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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 September 25, 2026

• 400 laws and counting: dental advocacy is driving change (ADA News) – A new ADA report looks at their dental advocacy efforts nationwide, with more than 400 enacted laws affecting access to care, workforce development, and practice operations. They are also urging policymakers to increase scrutiny of dental insurance practices, citing concerns about transparency, reimbursement, and consumer protection.
• When Treating Patients With Down Syndrome, Experts Suggest Specialized Vision Care Plans (Vision Monday) – Experts recommend tailored vision care approaches for individuals with Down syndrome to address their unique eye health needs and improve long-term outcomes.
• Survey Highlights Vision’s Role in Retirement Independence, Underscores Potential Costly Tradeoffs (Vision Monday) – New survey findings show that maintaining healthy vision plays a critical role in supporting independence and quality of life for retirees.
• State Medicaid Costs Just Saw Their Biggest Jump in Decades (Governing) – A pair of reports looks at the largest increase in state Medicaid spending in decades and ongoing fiscal pressures that may impact Medicaid funding, benefits, and program administration.
• 73% of small, mid-size employers considering dropping group coverage in 2027: Survey (Becker's Payer) – A recent survey indicates many employers are reassessing healthcare benefits due to rising costs and growing affordability concerns.
• National uninsured rate holds at 7.9% amid changing coverage mix (Becker's Payer) – Despite shifts between Medicaid, employer-sponsored, and marketplace coverage, the nation’s uninsured rate has remained relatively stable according to Census Bureau data.

News from the week of September 18, 2026

• Only 46% of Gen Z, Millennial health plan members trust payers: Accenture survey (Fierce Healthcare) – Accenture found fewer than half of younger health plan members trust insurers, highlighting opportunities to improve transparency and member engagement.
• How Medical Bills and Debt Impact Americans with Private Insurance (Commonwealth Fund) – New research highlights that many insured Americans still face substantial medical debt due to cost sharing, deductibles, and affordability challenges.
• Plan switches for dually eligible MA members increasingly common (Becker's Payer) – Frequent plan changes among dual-eligible Medicare Advantage members continue to raise concerns around continuity of care.
• Half of Medicare Advantage stars thresholds harder to reach in 2027 (Healthcare Dive) – New CMS quality benchmarks may make it more challenging for Medicare Advantage plans to achieve higher Star Ratings.
• Survey: Adults with Multiple or Complex Health Conditoins Face Significant Chllenges with Health Costs and Commonly Struggle to Access Care (KFF) – Survey results show individuals with multiple chronic conditions continue to face affordability and access barriers despite having insurance coverage. 
• How Medicaid work requirements could impact young adults (Urban Institute) – The Urban Institute details how new work requirement policies could create coverage disruptions for younger Medicaid members ages 19-34 and increase administrative complexity for states.
• New Vision Council Data Show Rising Prices Boost Optical as Volume and Provider Confidence Soften (Vision Monday) – New vision industry data show optical revenues increasing due to higher prices, while patient volume growth and provider sentiment have softened.

News from the week of September 11, 2026

• Supplemental health benefits boost employee retention (Benefits Pro) – A Prudential survey found employers offering supplemental benefits, including dental and vision, may be better positioned to attract and retain workers in a competitive labor market.
• Nearly half of small business employees are not offered health insurance: CBO (Becker's Payer) – New Congressional Budget Office data shows many small-business employees still lack employer-sponsored coverage, highlighting ongoing affordability and access challenges in the commercial and ACA markets.
• Coordinated care boosts oral health during pregnancy (Dr. Bicuspid) – New findings show that integrating dental care into prenatal care programs can improve oral health outcomes for pregnant women while supporting broader maternal health goals.
• Eyewear Spending Stabilizes After Cautious Quarters, The Vision Council Finds in Q2 inSights Report (Vision Monday) – Consumer spending on eyewear appears to be stabilizing after several softer quarters, suggesting improving confidence and demand in the optical market. 
• OBBBA's state-directed payment caps will trim some states' Medicaid spend by a quarter: study (Fierce Healthcare) – A new study estimates that state-directed payment caps under OBBBA could significantly reduce Medicaid spending in certain states, with 17 hard-hit states seeing cuts ranging from 10% to 25% of their total annual Medicaid spending.
• New Jersey Enacts Medicaid Employer Assessment (Brown & Brown) – New Jersey has approved a Medicaid employer assessment that will require employers with 50 or more employees enrolled in New Jersey Medicaid to pay a fee for each employee and dependent enrolled in New Jersey Medicaid.

News from the week of September 4, 2026

• From Medicare for All to Medicaid cuts, 5 healthcare fights on the ballot this midterm election (Becker's Payer Issues) – Healthcare remains a dominant political issue, with key debates ranging from Medicare expansion proposals to Medicaid funding policies and approaches for addressing healthcare affordability.
• Self-pay hospital visits spike as coverage losses mount (Becker's Payer Issues) – Hospitals are seeing more self-pay patients as insurance coverage declines, underscoring ongoing affordability challenges. While a new study found beneficiaries with more complex health conditions are increasingly leaving Medicare Advantage plans and enrollment in state-based Affordable Care Act marketplaces has declined 8.5%. Finally, researchers estimate that as many as 10 million adults could face coverage disruptions if work requirements are implemented.
• Docs are seeing more patients influenced by mis- and disinformation. What can they do about it? (Fierce Healthcare) – Physicians are increasingly encountering patients affected by health misinformation and are exploring new communication approaches to improve trust and support informed decision-making.
• “High-Deductible Health Plans Are Not the Answer” (University of Pennsylvania) – New research suggests high-deductible health plans can create barriers to care and may not effectively address underlying drivers of healthcare costs, adding to ongoing debates about cost-sharing strategies in employer-sponsored coverage.
• Physicians want compensation boost from AI productivity gains: survey (Healthcare Dive) – A physician survey found growing support for sharing the financial benefits generated by AI-driven productivity improvements with clinicians who use the technology in practice.
• NCQA to use Komodo data, AI tool to develop future HEDIS measures (Fierce Healthcare) – NCQA plans to incorporate advanced AI tools and real-world healthcare data into the development of future HEDIS quality measures, potentially reshaping performance measurement across the industry.

News from the week of August 28, 2026

• Many Medicare beneficiaries are confident they understand the program. The data says otherwise (Fierce Healthcare) – A new study finds that while many beneficiaries believe they understand Medicare coverage, significant gaps remain regarding plan options, benefits, and enrollment rules. Researchers suggest these knowledge gaps may contribute to suboptimal plan selection and higher out-of-pocket costs.
• As costs rise, C-suite is getting more involved in healthcare: Employer survey (Fierce Healthcare) – A new survey found senior executives are becoming increasingly involved in healthcare benefit decisions due to escalating costs. Employers are treating health spending as a strategic business risk rather than a routine HR function. Large employers are implementing a wide range of strategies, including benefit redesign, care navigation, and prescription drug management, to address rising healthcare expenses.
• Widespread losses, diverging futures: Why some health plans will emerge stronger while others face retrenchment (HealthScape) – Nearly 75% of health plans lost money in 2025, and HealthScape warns that the industry is splitting between well-capitalized organizations that can continue investing and adapting and financially weaker plans that may be forced to retrench, merge, or exit markets. While Moody’s reports that elevated medical spending remains a major obstacle to insurer margin recovery.
• 53% of US adults feel they have no say when AI is used in care (Fierce Healthcare) – According to Pew Research a majority of Americans report feeling excluded from decisions about when artificial intelligence is used in healthcare. The findings highlight growing concerns about transparency and patient consent.
• How Trump’s cuts are reshaping America’s health system (STAT News) – STAT news examines how federal healthcare funding reductions are affecting coverage, providers, and healthcare delivery across the country. Analysts suggest the policy changes could have broad implications for patients and health systems alike.
• Illinois enacts new protections against abusive vision benefit practices (American Optometric Association) – The American Optometric Association is supporting vision care market legislation across the country. In Illinois lawmakers approved legislation aimed at protecting providers and consumers from what they feel are restrictive or anti-competitive vision benefit practices.

