 2025

2025 Scorecard on State Health System Performance: Fragile Progress, Continuing Disparities (Commonwealth Fund) – The Commonwealth Fund has released their 2025 Scorecard on State Health System Performance documenting progress in the uninsured rates across states.
16 House Republicans tell leaders Senate's Medicaid changes go too far, threaten pulling support (Fierce Healthcare) – Push back against the proposed Senate Medicaid cuts are coming from some Republican House members, the American Hospital Association and the Senate Parliamentarian has said that some key provisions violate Senate rules.
How Medicaid and SNAP Cutbacks in the “One Big Beautiful Bill” Would Trigger Big and Bigger Job Losses Across States (Commonwealth Fund) – A report from the Commonwealth Fund predicts that cuts to Medicaid and SNAP will result in the loss of 1.22 million jobs nationwide and State GDP’s are expected to fall by $154.3 billion.
CMS slashes ACA sign-up periods, tightens eligibility in final rule (Healthcare Dive) – A new final rule impacting ACA enrollment and eligibility is expected to shrink coverage numbers.
More than half of US teens have had at least one cavity, but fluoride programs in schools help prevent them (MedicalXpress) – A recent study found that school fluoride varnish programs can help reduce cavities. The paper provides recommendations for overcoming barriers including cost and participation.
Digital Discover: Consumer Searches Reveal Contact Lens Realities (Contact Lens Institute) – A new report reveals why eyecare practices may want to be prepared to address questions and concerns raised by consumers in online searches for contact lens information.
Deloitte: Healthcare finance leaders see policy, economic storms ahead (Fierce Healthcare) – A Deloitte survey of health care CFOs shows concerns about business conditions due to regulatory changes, economic uncertainties and tariff disruptions as well as changing consumer expectations.

News from the week of June 20, 2025

2020 to 2022 Saw Nearly 2 Million Annual Emergency Room Visits for Dental Issues (Mesabi Tribune) – Updated federal statistics show that nearly 2 million ER visits per year are related to dental issues, a slight improvement from previous reports.
FTC growls at vision care providers over 'hiding' patient prescriptions (Benefits Pro) – The FTC has issued warning letters to nearly 40 contact lens providers after consumers continue to report difficulty getting their prescriptions.
The Employer’s Dilemma: When the Fully Insured Plan No Longer Works, What’s Next for Employers? (MedCity News) – Employers are adopting new approaches to fully insured plans including ICHRA adoption, which is seeing bipartisan support amid scrutiny in Congress.
KFF Health Tracking Poll: Views of the One Big Beautiful Bill (KFF) – Medicaid keeps gaining in popularity as Senate Republicans unveil their version of the budget bill that could cut it by $800 billion.
MedPAC: A look at payments to MA plans for supplemental benefits (Fierce Healthcare) – MedPAC has issued a report on the steep growth in Medicare Advantage supplemental benefits spending by the government, rising from about $21 billion in rebates in 2018 to roughly $86 billion. The Commission is calling for greater transparency for spending and utilization for supplemental benefits including dental and vision.
Medicaid Changes in House and Senate Reconciliation Bills Would Increase Costs for 1.3 Million Low-Income Medicare Beneficiaries (KFF) – KFF forecasts that 1.3 dual-eligible Medicare beneficiaries may lose Medicaid under the budget bill. Over 90% of older adults with Medicaid may find it harder to enroll in and maintain Medicaid.
From Payers of Claims to Partners in Care: The 2025 Healthcare Consumer Study (HealthEdge) – A recent report highlights the growing importance of affordability, transparency, member engagement, and the role of emerging technologies like artificial intelligence (AI) in shaping consumer expectations..

