Federal & State Policy
As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal and state policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Tune in for episode 2 of our mid-term elections podcast. Avalere experts, Chris Sloan and Tiernan Meyer, discuss potential state and federal-level scenarios for Medicaid expansion.
Tune in to hear the first episode in our 3-part series covering the mid-term elections and potential implications on health policy. Avalere expert, Chris Sloan, discusses potential implications of the mid-term elections on health policy. To kick off the series Avalere Founder, Dan Mendelson, covers pre-existing conditions.
New analysis from Avalere finds that 2.7 million individuals from states that have not expanded Medicaid could gain Medicaid coverage should their newly elected governors decide to expand the program or states pass expansion referenda on their ballots.
New analysis from Avalere finds that 102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.
In episode 1 of our series Fred Bentley, Sean Creighton, and Kenny Kan discuss the new supplemental benefits offered through Medicare Advantage plans for 2019.
Our analysis finds there will be winners and losers at the plan level under the new models.
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
MA plans expand coverage of supplemental benefits following administration’s policy change.
New research from Avalere finds that Medicare patients with rheumatoid arthritis (RA) may face higher out-of-pocket costs under a proposal to move Medicare Part B drugs into Part D, absent additional policy change to lower cost sharing in the Part D program.
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
Average premiums projected to grow 3.1% heading into next year.
In its proposed changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2019 (CY2019), the Centers for Medicare & Medicaid Services (CMS) proposes a potentially sweeping change to the way it values physician office and outpatient visits, also known as Evaluation & Management (E/M) codes.
New research from Avalere finds that Medicare Advantage (MA) beneficiaries with hypertension, hyperlipidemia, and diabetes experienced significantly fewer inpatient stays and emergency room visits relative to those in traditional fee-for-service (FFS) Medicare.
On June 27, CMS notified Massachusetts of a partial approval of the MassHealth program’s proposed 1115 waiver request.
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).
2019 rate filings suggest increased competition and plan choice
Earlier this year, the administration granted Medicare Advantage plans greater flexibility to target benefit designs for individuals with certain high-risk health conditions. These changes are expected to position the program for continued growth.
In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.
Avalere analysis finds that price of generic drugs has remained flat but the cost to seniors is increasing.