Here are 10 updates on moves by payers for ASCs to know in July, as reported by Becker’s:
1. UnitedHealth Group is complying with criminal and civil investigations by the Justice Department regarding its Medicare Advantage business, according to a July 24 regulatory filing by the company.
2. The percentage of eligible Medicare beneficiaries enrolled in Medicare Advantage plans rose to 54% in 2025, but the pace of the increase in enrollment slowed in 2025, according to a July 28 report from KFF.
3. Becker’s reported on seven bills by federal lawmakers aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage.
4. ACA premiums are set to rise by 15% on average in 2026, The Wall Street Journal reported July 18. The Journal used data analyzed by KFF to report rate increases for the largest insurers in 19 states.
BCBS Illinois is requesting premium increases above 25%. A spokesperson for Health Care Service Corp., the insurer’s parent company, said the plans are “priced to reflect anticipated healthcare needs.”
5. Attorneys representing Luigi Mangione, the man accused of killing UnitedHealthcare CEO Brian Thompson in late 2024, have accused the Manhattan District Attorney’s Office of improperly obtaining over 120 pages of confidential medical records from Aetna, Mangione’s health insurer.
6. CMS and the Department of Homeland Security entered an agreement that will enable Immigration and Customs Enforcement officials to access the personal data of the nation’s 79 million Medicaid members.
7. HHS said it has launched a study into “misleading” Medicare Advantage marketing practices “and the harms they cause to individuals.”
“In recent years, concerns about aggressive and deceptive marketing practices in Medicare Advantage have become more pressing,” the HHS OIG wrote in July. “These concerns have focused on agents and brokers used by Medicare Advantage plans who target and mislead seniors, at times enrolling them in plans without their knowledge or directing them to plans that substantially increase their out-of-pocket costs.”
8. A coalition of 21 Democratic-led states are suing HHS and CMS over new ACA rules they allege would impose significant barriers to receiving health coverage.
The lawsuit, filed July 17 in the U.S. District Court for the District of Massachusetts, challenges a final rule that CMS introduced earlier this year to amend ACA marketplace regulations, which the plaintiffs argue will lead to millions of people losing access to health insurance, raise costs for states, and reduce the availability of essential health benefits.
9. CMS will not approve any new waivers for states to allow continuous enrollment for Medicaid or CHIP beneficiaries longer than 12 months.
CMS has “concerns about the appropriateness of providing continuous eligibility,” said Drew Snyder, deputy CMS administrator and director of the Center for Medicaid and CHIP services in a July 17 letter to states.
10. More than half of employers plan to shift more healthcare costs to employees in 2026, according to a survey by Mercer.
