# Health Insurance Marketplace * **Definition:** A platform established by the Affordable Care Act (ACA) where individuals, families, and small businesses can compare and purchase health insurance plans, including options for those who are under-insured or uninsured, and may qualify for subsidies. * **Taxonomy:** Healthcare Topics / Health Insurance Marketplace ## News * Selected news on the topic of **Health Insurance Marketplace**, for healthcare technology leaders * 5.1K news items are in the system for this topic * Posts have been filtered for tech and healthcare-related keywords | Date | Title | Source | | --- | --- | --- | | 5/28/2025 | [**Revenue Cycle and Payer News - May 28, 2025**](https://www.healthitanswers.net/revenue-cycle-and-payer-news-may-28-2025/) | [[Health IT Answers]] | | 5/16/2025 | [**The Affordable Care Act's Lasting Impact On Healthcare Marketing - MedCity News**](https://medcitynews.com/2025/05/the-affordable-care-acts-lasting-impact-on-healthcare-marketing/) | [[MedCity News]] | | 5/2/2025 | [**CENTENE SUBSIDIARY ARIZONA COMPLETE HEALTH JOINS SETTLEMENT ...**](https://www.prnewswire.com/news-releases/centene-subsidiary-arizona-complete-health-joins-settlement-agreement-to-move-forward-with-statewide-long-term-care-medicaid-contract-302445359.html) | [[PR Newswire]] | | 5/1/2025 | [**California's primary care shortage persists despite ambitious moves to close gap**](https://www.news-medical.net/news/20250501/Californiae28099s-primary-care-shortage-persists-despite-ambitious-moves-to-close-gap.aspx) | [[News Medical Net]] | | 4/10/2025 | [**6 Types of Income You Might Be Surprised Are Taxed - AOL.com**](https://www.aol.com/6-types-income-might-surprised-170133623.html) | [[AOL]] | | 3/20/2025 | [**Sasikiran Vepanambattu Subramanyam Honored with 2025 Noble Business Awards for ...**](https://markets.businessinsider.com/news/stocks/sasikiran-vepanambattu-subramanyam-honored-with-2025-noble-business-awards-for-excellence-in-healthcare-automation-and-financial-systems-innovation-1034495958) | [[Business Insider Markets]] | | 3/7/2025 | [**HHS at a glance: The $1.7 trillion agency that shapes US healthcare**](https://www.beckershospitalreview.com/hospital-management-administration/hhs-at-a-glance-the-1-trillion-agency-that-shapes-us-healthcare.html) | [[Beckers Hospital Review]] | | 2/27/2025 | [**Medicare and the Health Insurance Marketplace**](https://www.aol.com/medicare-health-insurance-marketplace-141851753.html) | [[AOL]] | | 1/31/2025 | [**Can Central California DACA recipients enroll in Covered California? Here's what we know**](https://www.yahoo.com/news/central-california-daca-recipients-enroll-015933207.html) | [[Yahoo]] | | 1/10/2025 | [**Payer Roundup-UnitedHealth tagged with $165M fine; Scripps Health out of network with ...**](https://www.fiercehealthcare.com/payers/payer-roundup-unitedhealth-tagged-165m-fine-scripps-health-out-network-anthem-blue-cross) | [[FierceHealthcare]] | | 12/11/2024 | [**India Diabetes Care Market Report 2024: Focus on Digital Health Solutions and ... - Yahoo Finance**](https://finance.yahoo.com/news/india-diabetes-care-market-report-091100471.html) | [[Yahoo Finance]] | | 12/11/2024 | [**Djibouti Insurance Market Size, Share, Demand, Key players Analysis and Forecast 2024-2032**](http://prsync.com/imarc-group/djibouti-insurance-market-size-share-demand-key-players-analysis-and-forecast---4497800/) | [[PRSync]] | | 12/10/2024 | [**Smart Healthcare Market to Grow by USD 125.7 Billion (2023-2028), Segmented by Channel, Solution, and Geography, with AI Impacting Market Trends - Technavio**](https://www.prnewswire.com/news-releases/smart-healthcare-market-to-grow-by-usd-125-7-billion-2023-2028-segmented-by-channel-solution-and-geography-with-ai-impacting-market-trends---technavio-302326632.html) | [[PR Newswire]] | | 12/2/2024 | [**Future Market Trends for Electronic Health Records (EHR) System: Forecasting Size, Share ...**](https://www.linkedin.com/pulse/future-market-trends-electronic-health-records-ehr-system-forecasting-r1hde) | [[Linkedin]] | | 11/27/2024 | [**Centene Corporation Digital Transformation Strategy Report 2024 - ResearchAndMarkets.com**](https://www.businesswire.com/news/home/20241127312020/en/Centene-Corporation-Digital-Transformation-Strategy-Report-2024---Accelerators-Incubators-and-Other-Innovation-Programs---ResearchAndMarkets.com) | [[Business Wire]] | | 11/27/2024 | [**Centene Corporation Digital Transformation Strategy Report 2024 - Accelerators, Incubators and Other Innovation Programs - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241127312020/en/Centene-Corporation-Digital-Transformation-Strategy-Report-2024---Accelerators-Incubators-and-Other-Innovation-Programs---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-RLXHJgazfQJNuOVHefdHP-D8R-QU5o2AvY8bhI9uvWSD8DYIYv4TIC1g1u0AKcacnnViVjtb72bOP4-4nHK5ieT3WxPE8m_kWI77F87CseT) | [[Business Wire]] | | 11/22/2024 | [**The Patient Access Solutions Market Report 2024-2031: Evaluating Growth Prospects and a ...