Hospitals That Sue You for Getting Sick

By Wendell Potter – “People are having to choose between going to the hospital and staying home and dying. Because at least my family won’t be burdened with a lawsuit if I die at home.”That’s not a line from a dystopian novel. It’s what a real patient — identified only as GV0242002 in court records — told researchers after being sued by Sentara Health, Virginia’s largest hospital system and its most prolific medical debt litigant. A major new report from researchers at George Washington University Law School and Stanford University’s Clinical Excellence Research Center, produced with PatientRightsAdvocate.org, documents what happens when American health care’s hidden costs finally catch up with the people least able to pay them. Read Full Article...

HVBA Article Summary

1. Scale and Impact of Medical Debt Lawsuits: The report highlights that between 2010 and 2024, hospitals and medical providers in Virginia filed over a million lawsuits against patients to collect medical debt. These legal actions resulted in hundreds of thousands of wage and bank account garnishments, with significant additional costs from attorney fees and court charges. The aggressive pursuit of debt has placed a heavy burden on patients, many of whom were already financially vulnerable.

2. Role of Insurance and Systemic Opacity: The article emphasizes that both hospitals and insurers contribute to the problem by maintaining opaque pricing and benefit structures. Insurance plans with high deductibles and cost-sharing requirements often leave patients exposed to large, unpredictable bills, even when they are technically insured. This lack of transparency and cost-shifting enables both hospitals and insurers to increase their revenues while patients bear the financial risk.

3. Legislative Efforts and Remaining Challenges: Recent legislative changes in Virginia, such as the Medical Debt Protection Act, have introduced caps on interest rates and restricted certain aggressive collection practices. However, these reforms address only the aftermath of medical debt, not the underlying issues of hidden prices and complex billing that generate the debt. The article suggests that without greater transparency and changes to insurance benefit design, patients will continue to face significant financial exposure.

CMS finalizes higher Medicare Advantage rates for 2027 in gift to insurers

By Rebecca Pifer Parduhn – The Trump administration finalized significantly higher Medicare Advantage rates for 2027 than it had proposed after a full-court lobbying press from the insurance industry — and despite dogged concerns about overpayments in the privatized Medicare program. On Monday, the CMS locked in an average rate increase of 2.48% for next year, compared to the 0.09% increase that regulators proposed earlier this year. As a result, the government will send more than $13 billion in additional payments to MA plans in 2027, versus the $700 million raise that regulators initially planned. Read Full Article...

HVBA Article Summary

1. Final MA Rate Increase Exceeds Expectations: The Centers for Medicare & Medicaid Services (CMS) finalized a 2.48% average rate increase for Medicare Advantage plans, which rises to approximately 4.98% after risk adjustment. This increase was higher than analysts anticipated and was driven in part by the removal of proposed updates to the risk adjustment model. Regulators stated that while the model changes were not implemented, they may still be considered in the future to improve payment accuracy.

2. Risk Adjustment Changes Removed from Final Rule: CMS had proposed requiring insurers to use more recent data for risk adjustment calculations, aiming to better align payments with current patient costs and conditions. However, these changes were excluded from the final rule after pushback from insurers, who argued they needed more time to adapt to prior updates. Officials maintained that the decision does not dismantle the risk adjustment system but reflects a delay in implementing further modifications.

3. Policy Outcome Reflects Industry Pressure and Market Concerns: The final rule is seen as favorable to Medicare Advantage insurers, many of whom have faced higher medical spending and margin pressures. Industry lobbying efforts, along with concerns about potential plan exits and disruptions for beneficiaries, likely influenced the decision. While the rate increase may support insurer stability, some stakeholders note it may still fall short of fully addressing rising healthcare costs, leaving future adjustments uncertain.

