In the news
In the news.
What is moving in Medicare, and what it means for you.
Policy & oversight
Medicare Finalizes 2027 Doctor Pay Rule, Banning Remote Monitoring Vendors and Setting a MIPS Retirement Date
A rule finalized November 4 locks in a small physician payment cut, prohibits Medicare billing for remote monitoring services handled by outside vendors, and officially schedules the end of the MIPS quality program in 2031.
November 5, 2026Costs & IRMAA
Medicare Finalizes 2027 Outpatient Rule, Cutting Drug Costs for Patients at Hospital Clinics
CMS issued a final rule November 4 that sets a 2.3 percent hospital outpatient payment increase for 2027 and lowers what Medicare pays hospitals for 340B-acquired drugs, projecting average savings of about 900 dollars for beneficiaries who receive a qualifying drug at a hospital outpatient department.
November 5, 2026Policy & oversight
Democrats Win Back Congress, Naming Medicare Oversight and Medicaid Reversal as Top Health Priorities
Democrats gained control of the House and Senate on November 3, with health care ranking among the leading voter concerns. Their declared priorities include Medicaid spending cuts enacted in 2025, Medicare Advantage insurer oversight, and drug pricing, though President Trump retains veto power.
November 5, 2026Carriers & the market
CVS Health Plans to Split Into Two Companies, Keeping Aetna and Caremark Together
The corporate parent of one of the largest Medicare Advantage insurers announced it will separate its insurance and pharmacy benefits arm from its retail drugstores by 2028, reversing roughly a decade of vertical integration.
November 5, 2026Carriers & the market
Fairview Health Services Sued UnitedHealthcare for Listing It as In-Network in 2027 Medicare Advantage Plans After Exiting the Contract
A Minneapolis health system says UnitedHealthcare's open enrollment materials pointed current members to a provider directory that still included Fairview even after the system ended its contract. The case raises questions about directory accuracy during the annual enrollment window.
November 4, 2026Policy & oversight
CMS Holds Public Meeting Today on Which New Medical Devices Should Get Medicare Billing Codes
The agency is taking public input on prosthetics, wound care products, and other supplies seeking HCPCS Level II billing codes, with final coverage decisions expected in February 2027 and effective April 1.
November 2, 2026Drug prices & Part D
Third Medicare Drug Negotiation Cycle Closes, Including Part B Doctor-Office Drugs for the First Time
The formal negotiation period for 15 drugs ended November 1; CMS must publish any agreed-upon maximum fair prices by November 30, including the first-ever negotiated prices for drugs given in doctors' offices.
November 1, 2026Policy & oversight
Glendale Doctor Gets 15 Years for Billing Medicare 45 Million Dollars for Botox Shots She Never Gave
A California physician who submitted claims for Botox injections that were never provided, including on days her clinic was closed and while she was on vacation, was sentenced October 30 to 15 years in federal prison.
November 1, 2026Policy & oversight
West Virginia Receives More Than 19 Million Dollars in Federal Rural Health Grants for Telehealth, Drone Drug Delivery, and Mental Health
Eleven awards under the Rural Health Transformation Program will fund mobile clinics, drone-delivered medical supplies, remote eye care, and nursing apprenticeships, as part of West Virginia's nearly 199 million dollar share of the federal initiative.
October 31, 2026Policy & oversight
Federal Judge Blocks Part of Medicaid Work Rule That Narrowed Who Counts as Medically Frail
A U.S. district court found that CMS wrote an unlawfully restrictive definition of "medically frail" for the new Medicaid work requirements, blocking its enforcement in 25 states and the District of Columbia. The ruling directly touches Medicare beneficiaries who also rely on Medicaid.
October 31, 2026Policy & oversight
Illinois Man Pleads Guilty to Billing Medicare 227 Million Dollars for COVID Test Kits Never Sent
Syed Murtuza Kablazada, 36, admitted he paid a Pakistani company 11 million dollars for Medicare beneficiaries' personal data, then used three Chicago-area labs to file claims for test kits that were never requested or delivered.
October 31, 2026Policy & oversight
CMS Finalizes Rule Letting Top Organ Procurement Organizations Compete for New Service Areas
A federal rule published October 30 gives high-performing, Medicare-certified organ recovery organizations the ability to bid for territories where peer organizations have failed, while sharpening the tools CMS can use to remove bad actors.
October 31, 2026Policy & oversight
Federal Watchdog Finds CMS Lacks Automated Safeguards for More Than 160,000 Medicare Part B Drug Claim Mismatches
An OIG audit found that Medicare's billing systems were not built to flag claims where providers used procedure codes that did not match the outpatient drugs billed, covering more than 160,000 claim lines reviewed in a single year.
October 30, 2026Carriers & the market
NewYork-Presbyterian and UnitedHealthcare Reach Another Extension, Keeping Medicare Advantage In Network Through November 30
The October 31 deadline passed without a permanent deal, but both sides agreed to extend in-network coverage one more month. With open enrollment running through December 7, New York-area beneficiaries who use NYP should watch whether a permanent agreement lands before year-end.
October 30, 2026Medicare Advantage
Medicare Advantage Supplemental Benefits Are Hard to Compare During Open Enrollment, Group Finds
Plans often omit key details from shopping tools and use non-standard language, making it difficult for enrollees to find the right match before December 7.
October 30, 2026Drug prices & Part D
Average Medicare Part D Stand-Alone Premium Projected to Rise 50 Percent for 2027, KFF Finds
A KFF analysis published today finds the average monthly premium for stand-alone Part D drug plans is on track to climb from 34 dollars to 51 dollars for 2027, with deductibles also rising sharply, for enrollees who do not switch plans before December 7.
October 30, 2026Costs & IRMAA
Nearly All Medicare Stand-Alone Drug Plan Members Will Face a Deductible in 2027, With Averages Up Sharply
A KFF analysis of 2027 Part D plan designs finds average deductibles rising to 643 dollars for stand-alone plan enrollees and 489 dollars for Medicare Advantage drug plan members, while the share of enrollees subject to any deductible expanded in both plan types.
October 30, 2026Policy & oversight
Idaho Receives Nearly 186 Million Dollars in Federal Rural Health Grants for Workforce, Telehealth, and Community Care
The award, part of the nationwide Rural Health Transformation Program, will fund five priorities: workforce recruitment, facility upgrades, innovative care models, prevention programs, and technology modernization.
October 29, 2026Policy & oversight
Florida Receives 193.7 Million Dollars in Federal Rural Health Grants for Telehealth, Workforce, and Community Paramedicine
CMS awarded 193.7 million dollars to 45 Florida organizations through the Rural Health Transformation Program, with projects spanning the Panhandle, the Suncoast, the Treasure Coast, and the Florida Keys.
October 29, 2026Carriers & the market
CVS Health Becomes Fifth Insurer to Sue CMS Over 2027 Medicare Advantage Star Ratings
CVS Health filed a federal lawsuit Monday challenging the methodology behind its 2027 Medicare Advantage star ratings, joining at least four other insurers in court after CMS released quality scores on October 8.
October 29, 2026