"This interim summary report on risk adjustment is based on issuers submitting at least 90% of three quarters of claims data and 90% of enrollment data for the 2025 benefit year." [Also available: Appendix A: Interim 2025 Benefit Year Risk Adjustment State Averages with)State Billable Member Months (XLSX); and Appendix B: Interim 2025 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)]  MORE >>

"[F]or years after 2022, plans and issuers must calculate the QPA using annual guidance that specifies a percentage increase from the preceding year's figure. ... For 2026, the percentage increase is 1.0265311701, but the IRS also provides cumulative percentage increases to simplify the QPA calculation. A plan or issuer can either use the percentage increase or the cumulative percentage increase, so long as it uses the same method consistently."  MORE >>

"[1] Address the root causes of mental health issues ... [2] Improve health inequalities ... [3] Support care follow-through ... [4] Stop health-related expenses from becoming a cycle of illness."  MORE >>

"Traditional group health coverage can be a strong solution for many small employers, delivering tax benefits and regulatory stability.... For employers seeking more cost control and workforce flexibility, an ICHRA provides a structured alternative to informal stipends without sacrificing tax advantages.... If your organization currently provides informal reimbursements or stipends, now is the time to reassess and replace those offerings with a compliant, tax-advantaged structure."  MORE >>

"By attacking the rampant overbilling of private equity-backed provider groups and simultaneously allowing reference-based pricing at the facility level, Anthem is acting as a systemic market maker. They are forcing a level of cost containment that the legislative process completely fails to deliver."  MORE >>

"[AHIP] recommend[s] HHS work closely with states to consider legislative schedules and delay implementation of defrayal requirements until plan year (PY) 2028.... [S]ome additional verification proposals should be deferred until HHS can evaluate whether the Working Families Tax Cut (WFTC) pre-enrollment verification requirement and other recently enacted measures are achieving their intended program integrity effects.... HHS should not finalize provisions allowing non-network plans to receive QHP certification. The proposal raises important questions about consumer protection, balance billing, claims processing, adverse selection and compliance with existing ACA requirements."  MORE >>