News from the week of June 13, 2025

Rising costs push employers to rethink benefits strategies: WTW (Fierce Healthcare) – A new survey from WTW finds rising costs are pushing employers to be more strategic in their benefits programs, focusing on getting better value from existing contracts or switching partners in an effort to improve outcomes and increase value.
For VM's 2025 Top 50 U.S. Optical Retailers, Industry Grows Alongside Investments in People and Tech (Vision Monday - pages 16-32) – Vision Monday reports on the top optical retailers and provides some perspective on vision retail growth over the past decade.
Predicting emergency department visits for non-traumatic dental-related conditions among Medicaid beneficiaries (Nature) – A recent study used machine-learning algorithms to predict non-traumatic dental-related ED visits. The models they developed could help identify high-risk Medicaid beneficiaries as well as key risk factors and provide insights for developing outreach and care management strategies.
How Technology Is Personalizing Healthcare in 2025 (MedCity News) – Hyper personalized care delivered via technology is becoming a reality in health care. Patients increasingly expect faster, frictionless interactions with their providers and insurance companies.
Claim denials reversed less often for patients earning under $50K, study shows (Fierce Healthcare) – A recent report found that “patients with household incomes below $50,000 per year were not only the least likely to have their denied claims contested but also the least likely to have their claim denials reversed”.
KFF Health Tracking Poll: The Public's Views of Funding Reductions to Medicaid (KFF) – The current KFF Health Tracking Poll finds 54% of adults are concerned that reductions in federal Medicaid spending will negatively impact their ability to obtain and afford healthcare.

News from the week of June 6, 2025

Allocating CBO’s Estimates of Federal Medicaid Spending Reductions and Enrollment Loss Across the States (KFF) – KFF maps out likely federal Medicaid spending cuts and enrollment losses on a state by state basis and a new report looks at how these cuts and ACA subsidy expirations will impact providers.
Trump’s ‘One Big Beautiful Bill’ Continues Assault on Obamacare (KFF Health News) – Experts are assessing potential impacts to the ACA from the House budget bill while state exchange directors make a plea to senators to extend ACA tax credits.
HHS releases more detailed 2026 budget disclosing scope of cuts (Healthcare Dive) – HHS has released more details of its 2026 budget proposal including deep cuts to NIH as well as replacing institutes focused on dental, craniofacial and eye/neurological disorders with a new Institute of Neuroscience and Brain Research.
Health insurance coverage costs soar 6% in 2025 (TechTarget) – An annual survey of health costs finds an annual average cost increase of 6.1% for a family of four over the past two decades, far outpacing wage growth.
The Connected Patient Experience: 3 Tips to Empower Healthcare Delivery Through Innovation (MedCity News) – Patients expect high levels of convenience and better, more connected information regarding their health. A growing number of patients are using apps and wearables to track their personal wellness.
CMS commits to tech initiatives to give Medicare patients, providers easier access to health data (Fierce Healthcare) – CMS has outlined several new tech initiatives including a national healthcare directory, as well as a national identity verification solution and digital insurance card for Medicare.

News from the week of May 30, 2025

J.D. Power: Why commercial plans should be investing more in engagement, education (Fierce Healthcare) – A new survey finds customer satisfaction with their health plans continues to drop. The highest rated plans have invested in engagement, education and improved services often employing digital tools.
New Survey Uncovers Potential Gap in Consumer Awareness and Understanding of Healthcare Portal Security Practices (LexisNexis) – A new survey that looked at consumer usage and data security of healthcare portals finds opportunities for organizations to improve portal adoption and strengthen security while improving user experience.
By the Numbers: House Bill Takes Health Coverage Away From Millions of People and Raises Families’ Health Care Costs (Center on Budget and Policy Priorities) – The Congressional Budget Office has increased its estimate of the number of Americans likely to lose health coverage due to the new budget bill to 15.7 million people.
Utilization of Health Care Services by Medicaid Expansion Status (KFF) – A new KFF study looks at health spending and services in states that have adopted Medicaid expansion. The data shows that expansion states spend more per enrollee overall than non-expansion states and that nearly half of expansion enrollees have a chronic condition.
Proposed Medicaid Cuts Could Jeopardize Health Care Access for 3 in 10 Young Adults (Urban Institute) – The Urban Institute finds that proposed changes to Medicaid would negatively impact and create additional hurdles for the 3 in 10 young adults that access Medicaid as they transition to the workforce.
CMS Administrator Outlines His Vision for CMS at NFP Healthcare Investors Conference (JD Supra) – At a recent event, the new CMS Administrator said he is focusing on digital transformation of health care and eliminating “fraud, waste and abuse” as he seeks to put his mark on the agency.

