Major health insurers like Humana, UnitedHealth are cutting broker commissions to avoid costly Medicare enrollees

By Bob Herman - Major health insurers are taking drastic steps to discourage older adults from signing up for their private Medicare plans as they seek to boost profits, drawing the ire of insurance brokers and state regulators. Humana, UnitedHealthcare, Anthem, and Centene, and regional insurers like SummaCare, are among the firms that are halting or cutting commissions on Medicare plans. Some are even cutting off access to online enrollment portals, according to company notices obtained by STAT. Many of those decisions occurred after Oct. 15, when Medicare’s annual enrollment period started. It ends Dec. 7. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Insurers Restructuring Medicare Plans to Manage Risk and Costs: In response to market pressures and the Inflation Reduction Act, major insurers like Humana, UnitedHealthcare, and Aetna are adjusting their Medicare Advantage and Part D offerings. These changes include eliminating or reducing broker commissions, narrowing networks, and making enrollment more difficult—moves interpreted as efforts to offload higher-risk, costlier enrollees onto competitors. Some insurers have gone as far as shutting down broker portals and requiring paper applications to further limit new sign-ups.

2. State Regulators Raise Concerns About Consumer Impact and Fairness: Several state insurance departments, including those in Idaho, Mississippi, and South Carolina, have issued warnings to insurers, arguing that these practices may violate competition or consumer protection laws. However, regulatory oversight largely lies with the Centers for Medicare and Medicaid Services (CMS), which has yet to take definitive action despite growing pressure. CMS has stated it is reviewing the situation but has limited authority to immediately intervene or penalize insurers.

3. Brokers and Consumers Face Growing Barriers During Enrollment: Insurance companies’ elimination of commissions—especially for Part D drug plans—has left brokers unpaid for their services, reducing incentives to assist consumers. As a result, many seniors must navigate complex plan choices alone. Some brokerages have had to create DIY resources like webinars to help enrollees self-enroll, reflecting the widespread disruption and strain on the support system for Medicare beneficiaries.

Sen. Cassidy introduces legislation that would change the way consumer apps and wearables handle health data

By Emma Beavins – Senator Bill Cassidy, R-LA, unveiled a new health data privacy framework that sets out clear rules for how wearables and wellness apps handle sensitive health data. The U.S. does not have a comprehensive national data privacy framework. While Cassidy says the country needs a comprehensive privacy framework for all sectors of the U.S. economy, he says that healthcare requires special considerations. Read Full Article...

HVBA Article Summary

1. HIPRA Expands Health Data Privacy Beyond HIPAA: The Health Information Privacy Reform Act (HIPRA), introduced by Senator Cassidy, is designed to fill significant regulatory gaps left by the Health Insurance Portability and Accountability Act (HIPAA). While HIPAA governs traditional healthcare providers, insurers, and their affiliates, it does not cover consumer-facing technologies like health apps, smartwatches, and wellness platforms. HIPRA seeks to extend privacy protections to these increasingly popular tools by regulating how they collect, store, and share sensitive health data, such as blood pressure, weight, and reproductive health information.

2. Enhanced Consumer Rights and Security Measures: A major feature of HIPRA is the expansion of consumer rights in managing their own health data. The legislation grants individuals the ability to access, correct, or permanently delete their personal health information collected through digital health tools—something that HIPAA does not currently provide. It also outlines strict conditions under which data can be shared, mandates user consent, and introduces robust security safeguards modeled after federal standards. Additionally, it includes breach notification requirements to ensure individuals, regulators, and the public are informed if their data is compromised.

3. AI Regulation and Ethical Considerations in Health Data Use: HIPRA addresses growing concerns about the ethical use of health data in artificial intelligence systems. The law clarifies that even de-identified health information used to train AI models must comply with the “minimum necessary” disclosure standard, minimizing the amount of data shared. It also recognizes the risk that AI technologies could potentially re-identify anonymized data, thereby undermining patient privacy. To mitigate these risks, HIPRA calls for federal guidance and additional studies on data ethics, including the possibility of compensating individuals for the use of their identifiable health data.

