From Our Desk Original analysis · Health
All Health insights →V28 Risk Model Goes Full-Weight in PY 2026, Compressing MA Risk Scores by $11 Billion
CMS V28 risk adjustment model goes full-weight in PY 2026, cutting valid ICD-10 codes from 9,797 to 7,770 and projecting 3.12% average risk score compression. Plan bid strategy and $11B Trust Fund impact.
By Beth · 14 min read · May 29
CMS Prior Auth Metrics Go Public: Denial Rates, Processing Times, and Actuarial Pricing Impact
CMS-0057-F forces health plans to publish prior auth denial rates for the first time. Analysis of 50M+ MA determinations, plan-level variation, and 2027 rate filing implications.
By Beth · 14 min · May 28
CMS Depression Screening Measure Adds Behavioral Health Layer to MA Star Ratings for 2027
CMS adds a Part C Depression Screening and Follow-Up measure to MA Star Ratings starting 2027. Actuarial modeling of screening costs, follow-up utilization, and bonus revenue at stake.
By Beth · 14 min · May 27
$4.5M Gene Therapy Claims Force Stop-Loss Pricing Overhaul
48 FDA-approved CGTs with costs up to $4.25M break traditional stop-loss models. PEPM load framework, anti-selection adjustment, specific deductible stress test, and standalone product benchmarking.
By Beth · 10 min · May 27
Medicare Advantage Premiums Fall While Benefits Shrink: KFF Spotlight Exposes the Actuarial Trade-Off
KFF's 2026 MA Spotlight reveals premiums declining while supplemental benefits erode. Actuarial analysis of how plans use benefit design as a margin lever under CMS rate compression.
By Beth · 14 min · May 26
- Medicare Advantage Out-of-Pocket Limits: Variation and TrendsKFF · Yesterday
- CMS releases final rule on updates to No Surprises Act independent dispute resolution processAHA · Yesterday
- PacificSource latest insurer to exit the ACAHealthcare Finance · 2d ago
- PacificSource exits ACA exchanges, Montana amid financial strainHealthcare Dive · 3d ago
- Massachusetts AG sues UnitedHealthcare over alleged Medicaid fraudFierce Healthcare · 14h ago
ACA Tracker 2027 individual-market rate filings to date
Rate Review →Sourced from federal Rate Review and state DOI filings. Green indicates improvement vs. prior-year period.