News from the week of August 21, 2026

• Scheduling dental care during prenatal visits boosts oral health care during pregnancy (Medical Xpress) – Research suggests that coordinating dental appointments during prenatal care visits significantly increases the likelihood that expectant mothers receive necessary oral healthcare, helping improve both maternal and infant health outcomes.
• Practice of the Future Report (VSP Vision) – A new report explores how artificial intelligence, emerging technologies, and evolving care delivery models are expected to reshape the economics and operations of vision practices. In addition, as smart eyewear technologies continue to evolve, opticians are expected to play a larger role in product education, device support, and integrating digital vision solutions into patient care. Industry experts suggest integrating prescription lenses into AI-enabled smart glasses could accelerate consumer adoption.
• 83% of employers say rising healthcare costs are squeezing pay raises (Becker's Payer) – Most employers report that escalating healthcare benefit costs are limiting their ability to increase employee compensation, say healthcare costs hurt their competitiveness and expect costs to shift to employees. .
• Study examines how ICHRA adoption could help stabilize ACA risk pools (Fierce Healthcare) – Researchers suggest that broader use of Individual Coverage Health Reimbursement Arrangements could improve ACA marketplace stability by attracting additional healthy enrollees.
• JD Power: Member satisfaction with Medicare Advantage plans continues to slide (Fierce Healthcare) – A new JD Power study found declining satisfaction among Medicare Advantage members, driven by concerns about costs, access, and administrative complexity. The results signal mounting pressure on MA plans to improve member experience.
• What Americans Want Fixed in Health Care — and Who They Think Should Do It (Commonwealth Fund) – Survey findings reveal widespread concern about healthcare costs and access, along with differing perspectives on whether government, employers, or insurers should lead reform efforts. Consumers continue to identify out-of-pocket costs, premiums, and affordability challenges as their primary frustrations with the healthcare system.

News from the week of August 14, 2026

• Connecting the Dots: How a Unified Platform Enables Whole-Person Care (Medcity News) – SKYGEN’s Dr. Paul explains how integrated healthcare technology platforms help coordinate clinical, administrative, and member data to support whole-person care. While dental providers frequently identify early signs of chronic conditions such as diabetes, hypertension, and other systemic diseases, fragmented technology systems often prevent that information from being effectively shared with the broader care team.
• State of the U.S. Dental Economy Q2 2026 (ADA HPI) – The ADA Health Policy Institute's Q2 2026 report presents a generally positive outlook for the dental industry despite ongoing financial pressures. At the same time, the report highlights significant headwinds facing practices. Low reimbursement rates, insurance pressures, rising labor costs, inflation, and increasing operating expenses continue to squeeze margins. The report also includes a special focus on artificial intelligence, finding growing adoption of AI tools for administrative functions such as insurance verification, documentation, billing, and claims processing, while dentists remain far more cautious about using AI in clinical decision-making. 
• Massachusetts orders $8.4 million in dental insurance rebates under loss ratio law (Fierce Healthcare) – Massachusetts regulators required dental insurers to return $8.4 million to members after failing to meet medical loss ratio requirements. The Massachusetts initiative is already influencing other states, with additional dental loss ratio laws being adopted across the country as policymakers seek greater accountability in the dental benefits market.
• Medicare's paying less for cataract surgery. Eye doctors are turning to moneymaking lasers. (UPENN) – Declining Medicare reimbursement rates for cataract surgery are creating financial pressure for ophthalmology practices. In response, some providers are increasingly offering premium laser-assisted procedures and advanced lens options that are not fully covered by Medicare and can generate additional revenue. In addition, a healthcare startup has developed a rapid vision assessment tool designed to improve access and convenience. The innovation highlights growing consumer demand for retail-based healthcare solutions and digital eye care services. 
• Claims data transparency empowers employers to act on affordability: survey (Fierce Healthcare) – A recent survey found that employers with greater access to healthcare claims data are better positioned to identify cost drivers and manage healthcare spending. Increased transparency enables organizations to evaluate utilization patterns, negotiate with vendors, and implement targeted cost-containment strategies. A new report also finds employers are increasing their adoption of ICHRAs, reflecting growing adoption among organizations seeking greater flexibility and predictable benefits costs. 
• You Know What You’re Spending on Credentialing. You Don’t Know What It’s Costing You. (Becker's Payer Issues) – The article examines the hidden operational, staffing, and revenue impacts of inefficient provider credentialing processes. The author argues that most organizations can identify what they spend on credentialing services, but few measure the hidden costs associated with provider onboarding delays, network access issues, compliance risks, fraud exposure, and operational inefficiencies.

News from the week of August 7, 2026

• AI Is Being Used to Boost Medicaid Enrollment, but Not Without Concerns (KFF Health News) – Organizations serving Medicaid populations are increasingly deploying artificial intelligence tools and virtual assistants to help eligible individuals complete enrollment and reenrollment processes. There is a growing tension between improving efficiency and ensuring equitable access to public healthcare programs.
• Medicaid work rule leaves homeless people in the cold (NPR) – Critics argue Medicaid work requirements may disproportionately affect homeless populations. Administrative complexity, lack of stable housing, and limited access to technology could increase the risk of coverage losses among some of Medicaid's most vulnerable beneficiaries. 
• Democratic AGs file suit challenging 2027 ACA rule (Fierce Healthcare) – A coalition of Democratic state attorneys general has filed a lawsuit seeking to block a federal rule that would change Affordable Care Act marketplace operations beginning in 2027. The challengers argue that the regulation could make it more difficult for eligible consumers to enroll in and maintain coverage, potentially increasing the number of uninsured individuals. While new reporting looks at the factors leading to large premium increases for 2027.
• Why Some Family Health Insurance Is Now Much Pricier (UPENN) – Researchers from the University of Pennsylvania's Leonard Davis Institute examine how premium growth, cost-sharing obligations, and income disparities can leave households spending a larger percentage of their earnings on healthcare coverage. The authors also explore policy options that could improve affordability and reduce financial strain for families.
• Bridging the Divide: How Teleoptometry Is Transforming Care in ‘Healthcare Deserts’ (Vision Monday) – Teleoptometry is emerging as an effective strategy for addressing eye care shortages in rural and underserved communities where access to vision specialists is limited. By leveraging digital technologies, providers can conduct remote screenings, consultations, and follow-up care while expanding their reach beyond traditional clinic settings. 
• As AI use rises, younger adults skip preventive care, survey finds (Fierce Healthcare) – A new survey suggests that younger consumers, particularly Gen Z adults, are increasingly turning to artificial intelligence tools for health information before seeking professional medical advice. While respondents reported finding AI resources convenient and accessible, the findings raise concerns that reliance on technology may contribute to delayed preventive care visits and missed opportunities for early intervention.