**](https://www.linkedin.com/pulse/patient-access-solutions-market-report-2024-2031-evaluating-growth-7g92e) | [[Linkedin]] | | 11/6/2024 | [**Revenue Cycle and Payer News - November 6, 2024**](https://www.healthitanswers.net/revenue-cycle-and-payer-news-november-6-2024/) | [[Health IT Answers]] | | 10/22/2024 | [**Health Insurance Strategic Business Report 2024: Gig Economy and Freelance Workers ...**](https://www.businesswire.com/news/home/20241022295045/en/Health-Insurance-Strategic-Business-Report-2024-Gig-Economy-and-Freelance-Workers-Provides-New-Opportunities---Global-Market-Forecast-to-2030---ResearchAndMarkets.com) | [[Business Wire]] | | 10/22/2024 | [**Health Insurance Strategic Business Report 2024: Gig Economy and Freelance Workers Provides New Opportunities - Global Market Forecast to 2030 - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241022295045/en/Health-Insurance-Strategic-Business-Report-2024-Gig-Economy-and-Freelance-Workers-Provides-New-Opportunities---Global-Market-Forecast-to-2030---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-RLXHJgazfQJNuOVHefdHP-D8R-QU5o2AvY8bhI9uvWSD8DYIYv4TIC1g1u0AKcacnnViVjtb72bOP4-4nHK5ieT3WxPE8m_kWI77F87CseT) | [[Business Wire]] | | 10/2/2024 | [**GetInsured Signs Four-Year Contract with BeWell to Modernize and Evolve New Mexico's State-Based Health Insurance Exchange**](https://www.prnewswire.com/news-releases/getinsured-signs-four-year-contract-with-bewell-to-modernize-and-evolve-new-mexicos-state-based-health-insurance-exchange-302264941.html) | [[PR Newswire]] | | 10/1/2024 | [**Vance, Walz Spar on Healthcare - WSJ**](https://www.wsj.com/livecoverage/vance-walz-vice-presidential-debate-election-2024/card/vance-walz-spar-on-healthcare-SA4vvlNuqc1E9P0b0xSj?mod=mhp) | [[The Wall Street Journal]] | | 9/2/2024 | [**Millions more Americans lacked health insurance under Trump vs. Biden**](https://www.usatoday.com/story/money/2024/09/03/americans-without-health-insurance-under-trump-biden/75011896007/) | [[USA Today]] | | 8/5/2024 | [**Digital Therapeutics Alliance CEO joins FDA Digital Health Advisory Committee and more ...**](https://www.mobihealthnews.com/news/digital-therapeutics-alliance-ceo-joins-fda-digital-health-advisory-committee-and-more-digital) | [[MobiHealthNews]] | | 2/15/2018 | [**Healthcare consolidation doesn't pay off for patients, experts tell lawmakers at hearing**](https://www.fiercehealthcare.com/finance/healthcare-consolidation-mergers-premiums-healthcare-costs-congress) | [[FierceHealthcare]] | ## Topic Overview (Some LLM-derived content — please confirm with above primary sources) ### Key Players - **GoHealth**: A technology-driven health insurance marketplace that assists consumers in finding and enrolling in health insurance plans. - **Pennie**: Pennsylvania's official health insurance marketplace, reporting record enrollment but facing concerns over potential loss of premium tax credits. - **GetInsured**: A technology company that modernizes state health insurance exchanges, enhancing user experience and customer service. - **Covered California**: California's health insurance marketplace that partners with Deloitte and Google Public Sector for cybersecurity enhancements. - **Oscar Health**: A health insurance company that focuses on providing accessible and affordable healthcare options through the ACA marketplace. - **eHealth**: An independent licensed insurance agency that helps Americans find affordable healthcare coverage. - **Point32Health**: An insurer facing contract negotiation issues that affect access to care for thousands of patients in Massachusetts. - **Oscar Health, Inc.**: A health insurance provider expanding its offerings through the ACA marketplace in North Carolina, focusing on member satisfaction and straightforward costs. - **Centene**: A healthcare enterprise providing government-sponsored healthcare services, including Health Insurance Marketplace products. - **Dr. Mehmet Oz**: The newly appointed CMS Administrator, focusing on modernizing Medicare, Medicaid, and the Health Insurance Marketplace. - **Simplify Healthcare**: A company providing software solutions aimed at transforming business models for health insurance companies through advanced technology. - **Independence Blue Cross**: A health insurance provider implementing the Epic Payer Platform to enhance data exchange and improve health outcomes. - **Oracle**: Provider of the Health Insurance Data Exchange Cloud Service, enhancing data interoperability and efficiency for healthcare insurers. - **eHealth, Inc.