Weekly edition

Week of October 26 to November 1, 2026

The week in one place: 7 stories by section, and the figures that defined it.

ACA open enrollment opens with benchmark premiums up 13% for 2027

Marketplace shoppers face a second straight year of double-digit premium increases, and a higher cap on what they can be asked to pay for care.

Oct. 29
Policy
Judge strikes federal limit on Medicaid work rule exemption for medically frail adults
A federal court ruled that the administration narrowed a protection Congress wrote for people with serious health conditions, two months before Medicaid work requirements begin in expansion states.
3 min read
Oct. 29
Policy
Labor Department rule makes pharmacy benefit managers disclose pay to large employers
A Labor Department rule gives large self-insured employers a regular look at the rebates, fees and price spreads their drug benefit managers collect, starting with plan years that begin in mid-2027.
3 min read
Oct. 28
Policy
Medicare raises dialysis payments 2.7% for 2027, and patient coinsurance rises with it
A final rule sets next year's per-treatment rate for kidney dialysis, finishes folding phosphate binder drugs into the payment and expands extra pay for low-volume clinics.
2 min read

Oct. 27
The market
Centene's marketplace membership falls to 3.4 million from 5.8 million a year earlier
The insurer lost about 2.4 million exchange members after enhanced federal tax credits expired, and it credited higher prices for improving margins on the people who stayed.
2 min read
Oct. 27
The market
HCA puts third-quarter cost of patients who lost exchange coverage at $400 million
The hospital chain said people who dropped their marketplace plans kept coming for care without insurance, and Tenet reported the same shift two days later.
2 min read

Oct. 29
Patients and bills
An urgent care asked an uninsured patient for $400 before an epinephrine shot
KFF Health News' latest Bill of the Month shows that urgent care centers, which generally fall outside the federal law requiring emergency departments to treat first, can ask for payment before treating a patient in anaphylaxis.
2 min read

13%

average rise in benchmark silver premiums for 2027, after a 26% rise for 2026
ACA open enrollment opens with benchmark premiums up 13% for 2027
$704a month

national average benchmark premium for a 40-year-old in 2027, up from $625
ACA open enrollment opens with benchmark premiums up 13% for 2027
$12,000

the most a marketplace plan can make one person pay for covered in-network care in 2027
ACA open enrollment opens with benchmark premiums up 13% for 2027
13.1million

projected marketplace enrollment in 2027, down from 22.4 million in 2025
ACA open enrollment opens with benchmark premiums up 13% for 2027
25states and D.C.

the coalition that brought the case
Judge strikes federal limit on Medicaid work rule exemption for medically frail adults
80hours a month

work or community service required of most expansion adults starting Jan. 1, 2027
Judge strikes federal limit on Medicaid work rule exemption for medically frail adults
3.1million to 3.3 million

yearly drop in Medicaid enrollment CMS projected after the first year of work requirements
Judge strikes federal limit on Medicaid work rule exemption for medically frail adults
6months

stay of enforcement on frailty determinations granted to the states
Judge strikes federal limit on Medicaid work rule exemption for medically frail adults