News from the week of July 31, 2026

• Lawmakers introduce 3 bills to expand dental coverage under Medicaid, Medicare and CHIP: 6 notes (Becker's Dental) – Congressional lawmakers have introduced multiple proposals aimed at expanding dental coverage across public health programs. The legislation could significantly broaden access to preventive and restorative oral healthcare for children, adults, and seniors.
• More than 1 in 3 employers actively planning for, considering ICHRA: 8 notes (Becker's Payer) – Employers increasingly view ICHRAs as an alternative benefits strategy but awareness gaps remain.
• Medicare Advantage enrollment share to reach 57% by 2036: CBO (Becker's Payer) –The Congressional Budget Office projects continued expansion of Medicare Advantage enrollment over the next decade. The trend reflects beneficiaries' growing preference for managed care plans that offer supplemental benefits and coordinated care. While a new industry survey finds Medicare Advantage members generally experience lower out-of-pocket healthcare costs than beneficiaries enrolled in traditional Medicare.
• ‘Virtually everyone who lost their exchange coverage became an uninsured patient,’ UHS CFO says (Becker's Payer) – Loss of ACA marketplace coverage contributed to growing uninsured patient volumes. While a new KFF report analyzes ACA marketplace enrollment trends and variations across states.
• Medicaid Work Requirements: Federal Outreach Requirements and State Plans (KFF) – This overview examines state proposals and federal guidance related to Medicaid work requirements. It discusses implementation challenges, beneficiary communication obligations, and potential impacts on enrollment.
• 7 AI health insurance state laws passed in 2026 (Becker's Payer) – States are advancing a patchwork of legislation to regulate AI use in health insurance. Many of the new rules impact the use of AI for authorization decisions.

News from the week of July 24, 2026

• Are women in the U.S. on the precipice of taking over dentistry? (Dr. Bicuspid) – A recent study explores changing demographics and growing female representation in the dental profession and suggests that these trends may improve access to oral healthcare.
• MA Dental Benefits Are Growing, But The Data Needed For Accountability Are Not (Health Affairs) – Dental benefits now play a central role in Medicare Advantage enrollment, directly affecting how public dollars are allocated through plan payments and rebates. Yet the data needed to evaluate dental benefits at the plan-level have not evolved alongside their growing importance. .
• State dental insurance reforms continue momentum in 2026 legislative sessions (ADA News) – The ADA reports that this year's state-level efforts to reform dental insurance regulations and consumer protections focused on dental loss ratios, virtual credit card payments, network leasing, assignment of benefits, retroactive claim denials and downcoding.
• Medicaid Work Reporting Requirements: How Will States Protect Coverage for Pregnant and Postpartum Women? (Georgetown University) – A new report explores the challenges states may face in preserving coverage for pregnant and postpartum Medicaid members under new work reporting requirements while KFF analyzes how immigration-related public charge policies could impact between 1.4 to 4.1 million Medicaid/CHIP enrollees living in a household with a noncitizen due to public charge and other immigration-related fears.
• 1 in 4 workers stay in unwanted jobs for health coverage, survey finds (Healthcare Dive) – A survey suggests healthcare benefits remain a significant factor in employee job retention.
• The ‘Bot Vs. Bot’ Dynamic Between Providers & Payers Is Driving Up Costs for Everyone (Medcity News) – HSS chief digital and information officer Ashis Barad, who has worked on both the payer and provider sides of healthcare AI, thinks the industry’s growing “bot vs. bot” battle over prior authorizations and appeals is driving costs up.

News from the week of July 17, 2026

• ADA opposes insurance companies charging for paper checks (ADA News) – The ADA continues to oppose administrative fees charged to providers for receiving paper reimbursements while payers defend their payment practices to improve efficiency and reduce processing costs.
• As Baby Boomers Age, Demand for Geriatric Vision Care Services Intensifies (Vision Monday) – The aging population is driving increased demand for vision care services designed for older adults.
• Trust between providers and insurers climb, survey finds (BenefitsPro) – Survey results suggest provider-payer relationships are improving, driven by more collaboration and streamlined administrative processes.
• Feds push back HIPAA security rule overhaul to July 2027 (Fierce Healthcare) – Federal regulators have delayed major HIPAA cybersecurity and security rule updates and CMS has proposed replacing traditional MIPS reporting, expanding accountable care models, and modernizing physician reimbursement structures.
• Medicaid and the Road Ahead: Spending Cuts, Work Requirements and What’s Next for States, Providers and Families (KFF) – KFF reviews potential federal and state Medicaid policy changes and their impact on stakeholders while another article examines how Medicaid plans are working to improve member engagement and outcomes.
• A Profile of Dual-Eligible Individuals (KFF) – KFF outlines key demographic, health, and spending characteristics of dual-eligible beneficiaries who rely on both Medicare and Medicaid.

News from the week of July 10, 2026

• Eye doctors ask states to protect them from vision plan price pressure (Benefits Pro) – Optometrists are urging state policymakers to address reimbursement and pricing practices at an upcoming NCOIL meeting. Independent eyecare practitioners say they are being harmed by low rates, while vision plans say optometrists attempt to limit price competition will only harm consumers. 
• This is why U.S. dentists are being disciplined (Dr. Bicuspid) – A JADA analysis finds that 40% of disciplinary actions against dentists were due to gross negligence or repeated acts of clinical incompetence. 
• Obamacare rolls shrank dramatically in many states over the past year, new federal data shows (STAT) – Federal data shows significant declines in ACA Marketplace enrollment across multiple states while insurers are requesting substantial premium hikes for 2027 as costs and market uncertainty continue to grow. Finally, ongoing litigation could delay or reshape planned reforms to ACA marketplace operations and enrollment processes.
• CMS floats new Medicare payment category for AI diagnostics software (Becker's Payer Issues) – CMS is considering a new reimbursement approach for AI-powered diagnostic tools under Medicare payment policies that could accelerate adoption.
• 'Medicare Advantage has never saved a penny': Democrat-led bill seeks to rein in MA (Becker's Payer Issues) – Federal lawmakers introduced legislation aimed at increasing oversight and limiting perceived excesses in Medicare Advantage,

