Monday, March 30, 2026

Tomorrow, every Medicare Advantage plan, state Medicaid/CHIP managed care program, and QHP issuer must publish aggregate prior authorization metrics for calendar year 2025. Approval rates, denial rates, appeal outcomes, average turnaround times — all public for the first time. First reporting cycle.

CEO attestation required starting Wednesday. Hospitals must post median allowed amounts and 10th/90th percentile allowed amounts derived from ERA data. CMS will reduce CMPs by 35% for hospitals that waive hearing rights — but not for hospitals that fail to post machine-readable files entirely. Three years of toothless transparency rules end with a signature line.

The Consolidated Appropriations Act of 2026 introduced reporting requirements and structural changes for pharmacy benefit manager (PBM) payments. Medicare PBM compensation moves from percentage-based to service-based flat fees. Additional reporting requirements for PBM pricing and rebate practices now in effect.

Aurora McCausland, 300K followers on TikTok and Instagram, has lipedema — a progressive condition causing painful fat buildup in her legs. Her doctor prescribed two liposuction surgeries totaling $35,000. Cigna denied coverage twice. McCausland believes Cigna used her active social media presence to argue she wasn't sick enough. Her legs throb with pain, swell unpredictably, and feel "like they're filled with cement." Appearance doesn't match symptom severity — Stage 1 patients can have crippling pain.

66% of Americans say healthcare costs are their top financial worry — ahead of food and groceries (57%), utilities (57%), housing (52%), and gas (52%). Half of U.S. adults can't cover an unexpected $500 medical bill. 41% of adults carry medical debt they can't pay. One woman's ACA marketplace premium jumped from $406/month to $1,123/month after subsidies expired — she dropped coverage entirely.