Liz Lee

Inquired about the expected impact of Medicare Advantage benefit changes on market growth and churn in 2026, and the potential impact of expiring ACA subsidies on the market and membership.

Answer

The company expects the upcoming AEP to resemble last year's, with service area reductions and benefit changes, but carriers will still need to pursue balanced growth. This market volatility is seen as an opportunity for eHealth. Regarding the ACA, the company does not see the plans going away but expects potential disruption from changes in subsidy levels, which is viewed as a bipartisan issue likely to be addressed by Congress. This disruption also creates more shopping opportunities for eHealth.

Liz Lee's line asked about current trends in claim denial rates and how Waystar's platform helps providers manage and reconcile these denials.

Answer

CEO Matthew Hawkins explained that Waystar's software is designed to improve first-pass claim acceptance rates, thereby reducing denials. For claims that are denied, the company offers a denial and appeal management module. He also highlighted a new generative AI use case in development to further automate the appeals process, directly addressing this major client pain point.