State officials push for consistency in long-term care hybrid products

By Allison Bell – Some state insurance regulators are uneasy about how they and their colleagues are regulating life insurance policies and annuity contracts that include long-term care benefits. Concerns about the regulatory environment for LTC hybrid products surfaced last month at a Senior Issues Task Force session at the National Association of Insurance Commissioners' spring national meeting in San Diego. Consumer advocates and some regulators at the session talked about having only limited knowledge about how regulators outside their home states have been handling oversight of LTC hybrid products, according to draft meeting notes posted on the task force section of the NAIC's website. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. NAIC Develops State-by-State LTC Hybrid Guide: An NAIC staff member is compiling a guide outlining how each state regulates long-term care (LTC) hybrid insurance products. The initiative highlights existing variation in regulatory approaches across jurisdictions. The guide may help regulators better understand differences and identify areas for alignment. It could also serve as a reference for policymakers evaluating potential updates to oversight practices.

2. Regulators Discuss Need for Greater Consistency: Nevada regulator Ned Gaines and other participants suggested states may need a more uniform approach to LTC hybrid pricing and consumer protections. Current inconsistencies could affect both product design and consumer outcomes. This discussion may lead to future efforts to standardize regulatory frameworks. Greater consistency could also improve transparency and predictability for insurers and consumers.

3. State Variations in Premiums and Oversight: States differ in how they handle premium increases and regulatory reviews for LTC hybrid products. Some may allow insurers to raise premiums on LTC riders attached to life policies, while others may prohibit such increases. In addition, certain states may exempt LTC riders from the same level of review applied to stand-alone LTC insurance policies. These differences may influence how products are priced, approved, and offered in each state.

93% of uncovered employees say they would start GLP-1s if reimbursed

By Michael Popke – GLP-1 medications have officially crossed from trending to expected in the workplace, according to 9amHealth's new survey of more than 1,000 U.S. adults. The share of respondents using GLP-1s has more than doubled since 2023, reaching 49% — signaling a fundamental shift in employee expectations and creating new challenges for employers trying to balance access with cost. What's more, GLP-1 coverage now ranks among the top three most valued workplace benefits for more than 40% of respondents, on par with some of the most foundational workplace benefits. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. GLP-1 Coverage Influences Employee Retention and Recruitment: About 30% of workers say they would consider changing jobs to gain or maintain access to GLP-1 medications, highlighting their growing role in employment decisions. This trend underscores how health benefits are increasingly tied to talent attraction and retention strategies. Employers that do not offer coverage may face disadvantages in a competitive labor market.

2. High Demand for GLP-1s Driven by Lack of Coverage: Among employees without coverage, 93% report they would take a GLP-1 medication if it were covered, indicating substantial unmet demand. This reflects affordability as a primary barrier to access rather than lack of interest. The data suggests growing pressure on employers to expand benefits to meet employee expectations.

3. Rising Cost Pressures Require Balanced and Sustainable Coverage Models: A congressional analysis estimates obesity could drive up to $9.1 trillion in excess medical spending over the next decade, increasing urgency for effective interventions. While adding GLP-1 coverage may support employee health and retention, it also introduces financial and operational challenges. The report emphasizes the need for sustainable models that combine coverage with clinical oversight, behavior change support, and cost management strategies.

How to make a high-deductible health plan and HSA work for you

By Jackie Fortiér – When enhanced federal subsidies expired at the end of 2025, a lot of people buying their own health insurance on the state and federal exchanges saw their expected monthly rates jump. To keep costs down, many switched to a high-deductible health plan. These plans offer lower monthly payments, but in exchange, patients can face steep out-of-pocket costs when they need care. The plans are pretty common. In 2023, 30% of people who got insurance through their employer had a high-deductible plan, up from only 4% in 2006. Read Full Article...

HVBA Article Summary

1. High-Deductible Plans Are Increasingly Common: The expiration of enhanced federal subsidies led many individuals to select high-deductible health plans in order to keep their monthly premiums affordable. While these plans lower upfront costs, they often result in higher out-of-pocket expenses when medical care is needed. This trend reflects a broader shift in the insurance market, with a significant rise in the number of people covered by high-deductible plans over the past two decades.

2. Health Savings Accounts (HSAs) Offer Tax Advantages: Individuals enrolled in eligible high-deductible plans, including many bronze and catastrophic marketplace options, can open HSAs to help manage medical expenses. HSAs allow users to contribute pre-tax dollars, which can be used tax-free for qualified medical costs, and the funds roll over year to year. This makes HSAs a valuable tool for building a financial cushion against unexpected health expenses, though not everyone is aware of their eligibility or the benefits.