News from the week of July 2, 2026

• When Medicaid Pays the Bill: Routine Vision Benefits, Eye Care Use, and Eyeglasses Spending Among Dual-eligible Medicare Enrollees (National Bureau of Economic Research) – A recent study explores Medicaid-financed vision care utilization and spending for dual-eligible beneficiaries. Researchers found that Medicaid-funded vision benefits contribute significantly to eye exams, eyeglasses utilization, and access to routine vision care while reducing out-of-pocket costs for dual eligibles. Benefits lead to higher Medicaid spending on eyeglasses and modest spillovers to Medicare Advantage plans.
• AI Eye Screening May Narrow One Gap but Access to Care Still Depends on What Happens Next (Daily Scanner) – AI-powered retinal and eye disease screening tools may help identify vision problems earlier and improve diagnostic capacity, particularly in underserved areas. However, meaningful outcomes still depend on follow-up care availability, provider access, and patient adherence. .
• Nevada Medicaid expands dental benefits for adults (2 News Nevada) – Nevada expanded Medicaid adult dental benefits effective July 2026, adding coverage for preventive services, exams, cleanings, diagnostics, fillings, crowns, and periodontal treatment. The expansion significantly broadens adult oral-health access beyond emergency-only coverage. While the Chicago Tribune reports that Medicaid patients in Illinois can wait more than a year for dental care due to low reimbursements.
• How Has Projected Medicaid Spending and Enrollment Changed Since Passage of the 2025 Reconciliation Law? (KFF) – KFF examines the latest Congressional Budget Office reporting to get a better view of how federal policy changes may alter projected Medicaid enrollment and spending, reflecting revised estimates for beneficiary participation, state costs, and federal expenditures. While the latest tracker updates Medicaid/CHIP enrollment levels through March 2026.
• Report: Indiana leads nation in decline of children insured through Medicaid (Indiana Capital Chronicle) – Indiana has experienced the largest decline in Medicaid-covered children following redetermination efforts. The report highlights concerns about eligible children losing coverage due to administrative barriers, renewal challenges, or family confusion regarding eligibility requirements.
• 3 in 10 adults turn to AI or social media for health advice, citing difficulties accessing and affording care (Fierce Healthcare) – A new KFF poll found that nearly 30% of consumers now rely on AI tools or social media platforms for healthcare guidance, largely due to challenges accessing affordable healthcare and provider shortages. For health plans, this trend reinforces the need for trusted member-facing digital engagement tools, virtual care options, and AI-powered health education platforms to reduce reliance on unverified sources. 

News from the week of June 26, 2026

• About 4% of child dental sedation visits end with a problem (Dr. Bicuspid) – A large study found about 4% of pediatric dental sedation cases result in complications (e.g., ER visits), highlighting safety risks and the need for stronger monitoring and protocols.
• Emergency department use for nontraumatic dental conditions for Medicaid-enrolled children with special health care needs (JADA) – Research shows ED utilization remains high among Medicaid children with special needs for preventable dental issues.
• Medicare’s AI Push Snarls Patients and Doctors in Errors and Delays (KFF Health News) – A new AI-driven prior authorization pilot (WISeR) is causing confusion, delays, and administrative burden, raising concerns about access to care for seniors, while policymakers seek greater transparency.
• Congressional Budget Office calls for more research on No Surprises Act unintended impacts (Fierce Healthcare) – The CBO highlights uncertainty around unintended consequences of the No Surprises Act, calling for further analysis.
• Why So Few Appeals Happen and What That Reveals About Health Plans (Fierce Healthcare) – Analysis suggests structural barriers discourage members from appealing payer decisions. However, health plans should be aware of how this breakdown in process may ultimately cause reputation damage.

News from the week of June 19, 2026

• Trends in dentists' income, revenue and hours worked (ADA HPI) – A recent ADA Health Policy Institute report finds that dentist incomes have declined or remained flat over the past 15 years due to rising practice expenses outpacing modest revenue growth. Despite these pressures, gaps in income between male and female dentists and between practice owners and associates have narrowed, while dentists are working more hours overall, especially on administrative tasks.
• Study: Medicaid cuts could cost $87M in dental care (Dr. Bicuspid) – A new Harvard study quantifies how proposed Medicaid cuts could significantly reduce dental care access, particularly for adults. In addition, state dental organizations report that state level legislative proposals to address shortfalls in Medicaid funding could disproportionately impact optional adult dental benefits.
• ADA pilot program offers blueprint for increasing dentist participation within Medicaid, launches new multistate partnership (ADA News) – A multistate pilot project is looking at ways to improve Medicaid dentist participation through incentives, administrative simplification, and partnerships. The program aims to address provider shortages and improve network adequacy.
• Improving Patient Outcomes Through Inclusive Eyecare Services (Vision Monday) – Expanding inclusive eyecare services is improving outcomes for underserved populations. 

News from the week of June 12, 2026

• Surprising factor that keeps people away from the dentist (Dr. Bicuspid) – Non-clinical barriers including depression may be keeping people from visiting the dentist. The findings suggest improving mental health support and access to care could help increase dental utilization and overall oral health outcomes.
• Two Million Fewer Children are Enrolled in Medicaid Since Trump Took Office (Georgetown CCF) – Georgetown’s state-by-state Medicaid/CHIP enrollment tracker indicates a drop of 2 million children enrolled in Medicaid and CHIP through April 2026 since the start of the Trump administration, prior to Medicaid cuts being implemented.
• 10 key Medicare Advantage numbers to know in 2026 (Becker's Payer) – KFF has a new snapshot of enrollment, growth, and utilization trends shaping Medicare Advantage in 2026.
• Could a Court Ruling Upend Medicare Advantage Star Ratings? (HC Innovation) – Legal challenges to the star ratings system could disrupt quality measurement and payer incentives.
• Small businesses feel the squeeze as healthcare costs rise: Morgan Health (Morgan Health) – Reports illustrate employer-sponsored coverage affordability pressures persist while nearly half of working-age adults struggled to afford healthcare in 2025 including those with coverage.

News from the week of June 5, 2026

• Trump’s Medicaid Work Rules Force States To Scrap Plans and Rework Systems (KFF Health News) – CMS’s recently published Medicaid final rule is forcing states to scrap months of preparation less than seven months before work requirement rules become effective. Stakeholders also argue documentation requirements will create substantial burdens for members. We are also getting a view of how states like Montana and North Carolina are approaching budget strains and operational challenges in implementing the rules.
• CDC: 2025's uninsured rate stayed flat at 8.3% (Fierce Healthcare) – U.S. uninsured rates remained stable at 8.3% in 2025, though total uninsured increased slightly. Child enrollment in Medicaid and CHIP has declined below pre-pandemic levels.
• Why Ob-Gyns, States, and Plans, Should Care About Oral Health (Medcity News) – Stakeholders across healthcare are increasingly recognizing oral health as a critical component of overall health outcomes and are reacting by integrating dental screenings, education, and coverage into prenatal care to improve outcomes for mothers and infants and reduce long-term healthcare costs.
• Employers are facing a new threat to workers' oral health (BenefitsPro) – Employers are facing a growing challenge as rising cost disparities and consumer misunderstandings around dental procedures—such as unexpectedly high charges for services like deep cleanings—are creating affordability issues for workers, highlighting the need for better education, preventive care focus, and pricing transparency in dental benefits. .
• How Personalized Eyecare Can Impact the Patient Experience (Vision Monday) – Personalized eyecare is transforming the patient experience by using individual lifestyle, genetic, and health data to deliver more accurate, tailored treatments that increase engagement, satisfaction, and long-term patient loyalty.  
• New HSCC guide addresses cybersecurity risks specific to healthcare AI (Healthcare IT News) – Industry guidance highlights emerging AI-specific cybersecurity vulnerabilities.

