Andrew Shea

Are health insurance consumers more resilient than we thought? The 2026 MA and ACA cost reset may prove them to be. MA and the ACA have been through one of the most tumultuous periods since their debuts. On the MA front, about 2.7M non-SNP members were termed for 2026—a 50% rise from the record in 2025. The ACA hasn’t exactly been stable either with the enhanced APTC set to turn into a pumpkin at midnight on 12/31. With no end to the impasse in sight, most members under 55 will need to earn an extra 3 to 4% in 2026 income just to keep up with those increases. (i.e. those premium hikes will likely suck up more than 100% of whatever raise they may be able to secure. It’s far worse for older members.) But despite these headwinds, it appears MA and ACA consumers are more resilient than many thought. On the ACA front, the government recently announced that 2026 signups are down only by 2.5% (-400,000) vs. 2025-that’s 1/10th of the direst predictions for the subsidy fallout. For now it appears the “buy down” strategy (Gold to Silver, Silver to Bronze) has been more the play than “drop out.” (Whether these members stay enrolled should no premium relief come is another story.) And it appears that many MA members accepted their lower benefit/higher cost plans this year. Deft is tracking no fewer than 10 major regional carriers who termed large chunks of their business in hopes that members would re-enroll in more financially viable new ones. Based on conversations only, it appears as though some strong brands were able to hold onto a good majority of these termed members. One major regional carrier shared with me that they were able to reenroll north of 95% of them. In a few weeks we will see exactly how these high-terming regional carriers fared with their reenrollment efforts. Stay tuned. My gut tells me quite a few of these carriers will hold onto 70%+ of their termed members (those they want to retain, that is) despite the higher costs, tighter networks, and lower benefits these replacement plans offer. And this approach may show the path forward for others to follow in 2027. We very well may learn that ACA consumers value coverage more than many thought—they just had to buy down to keep it. And we may learn that large amounts of MA members came back to their old carriers despite being termed, accepting leaner coverage for the same safe brand. For both seniors and ACA members alike, there is no going back to 2024. Those days are gone forever. But it appears these resilient members will make do with what the market has left them, at least for the time being.

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𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐜𝐮𝐭𝐬 𝐛𝐞𝐭𝐭𝐞𝐫 𝐭𝐡𝐚𝐧 𝐞𝐱𝐩𝐞𝐜𝐭𝐞𝐝; 𝐡𝐨𝐦𝐞 𝐡𝐞𝐚𝐥𝐭𝐡 𝐥𝐞𝐚𝐝𝐞𝐫𝐬 𝐬𝐭𝐢𝐥𝐥 𝐛𝐫𝐚𝐜𝐞 𝐟𝐨𝐫 𝐢𝐦𝐩𝐚𝐜𝐭 𝐨𝐧 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐜𝐚𝐫𝐞 Home health agencies were thankful CMS trimmed the Medicare pay cut to 1.3%, down from 6.4% proposed in June. However, any cut threatens to limit access to care, industry leaders fear. With the much-anticipated final rule in hand, agencies have until the end of December to roll out other regulatory changes wrapped inside the rule. See below for a summary of said changes as published by DecisionHealth's Greg Hambrick in Home Health Line. 𝐓𝐡𝐞 𝐟𝐢𝐧𝐚𝐥 home health 𝐫𝐮𝐥𝐞 𝐚𝐥𝐬𝐨: • Changes the regulations for 𝐟𝐚𝐜𝐞-𝐭𝐨-𝐟𝐚𝐜𝐞 𝐞𝐧𝐜𝐨𝐮𝐧𝐭𝐞𝐫𝐬 for community referrals, allowing physicians, in addition to NPs, CNSs and PAs, to perform the face-to-face encounter regardless of whether they are the certifying practitioner. • Removes the 𝐂𝐎𝐕𝐈𝐃-19 𝐯𝐚𝐜𝐜𝐢𝐧𝐞 𝐪𝐮𝐞𝐬𝐭𝐢𝐨𝐧 from quality reporting beginning with 2026 results. CMS will remove the question with the updated OASIS-E2, expected to be released in April 2026. They will also remove four questions that had been previously set to be added to the OASIS regarding housing, utilities and food insecurity. • Updates the 𝐇𝐇𝐂𝐀𝐇𝐏𝐒 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐬𝐮𝐫𝐯𝐞𝐲with fewer, easier-to-understand questions focused on the agency’s performance, effective in April 2026. The changes will require the removal of three of the current measures used for the Patient Survey Star Rating. • 𝐀𝐝𝐝𝐬 𝐟𝐨𝐮𝐫 𝐧𝐞𝐰 𝐦𝐞𝐚𝐬𝐮𝐫𝐞𝐬 to Home Health Value-Based Purchasing (HHVBP) performance scores used to determine payment adjustments. This includes the addition of three new OASIS measures around bathing and dressing and one new claims-based measure, Medicare Spending Per Beneficiary. Three of the HHCAHPS measures will removed to account for the updated survey questions. Looking for ways to connect with fellow home health & home care leaders from across the country? Want to learn how to adapt your operations for greater efficiency and increased revenue? Join us at the Home Care Leadership Summit, May 19-21 in Orlando Check out the agenda: https://lnkd.in/e5f5et9G #homehealthrule #homehealthpayment #facetoface #HHCAHPS #HHVBP #OASIS #homehealthline.com #homecareleadershipsummit

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Retail investors don’t want a healthcare lecture. They want clarity. When thinking about where to engage the retail investor audience this year, Brew Markets made sense. Right format. Right depth. Right host. What stood out wasn’t jargon. It was how naturally the conversation translated pricing discipline, margin trajectory, and long-term strategy into plain English. Complex industry. Clear explanation. That’s the work.

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