AHIP

Medicare will end a subsidy program that reduced prescription drug plan premiums, as insurers can now price plans accurately without it. The Centers for Medicare & Medicaid Services (CMS) claims premiums will rise by less than $10 for most recipients, with some seeing lower costs. The subsidy, which averaged a $16 reduction, supported Medicare Part D plans offered through private insurers like UnitedHealth Group, Humana, and Aetna.

Industry groups have consistently urged CISA to reduce the scope of the Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), advocating for fewer companies to be covered, fewer incidents reported, and less detailed information shared. CISA has delayed finalizing the rule multiple times, with industry sources doubting a September 2025 completion timeline. The law mandates reporting major cyberattacks within 72 hours and ransomware payments within 24 hours to enhance federal information sharing.

The Trump administration's 2025 pledge to reduce prior authorization barriers in healthcare has faced criticism as insurers delay full implementation, while patients and advocates report little improvement. AHIP claims 6.5 million prior authorizations were eliminated, but critics call the pledge 'performative' and lacking enforcement. A House committee recently advanced a bill to mandate transparency in Medicare Advantage prior authorization processes.

New billing codes effective January will shift maternity care payments from bundled to à la carte, supported by OB-GYNs for better reflecting care complexity but raising concerns about increased patient costs and insurance implementation challenges.