News from the week of May 29, 2026

• What Trends Are Shaping the Dental and Vision Benefits Market? (MedCity News) – Based on interviews from SKYGEN's Transform26 Summit, MedCity News looks at evolving trends in dental and vision benefits, including cost pressures, value-based care, and digital engagement.
• CMS finalizes rule prohibiting adult dental benefits as an essential health benefit (ADA News) – CMS finalized a rule removing adult dental benefits from ACA essential health benefit requirements, potentially limiting coverage access and ACAP warns that this introduces additional uncertainty into an already unstable individual market.
• JAMA study projects pediatric Medicaid disenrollment would worsen oral health, raise health care costs (ADA News) – A JAMA study finds that pediatric Medicaid disenrollment could lead to poorer oral health outcomes and higher long-term healthcare costs while a recent survey shows most West Virginia Medicaid enrollees are unaware of upcoming work requirements, raising concerns about coverage disruptions due to lack of communication.
• Key Facts About Health Care Affordability for People With Medicare (KFF) – KFF reviews affordability challenges for Medicare beneficiaries, including out-of-pocket costs and access barriers despite coverage while the ADA is backing legislation designed to improve transparency and oversight of dental benefits within Medicare Advantage plans.
• AI, ICHRA gain steam as employers face exploding benefits spending (Becker's Payer) – Employers are increasingly adopting AI tools and ICHRA models to manage rising healthcare costs and shift benefits strategies.
• JD Power: Cost pressures worsen member experience with commercial plans (Fierce Healthcare) – Rising healthcare costs are negatively impacting member satisfaction, with affordability and service issues driving lower experience scores. The latest Milliman index shows healthcare costs for a typical U.S. family have risen to nearly $38,000 annually, driven by higher utilization and specialty care spending.
• Delta Dental report: Patient awareness of oral-systemic link reaches record high (Dr. Bicuspid) – Delta Dental’s latest report shows growing recognition of the connection between oral health and overall health, though knowledge gaps remain for specific conditions.
• Dental Student Demographics Have Changed. And Might Change Even More. (ADA HPI) – A new ADA HPI report find that over the past two decades, U.S. dental education has expanded significantly and become more gender-diverse, but racial and ethnic representation—particularly among historically underrepresented groups—has improved only modestly and continues to lag behind broader population trends. 

News from the week of May 22, 2026

• NADP: provider, patient benefits rose; dental plan enrollment fell in 2024 (Globe News Wire) – A recent NADP report spite finds that despite declining dental plan enrollment in 2024, insurers increased payments to providers and enhanced patient financial protection through higher annual benefit limits amid affordability pressures.
• Google Targets Fall 2026 to Debut ‘Intelligent Eyewear,’ Points to Partnerships With Warby Parker, Gentle Monster and Samsung (Vision Monday) – Google plans to launch AI-powered “intelligent eyewear” in fall 2026—developed with Samsung and design partners Warby Parker and Gentle Monster—that will use Android XR and Gemini to deliver hands-free, real-time assistance through both audio and display-enabled smart glasses.
• 71% of US adults use health-related apps, 64% devices: report (Fierce Healthcare) – A new survey found digital health tools have become mainstream, with most U.S. adults using apps and devices as part of daily health management and tracking routines. However, a CVS study found that while most Medicare-eligible individuals are interested in digital health tools, widespread gaps in digital literacy hinder their ability to effectively manage their care.
• Annual payments to Medicare Advantage brokers may top $10B: Study (Becker's Payer) – Payments to Medicare Advantage brokers have surged to around $10 billion annually, with most spending driven by ongoing commissions for member renewals rather than new enrollments.
• What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles (KFF) – Early 2026 ACA data shows premiums and deductibles rising sharply and enrollment declining as the end of enhanced subsidies pushes many consumers into higher-cost or higher-deductible coverage. In addition, CMS finalized a rule removing limits on non-standard ACA plan offerings to increase insurer flexibility and consumer choice while strengthening oversight and eligibility verification.

News from the week of May 15, 2026

• Regulation of AI in Prior Authorization and Claims Review: A Look at Federal and State Consumer Protections (KFF) – While AI is increasingly used in prior authorization and claims review to improve efficiency, existing federal oversight is fragmented and limited, state protections vary, and future federal AI policy could override state rules—creating uncertainty around how to balance innovation with consumer safeguards like fairness, transparency, and human review. Meanwhile, a recent survey finds most payers are prioritizing vendor-developed AI over in-house solutions to accelerate adoption and reduce complexity.
• The Cost of the GOP’s Medicaid Cuts: ER Bills for States and a Spiraling Oral Health Crisis (Talking Points Memo) – Proposed state cuts to Medicaid including lower caps and other measures could drive higher emergency care costs, reduce access to care and worsen oral health outcomes nationwide.
• CMS to withhold $1.3B in Medicaid funds from California, puts state officials on notice about fraud (Fierce Healthcare) – CMS is withholding $1.3 billion from California’s Medicaid program over alleged fraud concerns and demanding stronger enforcement.
• 1 in 5 marketplace enrollees dropped their coverage in 2026: media report (Fierce Healthcare) – Roughly one in five ACA marketplace enrollees lost or dropped coverage during the first few months of this year, largely driven by rising premium costs.
• Digital Fatigue: Healthcare’s Next Patient Experience Crisis (MedCity News) – Digital overload is emerging as a key barrier to patient engagement and satisfaction.

News from the week of May 8, 2026

• 2026 Report on State Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies Includes Special Edition on Medicaid Work Requirements (Georgetown University) – A recent webinar digs into KFF’s new reports on state Medicaid and CHIP eligibility and renewal policies, with a focused analysis on the expansion and implications of Medicaid work requirements while another recent report finds a majority of Medicaid mothers are concerned about losing coverage during pregnancy or postpartum, reflecting growing instability in the program.
• KFF Health Tracking Poll: Health Care Costs and the Midterms (KFF) – A KFF poll finds that rising healthcare costs are a major voter concern heading into the midterm elections, influencing public attitudes toward health policy and political leadership. In addition, a new survey finds that half of consumers surveyed are reducing healthcare utilization due to cost confusion and lack of transparency.
• Vision Care Spending Edged Downward in Q1 2026, The Vision Council’s Consumer inSights Report Shows (Vision Monday) – Vision care spending declined slightly in the first quarter of 2026, reflecting cautious consumer behavior amid broader economic pressures, according to The Vision Council’s Consumer inSights report.
• How PE Is Adjusting Its Healthcare Playbook Now that It’s Under the Microscope (Medcity News) – Private equity firms are adapting investment strategies in healthcare amid increased regulatory scrutiny and market pressure, while a new dental industry report shows dental DSOs are preparing for increased acquisition activity in 2026, driven by recapitalization cycles and more selective, risk-focused dealmaking.
• What’s keeping health plan leaders up at night? (Becker's Payer News) – Health plan executives cite rising medical costs, regulatory scrutiny, technology disruption, and member affordability as their top ongoing concerns.