News from the week of May 23, 2025

Health Provisions in the 2025 Federal Budget Reconciliation Bill (KFF) – As details spill out regarding the House Republican’s “big beautiful” bill that passed earlier this week, KFF is tracking the impact on Medicaid and other health programs. One provision includes cuts to general Medicaid funding for states that use their own budgets to cover undocumented residents. Other concerns involve the impact on the Affordable Care Act, while some elements would impact HSAs and incentivize a shift to ICHRAs.
How State Medicaid Choices Eased Children’s Coverage Loss After COVID-19 (University of Pennsylvania) – The University of Pennsylvania looks at how some states were able to limit children’s CHIP coverage losses through continuous eligibility and streamlined processes during the "unwinding".
Senators reintroduce bill that seeks to reform prior authorization in Medicare Advantage (Fierce Healthcare) – Prior authorization reforms which could ease administrative burdens on providers and reduce care delays for patients have been reintroduced in a Senate bill while CMS is putting additional effort towards increasing MA plan audits.
How Payer-Provider Collaboration is Creating A More Patient-Friendly Healthcare Industry (HIT Consultant) – Successful payer-provider programs are helping solve problems and improve patient access.
CareQuest State Oral Health Dashboard (CareQuest) – New reports on oral health status by state and adult dental coverage are available from CareQuest.
The 2025 State of America’s Oral Health and Wellness Report (Delta Dental) – Delta Dental's annual report card dives into patient understanding of oral health and the practice of good oral hygiene across different generations.

News from the week of May 16, 2025

The GOP’s Trying Again To Cut Medicaid. It’s Only Gotten Harder Since 2017 (KFF Health News) – In Washington, the focus is on the 2025 budget reconciliation bill. The Congressional Budget Office notes that the measure would result in an additional 13.7 million Americans becoming uninsured by 2034. KFF has a tracker that is following specific provisions in the bill.
As MA growth slows, analysts urge optimism (Healthcare Brew) – Increases in regulations and higher utilization have forced plans to recalibrate how to price and market Medicare Advantage plans while more seniors opted for traditional Medicare than in previous years.
CMMI revamps strategy to focus on disease prevention, cost savings (Healthcare Dive) – The Center for Medicare and Medicaid Innovation is shifting its focus to preventing chronic disease.
FDA to pull prescription fluoride supplements from market (ADA News) – The ADA is reaffirming its support of fluoride supplements after the FDA announced plans to remove prescription fluoride supplements from the market.
Prevent Blindness Cheers the Reintroduction of ‘Early Detection of Vision Impairments for Children Act’ (Vision Monday) – Prevent Blindness is supporting a bill that would address children’s vision through grants to improve early identification and vision care coordination of potential vision problems.
The Vision Council's Research Webinar Reveals Trends in Managed Vision Care (Vision Monday) – New research finds consumers with individual eyecare plans had the highest levels of satisfaction, while Medicaid ranked lower due to limited allowances. Patients also gave high marks to providers that were able to assist with required paperwork.

News from the week of May 9, 2025

Forrester: How payers can balance cost cutting with customer experience improvements (Fierce Healthcare) – A new report provides insights on ways to both improve the customer experience while effectively managing costs.

Healthcare Associations Speak Out Against White House’s Plan for Massive HHS Cuts (HCI Innovation Group) – Healthcare groups and the public are voicing strong opposition to additional HHS cuts in the White House’s 2026 budget proposal.

Medicare Advantage Insurers Often Use Rewards and Incentives to Encourage Enrollees to Complete Health Risk Assessments (HRAs) (KFF) – While most Medicare Advantage enrollees are in plans that offer rewards or incentives for completing a Health Risk Assessment, limited data makes it difficult to determine the impact on members.

Responding to Federal Medicaid Reductions: Which States Are Most at Risk? (KFF) – A series of reports from KFF detail which state Medicaid programs are most at risk and what we might see in the form of provider tax regulations and per capita caps on the ACA expansion population.

Congressional District Interactive Map: People with Medicare and Medicaid (Dual-Eligible Individuals) (KFF) – KFF is out with a map highlighting dual eligible membership across congressional districts.

NADP Foundation Report: Addressing Retiree Oral Health Needs. An analysis of current dental coverage and recommendations for expanded coverage (NADP) – A new analysis reveals large gaps in dental coverage for individuals aged 55 and older, leaving nearly 31% of this group without coverage.

2025 Global Priorities Survey (International Insurance Society) – A survey of insurance executives from across different sectors reports their leading concerns include inflation, operational efficiency, AI and expense management.

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