**: A company that achieved HITRUST i1 certification for its carrier integration platform, emphasizing data security. - **Christian Healthcare Ministries**: A health cost-sharing ministry that partnered with HealthTap to provide virtual care services. - **Innova Solutions**: An Authorized Solution Partner of Simplify Healthcare, focused on enhancing operational efficiency for healthcare payers. - **Humana**: A health insurance company that has partnered with Google Cloud to modernize its cloud infrastructure and develop generative AI solutions. - **Cigna Group**: A health insurance unit reducing its Medicare Advantage offerings in several states. - **FirstEnroll**: A health insurance billing and enrollment TPA that has expanded its leadership team to enhance customer-centric solutions. ### Partnerships and Collaborations - **GetInsured and BeWell New Mexico**: A four-year contract to modernize and operate New Mexico's health insurance exchange technology platform. - **Simplify Healthcare and Innova Solutions**: A partnership to enhance operational efficiency and member experience for healthcare payers. - **Ontrak and Sentara Health Plans**: Expanded partnership to enhance behavioral healthcare services for Marketplace members. - **Covered California and Google**: Partnered to implement Google Security Operations for enhanced cybersecurity in the CalHEERS marketplace. - **Independence Blue Cross and Epic**: Collaboration to implement the Epic Payer Platform for better care coordination. - **Cigna Healthcare and Infirmary Health**: Agreement allowing Cigna's Medicare Advantage customers to access Infirmary Health's facilities and doctors in-network. - **Christian Healthcare Ministries and HealthTap**: Partnered to offer virtual primary and urgent care services to members. - **CareSource and Radiant Alliance**: Formed a strategic alliance to improve health outcomes for individuals with complex health needs. - **Cohere Health and MCG Health**: Collaborated to enhance the prior authorization process for healthcare providers and patients. - **Anthem Blue Cross and Stamford Health**: Established a multi-year agreement for uninterrupted access to care for Anthem members. - **University of Pennsylvania Health System and Independence Blue Cross**: Established a long-term agreement on reimbursement rates to strengthen their partnership in Philadelphia's healthcare landscape. - **Humana and Google Cloud**: A multiyear agreement to modernize cloud infrastructure and develop AI solutions for healthcare. - **Diverge Health Funding**: Led by Google Ventures to scale operations in multiple states. - **Kaiser Permanente and Geisinger**: First acquisition of Kaiser’s nonprofit subsidiary aimed at promoting value-based care. - **CareSource and Communities In Schools**: A partnership to provide support services aimed at helping students stay in school and addressing health disparities. - **Centivo and Eden Health**: Acquisition to enhance offerings in primary care and mental health support. - **PsychArmor and CareSource**: Partnering to achieve Military & Veteran Ready Organization Certification, enhancing support for veterans and military families. - **CareSource and ElderServe Health**: Aiming to improve long-term support services for vulnerable populations in New York. - **Homethrive Funding**: Co-led by TELUS Global Ventures and 7wire Ventures to enhance its technology platform for caregivers. - **Walmart and Fabric**: Walmart sold its virtual care subsidiary to enhance virtual care services. ### Innovations, Trends, and Initiatives - **Marketplace Enrollment Trends**: Pennie's record enrollment indicates growing trust, but concerns over the expiration of premium tax credits loom. - **Health Insurance Data Exchange Cloud Service**: Oracle's cloud-native solution streamlining data exchanges for insurers, supporting real-time data exchange and compliance. - **Ambetter Health Gwinnett Clinic Select**: A new health insurance plan launched to provide cost-effective solutions in Georgia's marketplace. - **CMS Modernization Efforts**: Dr. Oz's leadership at CMS focuses on improving health outcomes and modernizing the Health Insurance Marketplace. - **Precision Insurance Plans (PIPs)**: Emerging concept tailoring insurance coverage to individual health risks, utilizing advanced data analytics and AI. - **AI in Health Insurance**: GoHealth launched AI and proprietary