3. Strategic Use of Benefits and Cost Management Is Key: The article emphasizes the importance of understanding plan details, such as what services are covered at no cost and how deductibles reset annually. Consumers are encouraged to schedule necessary care early in the year, compare cash prices to insurance rates for certain services, and keep marketplace income information updated to avoid tax surprises. These strategies can help individuals maximize their coverage and minimize unexpected financial burdens.

Americans want weight-loss pills for cost and convenience

By Leah Douglas – Americans starting weight-loss medicines for the first time want lower cost and greater convenience as they consider pills from Novo Nordisk (NOVOb.CO) or Eli Lilly (LLY.N), according to seven doctors who specialize in obesity. Novo's Wegovy pill has been on the market since January, while Lilly's just-approved Foundayo joins the fray this week. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Preference for Pills Driven by Convenience and Cost: Many Americans new to weight-loss medications are opting for oral options due to their ease of use, lower price, and the avoidance of needles. Pills like Novo's Wegovy and Lilly's Foundayo do not require refrigeration and can be taken discreetly, making them more attractive to patients who are uncomfortable with injections. Doctors report that these factors are expanding access to obesity treatments for people who may have previously avoided them.

2. Differences in Drug Administration and Effectiveness: While both oral and injectable weight-loss drugs are available, the new pills have specific administration requirements that may influence patient choice. For example, oral Wegovy must be taken on an empty stomach with water, whereas Foundayo can be taken at any time without restrictions. Clinical trials show that Foundayo leads to an 11% reduction in body weight over 72 weeks, while oral Wegovy achieves about a 14% reduction over 64 weeks, offering patients and doctors more flexibility in tailoring treatment.

3. Affordability Remains a Major Barrier: Despite the lower starting prices of the pills compared to injectables, weight-loss medications are still largely unaffordable for many Americans. Insurance coverage for these drugs is often limited, resulting in significant out-of-pocket costs and making them more accessible to higher-income individuals. Physicians note that cost is the most significant factor in patient decision-making, and even with new oral options, the market remains out of reach for many who could benefit.

Building a benefits dream team: Choosing the right ancillary partner

By Lee Hafner – Ancillary benefits can be a great way to cover gaps that core offerings leave behind, but if they're a challenge for benefit leaders to administer or employees to adopt, even the best ones will fall flat. This is where the importance of carrier and vendor selection comes in, says Diana Steinhoff, CEO of insurance firm Renaissance Benefits. The right ones provide offerings employees appreciate, such as supplemental medical, dental, vision, fertility and behavioral health options,  but just as important, they make processes of maintenance and communication simple for benefit leaders. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Simple, High-Value Benefits Support Easier Plan Management: The effectiveness of ancillary benefits depends not only on the offerings themselves but also on how easily they can be managed and communicated. Benefits that are easy to understand, easy to administer, and provide clear value can help ensure smoother plan operations for employers and employees. When carriers focus on delivering straightforward and impactful offerings, benefit leaders may spend less time managing complexity. This can allow them to focus more on expanding and improving the benefits included in their plans.

2. Consolidation and Technology Can Reduce Administrative Burden: Collaboration with brokers and carriers helps benefit leaders identify solutions that meet both benefit and administrative priorities, including technology tools and billing structures. Carriers that consolidate multiple ancillary benefits into a single solution and provide user-friendly digital platforms can simplify claims filing and accelerate payment timelines. These streamlined systems reduce HR workload while improving the overall employee experience.

3. Strategic Benefits Programs Support Talent Attraction and Retention: A well-designed ancillary benefits program can strengthen an organization’s ability to attract and retain talent across generations, from Gen Z to baby boomers. By working closely with brokers and carriers, benefit leaders can develop innovative offerings that align with evolving workforce expectations. Prioritizing simplified management and positive employee feedback helps ensure these benefits deliver meaningful value and engagement.