Thursday, July 9, 2026

Insurers in the Affordable Care Act marketplace filed preliminary rates seeking a median 14% increase for 2027, following significant hikes this year. The requests, driven by rising healthcare costs and the expiration of enhanced federal subsidies, signal higher out-of-pocket premiums for patients. ACA exchange enrollment also declined in 2025, adding financial pressure. Billing teams should monitor final rate approvals by state insurance commissioners and prepare for patients questioning higher premiums and potential plan changes during the 2027 open enrollment period. The comment period on these preliminary filings runs through early fall.

CMS detailed proposed safeguards to combat Medicare fraud in its 2027 home health payment rule. The agency is seeking expanded authority to investigate and revoke Medicare enrollment for providers deemed problematic. This follows recent proposed rules for hospital outpatient and home health settings that include similar integrity provisions. While primarily aimed at program-wide abuse, the focus signals CMS's continued shift toward stricter enrollment oversight for all provider types. Practices should ensure their Medicare enrollment records are current and compliance programs are active to avoid scrutiny under these broader enforcement powers.

CMS proposed granting the Neuspera Integrated Sacral Neuromodulation System the same Medicare payment rate as legacy implantable SNM devices in the 2027 payment rule. The decision, if finalized, would establish consistent reimbursement for the newer integrated system, potentially expanding treatment options for patients with overactive bladder and urinary retention. Providers offering urologic or pelvic floor services should review the proposed rule's details on CPT code alignment and payment specifics for this technology. The final rule is expected in November 2026.

A temporary Medicare bridge program for GLP-1 weight-loss drugs is now live. The program offers coverage for eligible Medicare Part D beneficiaries at a $50 monthly copay. This is a stopgap measure initiated by the Trump administration, distinct from the broader coverage questions facing commercial insurers. For practices, this changes coverage verification for a subset of Medicare patients seeking GLP-1s for weight management. Confirm patient eligibility and plan participation before prescribing, as this is a specific, limited program with defined parameters.

Indiana has initiated its Medicaid work requirement program, a policy approved under a Trump administration waiver. Certain able-bodied adults must now meet monthly work or community engagement hours to maintain their Medicaid coverage. The state's implementation follows the administration's final rule on Medicaid work requirements issued in late June. For practices in Indiana, this policy shift introduces new patient eligibility churn and coverage verification challenges. Monitor patient reports of coverage loss and be prepared to assist with documentation requests related to exemptions.