News from the week of May 1, 2026

• Rising Health Care Costs Are Keeping Americans Awake at Night, Imagine360 Survey Finds (Vision Monday) – A bevy of new reports show that health care cost pressures are at the top of consumer economic worries, with many reporting significant anxiety and lost sleep over medical expenses..
• The Commonwealth Fund 2026 State Health Disparities Report (Commonwealth Fund) – The Commonwealth Fund 2026 State Health Disparities Report details significant racial and ethnic disparities in healthcare access, quality, and outcomes persist in every U.S. state, and warns that recent and impending federal policy changes could widen these gaps despite recent gains in coverage. Related research highlights the gap in dental provider access among rural patients.
• Only 1 in 4 employers able to ‘absorb’ increasing health benefit costs without impacting business (Fierce Healthcare) – A new survey shows that just one-quarter of employers can absorb rising health benefit costs without cutting wages, benefits, or staffing, while benefits brokers are also under increased pressure to evolve their value proposition. Employers are increasingly speaking out about unsustainable healthcare cost growth and demanding greater transparency, accountability, and affordability from health plans and providers, while they implement strategies to help lower-wage workers access health coverage.
• ACA payment failures rise sharply as subsidies expire: WSJ (Becker's Payer News) – As enhanced ACA subsidies expire, a growing number of enrollees are failing to pay premiums, leading to a sharp increase in coverage terminations, according to a Wall Street Journal analysis. In addition, a coalition led by the ADA is urging CMS to reconsider proposed changes that could reduce adult dental coverage through ACA plans, warning the rollback would worsen access and oral health outcomes for vulnerable populations.
• Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for Major Medicaid Policy Changes (KFF) – A KFF report outlines how states are updating eligibility, enrollment, and renewal processes ahead of major Medicaid changes, with a focus on maintaining coverage continuity as pandemic-era flexibilities unwind.
• Looking beyond fragmentation: How centralization can fix dental provider data (Healthcare Dive) – This article by SKYGEN's John School argues that centralizing dental provider credentialing and directory data can reduce fragmentation, lower administrative costs and improve accuracy and efficiency for providers, payers, and patients across the dental care ecosystem.

News from the week of April 10, 2026

• States Face Another Challenge With Medicaid Work Rules: Staffing Shortages (KFF Health News) – States attempting to implement federal Medicaid policy changes related to work requirements and coverage of noncitizen population are struggling due to significant administrative staffing shortages amid tight deadlines. Budget strains are prompting states to look towards managed care organization taxes to backfill Medicaid funding gaps, but federal limits and political resistance make the strategy legally and financially complex.
• CMS gives Medicare Advantage rates a 2.48% bump for 2027 plan year in final rule (Fierce Healthcare) – CMS finalized a 2.48% average payment increase for Medicare Advantage plans in 2027 as well as changes to the MA Star Ratings system, providing a boost to insurer revenues amid rising medical costs.
• ICHRAs, a growth opportunity for insurers, face uphill battle (Healthcare Dive) – Individual Coverage HRAs present a potential growth avenue for insurers but face adoption challenges tied to complexity and employer awareness.
• ADA raises concerns about CMS CRUSH initiative proposals affecting dentistry (ADA News) – The ADA cautioned that CMS’s proposed CRUSH initiative could create administrative burdens and unintended consequences for dental providers.
• Women In Optometry Publishes ‘Closing the Gaps in Eye Care: The Optometric Workforce Report 2026’ (Women in Optometry) – Women In Optometry’s 2026 workforce report examines persistent gaps in access to eye care, highlighting shortages, demographic shifts, and opportunities to strengthen the optometric workforce nationwide.
• Consumers' satisfaction with health plan apps improves with familiarity: JD Power (Fierce Healthcare) – JD Power finds that consumer satisfaction with health plan mobile apps increases significantly the more frequently members use them, while a Pew survey shows that despite rising use of AI chatbots, most U.S. adults continue to trust healthcare providers as their primary source of reliable medical information.

News from the week of April 3, 2026

• Brokers expect rise in sales despite rising administrative complexity (BenefitsPRO) – A new survey finds benefits brokers are optimistic about growth in core and voluntary benefits sales, even as administrative complexity and education gaps continue to slow adoption.
• U.S. employers changed the health plan cost increase curve, researchers say (BenefitsPro) – Researchers report that employers have successfully slowed health plan cost growth through benefit redesign, tighter networks, and more aggressive purchasing strategies.
• State Mitigation Strategies Could Blunt Medicaid Coverage Losses (MedCity News) – Analysts say proactive state policies, such as streamlined renewals and outreach, could reduce coverage losses tied to federal Medicaid changes.
• California kids are going without vision care, and the problem is getting worse (Cal Matters) – Growing numbers of children in California are missing routine vision screenings and eye care due to access gaps, workforce shortages, and coverage barriers.
• State-Run Insurance Plans for Foster Kids Leave Some of Them Without Doctors (KFF Health News) – An investigation finds that some state-run insurance plans for foster children suffer from narrow networks and administrative hurdles that leave kids without consistent access to doctors.
• KY bill making sweeping changes to Medicaid adds copays (but they’re lower now) (Kentucky Lantern) – A Kentucky Senate bill proposes broad Medicaid reforms, including introducing copays while setting them at lower levels than initially thought.

News from the week of March 27, 2026

• Organized Dentistry Coalition urges CMS to not prohibit adult dental coverage (ADA News) – A coalition representing organized dentistry is urging CMS to preserve adult dental coverage, warning that restrictions could reduce access to essential oral health care for millions of patients.
• Millions Could Lose Medicaid Coverage Due to New Rules (Robert Wood Johnson Foundation) – A new Robert Wood Johnson Foundation report estimates that proposed Medicaid work requirements could result in 5 to 10 million people losing coverage by 2028, while a separate article explores whether elements of H.R. 1’s Medicaid changes could still be gradually implemented through administrative or regulatory actions.
• CMS reveals new Medicaid model that supports coordination for children with complex needs (Fierce Healthcare) – CMS introduced a Medicaid model focused on better coordinating care for children with complex medical and social needs.
• Hospital ads can increase ED visits, Medicare spending, new Penn study finds (Fierce Healthcare) – A University of Pennsylvania study found that increased hospital advertising modestly boosts emergency department visits and Medicare spending, drawing patients to costlier ED care who might not have otherwise sought hospital services.
• Rising Health Costs Push Some Middle-Aged Adults To Skip the Doc Until Medicare (KFF Health News) – Facing steep premium hikes and high out‑of‑pocket costs after expiring ACA subsidies, many adults aged 50–64 are delaying needed care until Medicare eligibility, raising risks of poorer health outcomes and higher eventual costs.
• ‘The 1980s called’: CMS finalizes rule to phase out fax, mail (Becker's Payer News) – CMS finalized a rule to eliminate fax and mail for claims documentation by 2028, replacing them with standardized electronic exchanges projected to save the industry over $781 million annually.

News from the week of March 20, 2026

• People with medical debt often defer care, even if they are insured (BenefitsPro) – A national study found medical debt significantly increases the likelihood that adults, insured or not, delay dental care (42%). A significant number also delay medical and mental health care.
• Where do healthcare leaders stand with APIs for the CMS interoperability, prior auth final rule? (Becker's Payer Issues) – A WEDI survey shows many payers are progressing on CMS‑mandated API requirements, while a substantial share of providers have yet to begin and are unlikely to meet the 2027 deadline. While KFF questions whether the tradeoffs from prior authorization are worth it.
• CMS’ New Approach to Federal Medicaid Spending in Cases of Potential Fraud (KFF) – CMS has adopted a more aggressive fraud‑response model that withholds or defers federal Medicaid funds when potential fraud is suspected, shifting financial risk to states and potentially affecting enrollees and providers. NPR dives into the unprecedented threat to Minnesota's Medicaid funding.
• Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements (KFF) – The 2025 reconciliation law imposes new Medicaid work requirements starting in 2027, prompting states to rapidly redesign policies, upgrade systems, and prepare for major operational changes.
• KFF Follow-Up Survey of Marketplace Enrollees (KFF) – A KFF survey finds that after enhanced ACA premium tax credits expired, half of Marketplace enrollees report their costs are “a lot higher,” and most expect to cut back on basic household expenses to maintain coverage.
• Health System Pulse Survey: Medicare Advantage Is No Longer a Growth Strategy — It’s a Capital Allocation Decision (Alvarez and Marsal) – Health system executives report that declining reimbursement, rising denials, and operational friction are forcing them to reevaluate and strategically limit their participation in Medicare Advantage.