Trump Administration delays Healthcare Price Cuts Act proposal as ACA subsidy deadline looms

By Alan Goforth – With the clock ticking on the expiration of enhanced Affordable Care Act premium subsidies, the Trump administration was expected to announce its own proposal called the Healthcare Price Cuts Act: However, the administration’s proposal has been postponed, according to CNN. “Until President Trump makes an announcement himself, any reporting about the administration’s health care positions is mere speculation,” a White House spokesperson told Politico. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Proposed Changes to ACA Subsidies: The White House framework reportedly includes capping eligibility for ACA subsidies at 700% of the federal poverty level and instituting a minimum premium payment for all enrollees. It also introduces a provision allowing individuals who opt for lower-premium Marketplace plans to deposit the difference into tax-advantaged savings accounts funded by unused subsidy dollars. These changes are designed to preserve cost efficiency while maintaining access, and reflect a broader policy direction shared by moderate lawmakers from both parties.

2. Political and Legislative Dynamics: Lawmakers across the aisle have introduced proposals aimed at reforming or extending the enhanced subsidies introduced during the pandemic. One bipartisan plan from Reps. Bacon, Hurd, Suozzi, and Gottheimer would extend the subsidies for two years while starting to phase out support for families of four earning more than 600% of the federal poverty level, or about $200,000 annually. During the recent government shutdown negotiations, Senate Republicans agreed to a December vote on this issue in exchange for extending federal funding into January, indicating strong political momentum behind a compromise.

3. Impact and Public Opinion: Since the introduction of enhanced subsidies, ACA enrollment has surged from 11.4 million in 2020 to 24.3 million in 2025, showing the policy's significant role in expanding healthcare access. These subsidies expanded eligibility beyond the previous 400% income cap and limited premiums to 8.5% of a household’s income. If the subsidies are allowed to expire, premiums are projected to more than double in 2026, potentially reversing coverage gains. Recent polling shows that over 75% of adults support maintaining these tax credits, underscoring widespread public backing for continued financial assistance.

Caregiving demand pushes women out of full-time roles

By Lucy Peterson – Caregiving needs are surging in the U.S., and while some can hire professional support, many — especially women — are being pushed out of the workforce as they shoulder these responsibilities. Last week, Guardian Life Insurance Company of America, released a new report revealing a sharp rise in the percentage of full-time employees who are also managing caregiving responsibilities and an increasing number of women leaving full-time roles due to the difficulty of balancing jobs and care. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Caregiving Among Full-Time Workers Is Growing—With a Shift Toward Male Caregivers: As of the latest report, 43% of full-time workers are also caregivers, representing a 13% increase since 2019. This trend includes a notable demographic shift: men now account for 57% of full-time working caregivers, a 44% rise from 2023, while women make up 43%, a 56% decline from the previous year. This indicates not only the growing prevalence of caregiving among employees but also a significant change in who is taking on this dual role.

2. Women Face Greater Career Impact Due to Caregiving Demands: While men are increasingly present in caregiving roles, women still comprise the majority of all caregivers overall. The report highlights a sharp gender disparity: women are five times more likely than men to have exited the workforce due to caregiving responsibilities. Additionally, nearly two-thirds of C-suite executives acknowledged that return-to-office (RTO) mandates have disproportionately led women to quit, pointing to structural workplace issues that may be exacerbating gender-based attrition.

3. Caregiving Creates Economic Strain and Highlights the Need for Workplace Support: The financial and emotional burdens of caregiving are substantial. If unpaid care work were valued at the same rate as professional caregiving, it would exceed $1.1 trillion annually. Still, 38% of caregivers report living paycheck to paycheck, and 2 in 10 say caregiving has hurt their household’s financial confidence. With caregiving demands increasing as the population ages, the report urges employers to take action—offering flexible work arrangements, access to financial guidance, and fostering open conversations—to improve the mental, physical, and financial well-being of caregiving employees.

Updated: CMS unveils negotiated prices for Ozempic, Wegovy and other drugs from second round of IRA talks

By Nicole DeFeudis – The government on Tuesday announced final prices for the second round of drugs negotiated by Medicare under the Inflation Reduction Act, including for Novo Nordisk’s blockbuster semaglutide products Ozempic and Wegovy. The negotiated prices are up to 85% lower than the list prices for the drugs. Read Full Article...

HVBA Article Summary

1. Medicare Drug Price Negotiations Yield Notable Discounts and Projected Savings: The Centers for Medicare & Medicaid Services (CMS) announced that negotiated prices for ten drugs, including major GLP-1s like Ozempic and Wegovy, will take effect in 2027, offering discounts as high as 79% off list prices. CMS estimates that these changes could save Medicare $12 billion in 2024 terms (or $8.5 billion accounting for the now-defunct Coverage Gap Discount Program), with beneficiaries projected to save $685 million out-of-pocket in 2027.

