ACA Pay-or-Play Penalty Increases Released for 2027
The IRS released updated ACA employer shared responsibility penalties for 2027, with both penalties increasing from 2026 levels. The “A” penalty rises to $3,780 per full-time employee annually, while the “B” penalty increases to $5,670 per affected employee. These apply to Applicable Large Employers that fail to offer affordable, minimum-value coverage. No immediate action is required, but ALEs should monitor ACA compliance throughout the year.
How TrumpRx Works With Medicare Prescription Drug Coverage
TrumpRx offers Medicare beneficiaries a cash-pay alternative to Part D prescription pricing, with transparent upfront costs and no enrollment requirements. At the pharmacy, compare the discount price against your Medicare copay and choose the lower option. Keep in mind that TrumpRx purchases do not count toward your Part D deductible or annual out-of-pocket maximum, a tradeoff each beneficiary should weigh based on their medications and spending goals.
Health Insurance Preauthorization: What Employers Need to Know
Preauthorization covers 9% of claims but drives 23% of medical spend, making it a key cost control lever. Growing concerns over care delays, patient burden, and AI-driven denials have prompted health plans to voluntarily reduce requirements. Employers must shift from passive acceptance to active governance, monitoring approval rates, denial patterns, and vendor practices to balance cost control with member access and fiduciary responsibility.
Hiding in Plain Sight: The Rise of In-Network Virtual Providers and Clinics
Virtual specialty providers spanning behavioral health, women’s health, digestive care, and more are increasingly embedded directly into health plan networks. They bill like traditional in-network providers with no added fees, yet most employers and members are unaware they exist. Employers should inventory these providers with their carriers, address navigation barriers, and proactively communicate available virtual options to their workforce.
Brown & Brown 2026 High-Cost Claims Report
The Brown & Brown 2026 High-Cost Claims Report analyzes employer health plan claimants exceeding $25,000 in annual medical and pharmacy spend. Key findings show high-cost claimant prevalence rose 9.1%, driving 70% of total PMPM claim trend. Cancer, musculoskeletal, circulatory, and digestive conditions led medical spend, while Humira Pen, Stelara, Dupixent, and Skyrizi Pen topped pharmacy costs. Average spend per high-cost claimant remained stable.