News from the week of March 13, 2026

• House GOP leaders set sights on dental, vision markets following PBM reform (BenefitsPro) – House Republican leaders have signaled their intent to scrutinize private dental and vision insurance markets based on findings in a new GAO report that highlights high levels of market concentration across states.
• Overpayments to Medicare Advantage plans are costing seniors billions, Joint Economic Committee finds (Healthcare Dive) – Another congressional report found Medicare Advantage overpayments inflated Medicare Part B premiums by $212 per enrollee in 2025, totaling $13.4 billion in added costs for seniors.
• Eyes on the Future: How Retinal Imaging Is Reframing Preventive Medicine (MedCity News) – Emerging research shows retinal imaging is becoming a powerful noninvasive tool for detecting cardiovascular, metabolic, and neurodegenerative risks, transforming routine eye exams into systemic health screenings.
• 100 Hours a Week on Screens: The Data Behind America’s Digital Eye Strain Crisis (WebPro News) – New research shows that heavy screen use has led to widespread digital eye strain, affecting 59% of employees and causing measurable productivity losses. Overall, workplace visual discomfort is associated with nearly a 19% decline in productivity, underscoring the growing impact of visual health on job performance.
• How Does Cost Affect Access to Health Care? (Peterson-KFF) – Rising healthcare costs are leading many U.S. adults to delay or forgo needed medical and dental care, with about 1 in 5 skipping dental visits in 2023. At the same time, roughly one‑third of Americans are cutting expenses or taking on debt to afford care, even postponing major life decisions due to financial strain.

News from the week of March 6, 2026

• Medicaid Reviews May Disenroll Vulnerable Dual Eligibles (UPENN) – UPenn researchers warn that Medicaid eligibility reviews could inadvertently remove vulnerable dual‑eligible beneficiaries who still qualify for coverage while other research shows that Medicaid disenrollment surges at age 19—with rates up to 83.9% in some states—due to eligibility rules shifting from child to adult categories. Finally, KFF’s Medicaid enrollment tracker resurfaces to provide ongoing updates on national enrollment trends and disenrollment patterns.
• How Will the Loss of Enhanced Premium Tax Credits Affect Older Adults? (KFF) – With the expiration of ACA enhanced premium tax credits, older adults—especially those aged 50–64—face doubling premium costs and major affordability challenges due to age‑based pricing.
• Medicaid Is Paying for More Dental Care. GOP Cuts Threaten To Reverse the Trend (KFF Health News) – Expanded adult Medicaid dental benefits have improved access in many states, but projected federal funding cuts of over $900 billion could force states to scale back or eliminate these gains.
• Credentialing Doesn’t Have to Be “Death”: A Smarter Approach for Dental Practices (Dental Managers) – Dental credentialing is often overwhelming due to fragmented, repetitive payer requirements, but emerging streamlined, centralized approaches like SKYGEN’s Dental Hub can significantly reduce administrative burden for dental practices.
• ADA reaffirms importance of clinical exams in early oral cancer detection (ADA News) – Updated ADA guidelines emphasize that comprehensive clinical exams remain the primary method for early oral cancer detection, with adjunctive cytology tests recommended only in limited cases. While new research shows oral cancer patients face high medical costs but receive fewer dental visits and treatments than peers, underscoring the need for integrated medical‑dental care and expanded coverage.
• What Role Do Vision-Test Kiosks Have in Patient Eyecare? (Vision Monday) –  AI‑enabled vision‑testing kiosks are expanding nationwide, prompting concerns from optometric groups that consumers may mistakenly view quick, remote‑reviewed kiosk exams as substitutes for comprehensive eye exams

News from the week of February 23, 2026

• 2025 CAQH Index Shows U.S. Healthcare Avoided $258 Billion and Accelerated Automation, Interoperability and AI Adoption (CAQH) – The latest CAQH Index highlights concerns about cybersecurity slowing some electronic adoption efforts. However, while dental administration transactions grew by 6%, spending also fell 4%.
• Health Insurer Financial Performance in 2024 (KFF) – KFF looks at the details of why payer margins dipped slightly in 2024, with Medicare Advantage remaining the most profitable segment and Medicaid managed care the least, reflecting varied market pressures across lines of business.
• Opinion | The problem is clear: Medi-Cal is failing to protect children's eyesight (Cal Matters) – California’s low reimbursement rates and limited access to pediatric vision care leave most Medi‑Cal kids without needed eye exams, worsening learning barriers. While another report finds U.S. office workers spend nearly 100 hours per week looking at screens, with 71% reporting visual discomfort that reduces productivity by about a full workday per week.
• Dental guidelines call for more judicious use of X-rays (Medical Xpress) – New ADA guidelines advise dentists to order X‑rays only when clinically necessary, noting that routine annual imaging isn’t always justified and that modern techniques have reduced radiation exposure to very low levels.
• 2026 Star Ratings Shift: 4 Strategies for MA Plans (MedCity News) – CMS is proposing major changes to the Medicare Advantage Star Ratings program—including removing numerous administrative and some clinical measures, eliminating the Health Equity Index incentive, and shifting emphasis toward outcomes and patient experience—which will require plans to invest in data‑driven quality improvement, clinical performance, and member‑experience strategies to maintain or improve ratings.
• HHS: No Surprises Act hit self-insured plans hardest (Becker's Payer) – A new HHS report finds the No Surprises Act drove significantly steeper declines in out‑of‑network payments for self‑insured employer plans than for fully insured plans. In addition, more than 60 employer groups and insurers are urging federal agencies to crack down on what they call systematic misuse of the No Surprises Act’s arbitration process, claiming a handful of provider groups drive inflated claims and win roughly 85% of disputes.

News from the week of February 16, 2026

• States are staying the course on health equity policy: Three ways health plans can align (HealthScape Advisors) – States continue expanding health‑equity statutes and regulatory expectations, creating both compliance requirements and strategic opportunities for health plans. HealthScape notes that plans can align by integrating equity into operations, building ROI‑driven models, and advancing capabilities beyond one‑off or charity‑based initiatives.
• CMS proposes reversal of adult dental essential health benefit policy in payment notice (ADA News) – CMS is proposing to reverse a 2024 policy that would have allowed states to include routine adult dental services as an essential health benefit starting in 2027. The proposal also reduces required essential community provider participation in dental networks and is open for public comment through March 13, 2026.
• Dental insurers brace for rise of cash‑for‑coverage employer health plans (Benefits Pro) – Health benefit costs are projected to rise sharply in 2026—6.5% on average—driven by higher prices, increased utilization, and costly treatments, putting employers under pressure to modify plan designs and potentially spurring alternative coverage models. Dental plans may be particularly affected as employers face sustained cost growth for the fourth consecutive year.
• Medicare Advantage grows less than 1% during annual enrollment: 7 notes (Becker's Payer) – Medicare Advantage enrollment grew by only about 1% during the latest enrollment period, driven mostly by Special Needs Plans while several major insurers experienced declines. Smaller plans captured significant new membership, signaling shifting competitive dynamics in the MA market.
• HIMSSCast: 2026 could be the most challenging year yet for Medicare Advantage payers (Healthcare Finance News) – Medicare Advantage plans face mounting pressure from rising medical costs, aging populations, and CMS’s proposed risk‑adjustment changes, resulting in margin compression and reduced benefit richness. Experts say plans must shift focus from documentation to clinical outcomes and member experience as competition and consolidation intensify.