2. Mixed Industry Reactions Highlight Ongoing Legal and Policy Tensions: Pharmaceutical companies expressed varied responses: some, like GSK and Boehringer Ingelheim, were cooperative and supportive, while others—such as Bristol Myers Squibb and Astellas—criticized the process and questioned the negotiated prices' reflection of clinical value. Several companies, including AstraZeneca and Bristol Myers Squibb, are continuing legal challenges, arguing that the Inflation Reduction Act’s negotiation process infringes on constitutional rights.

3. Specific Pricing Details and Broader Access Goals Remain in Flux: CMS released detailed negotiated prices for semaglutide-based drugs, though uncertainties remain about how these will align with previously announced pricing deals, such as Novo Nordisk's $245/month agreement with the White House. Novo emphasized that the IRA pricing applies only to Medicare Part D and that broader access efforts are ongoing, particularly as anti-obesity drugs are not currently covered for obesity treatment under Medicare.

Why long-term care should be included in financial planning

By Lee Hafner – Many Americans will not be able to afford the long-term care (LTC) they, or aging loved ones they're caring for, will someday require. Benefits including long-term-care insurance (LTCi) and predictive AI technology that assesses potential future needs can encourage employees to invest in this later-life stage ahead of time. According to the U.S. Department of Health and Human Services, 70% of people who live past age 65 will need some type of LTC, which can range from help with daily needs such as bathing, dressing and food preparation at home, to more intensive care such as living in a nursing home. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Traditional Insurance Often Falls Short on Long-Term Care, Leading to High Out-of-Pocket Costs: Long-term care (LTC) services—such as in-home health aides or nursing facilities—are typically not covered by standard health insurance, Medicare, or employer health plans. According to KFF, annual costs range from $68,640 for part-time in-home care to over $200,000 for full-time care, with a private nursing home room averaging $116,800 per year. Without LTC insurance (LTCi), these expenses can escalate into hundreds of thousands or millions of dollars over time, placing heavy strain on families.

2. Early Education and Purchase of LTC Insurance Can Prevent Costly Consequences: LTCi is designed to fill gaps left by regular insurance, and purchasing it in one’s 50s to early 60s is often most cost-effective. Premiums for a $165,000 policy average $950/year for a 55-year-old man, $1,500 for a woman, and $2,080 for a couple, with rates rising and approval harder to obtain with age or health issues. Only 14% of surveyed adults over 50 correctly identified who would cover long-term care costs, indicating a widespread need for awareness and earlier planning.

3. Supporting LTC Planning Benefits Both Employees and Employers: Without LTC planning, employees may reduce work hours or retire early to care for loved ones, especially if insurance is not in place. A study by CLTC and UMass Boston showed these strains are more common among uninsured families, while tools like Waterlily help forecast care needs and costs using AI-based inputs. Nearly 45% of users adopt a new policy or annuity after receiving projections, helping employers foster workforce stability and financial well-being.

How AI is changing the fight against health care fraud

By Martina Schmidt – The enormous size and scope of the U.S. health care system make it an attractive target for fraudulent activity. So far in 2025, the Department of Justice has already uncovered tens of billions of dollars’ worth of fraudulent activity related to health care. The unique vulnerabilities of older adults, including their high use of medical services, cognitive decline, and lack of technological literacy, make this demographic a prime target for health care fraudsters. Read Full Article...

HVBA Article Summary

1. Elderly Individuals Are Primary Targets of Health Care Fraud: Older adults are especially susceptible to health care fraud schemes that exploit services like Medicare, the Department of Veterans Affairs, hospice care, home health services, and telemedicine. As the U.S. population continues to age, these fraudulent activities are expected to increase, posing growing risks to seniors' financial security, physical health, and emotional well-being.

2. AI Is a Double-Edged Sword in Health Care Fraud: Advances in artificial intelligence have created both new challenges and new tools in the fight against health care fraud. While scammers now use AI to craft highly convincing robocalls, fake documents, and phishing emails that deceive even cautious seniors, investigators and regulators are also leveraging AI. Tools such as pattern recognition, natural language processing, and predictive analytics help detect irregularities in billing, provider behavior, and communication, significantly speeding up fraud detection and prevention.

3. Proactive Measures Can Help Seniors Avoid Fraud: Seniors can better protect themselves by staying informed about evolving scam tactics and taking deliberate precautions. These include carefully reviewing Medicare documents and claims, avoiding unsolicited offers that request personal or insurance information, using strong passwords and two-factor authentication, and verifying suspicious communications before responding. Discussing concerns with trusted individuals and reporting any questionable activity can also serve as an effective defense against becoming a victim.