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- New Law Passes In Washington DC kicking as many as 17 million off Medicare, Medicaid, and effecting future rural hospitals funding.
- Rising Premiums and Costs: Health insurance premiums continue to climb, with an average 8% increase in the group market expected in 2025. Prescription drug costs, including new therapies like GLP-1s, and increased spending on behavioral health services are major contributors.
- Focus on Customer Experience: The industry is prioritizing a seamless and personalized experience for customers, using digital tools and emphasizing health insurance literacy.
- Generative AI and Digital Health: Expect a significant increase in the use of generative AI for tasks like claims processing and fraud detection. Digital health initiatives, leveraging data and AI for preventive and proactive care, are also a major trend.
- Personalized Benefits: Employers are moving towards offering more personalized benefit packages that cater to the diverse needs of a multi-generational workforce.
- Behavioral Health Focus: Mental health support is becoming a priority for employers, with more resources and services being offered within health plans. NOTE:Wheatley Insurance has Virtual Mental Health Plans, Virtual Physicians…at affordable prices.
- Policy and Regulation:
- CMS has finalized rules impacting the ACA Marketplace, including changes to eligibility for DACA recipients and adjustments to cost-sharing and premium calculations.
- Maryland has signed new laws addressing telehealth access, specialty drug coverage, and hearing aid coverage.
- Potential changes to federal healthcare policy, including potential PBM reforms and the expiration of enhanced ACA subsidies, are being closely watched.
- Some states, like California, Massachusetts, and New Jersey, continue to enforce individual health insurance mandates.
- California has expanded mandated infertility treatment coverage for large employers, including IVF.