News from the week of February 9, 2026

• What payer experts, leaders are thinking about 2026 (Healthcare Brew) – Payer executives expect 2026 to bring rising premiums, consolidation pressures, and rapid AI adoption, as well as growing costs associated with dual‑eligible populations and increased regulatory scrutiny.
• KFF Health Tracking Poll: Prior Authorizations Rank as Public’s Biggest Burden When Getting Health Care (KFF) – A new KFF poll finds prior authorization is the biggest non‑cost barrier to care, with about one‑third of insured adults saying it is a major burden and nearly 70% reporting it causes delays or denials.
• Hospital Spending Accounted for 40% of the Growth in National Health Spending Between 2022 and 2024 (KFF) – KFF finds hospital care drove 40% of national health spending growth from 2022–2024, rising faster than overall expenditures and reflecting increased utilization and higher prices. While a fraction of the growth in hospital care spending, dental services is said to have grown by 3% with an increase of $22B during that same period. Since 2005 the increase in spending on dental services is said to have reached $102B.
• Employee health plan costs eat up 10% of wages (TechTarget) – A recent Commonwealth Fund survey shows rising employer‑sponsored health plan costs—driven by prescription drug spending and increasing premiums—are consuming a larger share of wages, with significant projected increases again in 2026.
• NBEO Shares Continued Concerns Over Optometric Licensing Measures in Kentucky, Citing ‘Gaps in Public Protection’ (Vision Monday) – The National Board of Examiners in Optometry (NBEO) warns that Kentucky’s emergency licensing measures still leave “gaps in public protection,” noting that some optometrists were licensed between 2020–2023 without passing all NBEO exam components due to pandemic-era waivers, prompting ongoing concerns about competency and patient safety.
• Did expanding Medicare dental benefits make a difference? (Dr. Bicuspid ) – A study finds the expansion of Medicare dental benefits did not significantly increase dentist participation, with declines especially among oral surgeons, and researchers note they lacked sufficient claims or outcome data to assess patient impact.

News from the week of February 2, 2026

• A Closer Look at Nebraska, the First State Planning to Implement a Medicaid Work Requirement (KFF) – Nebraska will become the first state to implement Medicaid work requirements on May 1, 2026, requiring most expansion‑group adults to meet 80 hours of work or related activities monthly amid complex operational and eligibility system changes.
• No Clicks, No Searches – So How Do Patients Find Dentists Now? (Dental Managers) – Dental patient acquisition is shifting as up to 40% of younger patients now ask AI tools—not Google—for provider recommendations, making AI visibility and consistent online data essential for dental practices.
• Nearly 45% of healthcare payments tied to APMs: Survey (Tech Target) – An AHIP survey shows 44.9% of U.S. healthcare payments in 2024 flowed through alternative payment models, with nearly 29% involving downside risk—reflecting steady movement toward value‑based care.
• Americans’ Challenges with Health Care Costs (KFF) – KFF polling finds health care costs are Americans’ top financial worry, with nearly half reporting difficulty affording care and one‑third delaying needed services due to cost pressures.
• 2026 Dental Salary Survey Report (Dental Post) – The 2026 dental salary report shows stabilization across many roles, but dental assistants face declining satisfaction and persistent pay and workload disparities, signaling ongoing pressure in this segment of the workforce. While a new whitepaper recommends early‑exposure strategies to expand and diversify the oral health workforce.

News from the week of January 26, 2026

• ADA’s HPI 4th Quarter State of the US Dental Economy (ADA HPI) – The most recent ADA HPI survey shows dentists are facing a “fiscal squeeze” driven by softening demand, rising costs, and continued skepticism about the broader economy, while planning staffing increases and expressing concern over insurance issues heading into 2026.
• New screening tool adapted for US older adults to detect oral frailty (Medical Xpress) – Researchers have adapted a screening tool developed in Japan for the U.S., enabling earlier detection of oral frailty and associated health risks such as malnutrition, physical decline, and increased mortality.
• Medicaid and Upcoming State Budget Debates (KFF) – States entering FY 2027 budget planning face fiscal strain from slowing revenues, federal Medicaid cuts, and rising care costs, positioning Medicaid as a central pressure point in upcoming policy debates.
• How Rural Health Transformation Program Awards Can Improve Oral Health Access (CareQuest) – States are leveraging new federal rural health funds to expand dental workforce capacity, teledentistry, and mobile care models to address significant oral health access gaps in rural communities.
• Medicare Advantage overpayments will total $76B this year: MedPAC (Healthcare Dive) – MedPAC estimates that Medicare Advantage plans will be overpaid by $76 billion in 2026 due to factors like upcoding and favorable selection, fueling concerns about excessive taxpayer costs.

News from the week of January 5, 2026

• Rising Costs & Medicare Advantage Flaws to Drive Healthcare Reform Talks in 2026 (Med City News) – In 2026, rising healthcare costs may push Congress to act to encourage younger, healthier people to purchase insurance through the ACA to help control overall cost of care. While a Cornell study found proposals to use health savings accounts (HSAs) to replace expired premium tax credits is widely predicted to worsen affordability on ACA exchanges. In addition, Medicare Advantage reforms may focus on addressing flaws in risk adjustment.

• AMA’s Strategic Push for Permanent Medicare Telehealth Reform (HIT Consultant) – The AMA is urging Congress to permanently authorize Medicare telehealth services before the current waiver expires in January 2026, citing a 43-day government shutdown in 2025 that caused a 24% drop in telemedicine visits and calling for the CBO to modernize its cost-calculation methods for telehealth.

• New ADA recommendations confirm dental imaging most effectively used in moderation (ADA News) – New ADA guidelines recommend ordering dental imaging only when clinically necessary to reduce radiation exposure, marking their first update in over a decade and the first to address both traditional radiography and cone-beam computed tomography. In addition, a study finds dentists’ use of silver diamine fluoride (SDF) to prevent caries is strongly influenced by reimbursement policies, with many reporting increased adoption after Medicaid coverage expanded and expressing willingness to use SDF more if restrictions were reduced.

• A Massive Wave of Eye Disease is Coming, and Healthcare is Unprepared (Fierce Healthcare) – A looming public health crisis is predicted as vision-threatening eye diseases surge due to America’s rapidly aging population, with cases of macular degeneration, glaucoma, and diabetic retinopathy projected to nearly double by 2050, driving costs to $373 billion annually. Adoption of innovative care models, including remote monitoring and predictive analytics could prevent widespread vision loss and reduce healthcare burdens.