technology tools to enhance efficiency in the health insurance marketplace. - **Healthcare IT Market Growth**: Expected to grow significantly due to increasing demand for interoperability among healthcare systems. - **Advanced Software Solutions**: Simplify Healthcare's software solutions are designed to transform health insurance business models through technology. - **Tribal Sponsorship Program in Nevada**: Aims to provide health insurance coverage for tribal citizens, improving access to care. - **Value-Based Care Adoption**: The 2024 HCPLAN survey indicates a significant increase in value-based care arrangements among health insurance plans. - **CareSource's Enhanced Benefits Package**: An initiative to support healthier living for dual-eligible individuals in Georgia. - **Generative AI in Healthcare**: Humana's collaboration with Google Cloud aims to leverage AI for cost reduction and improved member experiences. - **Epic Payer Platform**: A technology aimed at streamlining workflows and improving health outcomes through better data exchange. - **HITRUST i1 Certification**: eHealth's achievement demonstrates commitment to high standards of information security in healthcare. - **NCD and Tenure Health Merger**: Aims to create a comprehensive platform for health consumers, enhancing product development and distribution. - **AI-Driven Solutions**: Innova Solutions aims to implement Simplify Healthcare's technology to enhance operational efficiency. - **Google Security Operations**: Provides advanced threat detection and incident response capabilities to improve cybersecurity for Covered California. - **CheckinAsyst Integration**: A digital patient intake platform integrated with Oracle Health's EHR to streamline patient workflows and payment processes. - **Patient Access Solutions**: Rapid growth due to advancements in digital technologies and patient engagement strategies. - **AI in Healthcare**: Ontrak utilizes AI to engage vulnerable populations in behavioral health, aiming to improve health outcomes. ### Challenges and Concerns - **Claim Denials**: Nearly 20% of Americans with marketplace insurance experienced claim denials, leading to unexpected bills. - **Regulatory Changes Impacting Coverage**: Proposed regulations by the Trump administration could disrupt access to ACA marketplace coverage for millions. - **Rising Healthcare Costs**: Continuous increase in healthcare costs prompting individuals to seek insurance to mitigate financial burdens. - **Access to Care**: Despite increased insurance coverage, many insured Americans face barriers to accessing care due to administrative burdens. - **High-Deductible Health Plans**: Over 40% of Americans under 65 have these plans, leading to affordability issues for necessary care. - **Affordability Crisis**: Employers facing challenges in managing rising premiums and out-of-pocket expenses while retaining employees. - **Data Privacy Concerns**: The integration of digital technologies in health insurance raises issues regarding data security and patient privacy. - **Medicare Advantage Directory Inaccuracies**: Nearly half of MA plan directories contain inaccuracies, leading to potential harm for beneficiaries. - **Insurance Denial Practices**: Controversial outsourcing of prior authorization reviews to companies incentivized to deny claims, raising ethical concerns. - **Contract Negotiation Failures**: Point32Health's inability to negotiate contracts has led to loss of access for thousands of patients. - **Potential Loss of Premium Tax Credits**: Without federal action, 90% of Pennie's enrollees may face significant premium increases in 2026. - **Cybersecurity Risks**: A ransomware attack on Change Healthcare disrupted services and exposed health information of millions. - **Regulatory Gaps**: Challenges in the health-tech sector include regulatory gaps and limited access to technology, hindering widespread adoption. - **Disparities in Coverage**: Concerns regarding inequitable coverage for prosthetics compared to other medical devices, affecting amputees. - **Private Equity Influence**: The acquisition of physician groups by private equity firms raises concerns about profit-driven healthcare models impacting patient care. - **Data Privacy and Security**: Concerns regarding patient data security and privacy in the context of increasing digital health solutions. - **Regulatory Variability**: Varying regulations across countries affecting the adoption of virtual hospitals and telemedicine. - **Data Security and Privacy**: Significant hurdles in implementing AI technologies in healthcare, including concerns over data security and privacy protection.