In the news
In the news.
What is moving in Medicare, and what it means for you.
Carriers & the market
Federal Watchdog: The Three Largest Medicare Advantage Insurers Denied Long-Term Hospital Requests More Than 70 Percent of the Time
A June 2026 OIG data brief found that UnitedHealthcare, Humana, and CVS Health denied prior authorization requests for long-term acute care hospital stays at the highest rates among the 19 Medicare Advantage organizations studied, and that many of those denials were overturned when patients appealed.
August 8, 2026Policy & oversight
OIG Found More Than 15 Million Dollars in Medicare Payments Where Emergency Room Billing Codes Were Used at Non-Emergency Sites
A March 2026 federal audit identified improper and potentially improper Medicare payments made when physicians and hospitals used emergency department billing codes for care not actually delivered in an emergency department, and found that Medicare lacked automated safeguards to catch the mismatches.
August 8, 2026Medicare Advantage
Starting in 2027, Medicare Advantage Plans Are No Longer Required to Tell Enrollees About Benefits They Have Not Used
A consumer-protection rule that required Medicare Advantage plans to send mid-year notices about unused supplemental benefits was rescinded in the 2027 Medicare Advantage final rule, placing the responsibility for tracking dental allowances, over-the-counter cards, and similar extras on enrollees.
August 8, 2026Drug prices & Part D
KFF: Medicare Advantage Drug Plans Received Over 600 Dollars Per Member in Rebates That Standalone Drug Plans Cannot Access
A KFF analysis explains the structural payment asymmetry that makes it harder for standalone Part D plans to compete on drug premiums, as the number of those plans hits record lows ahead of open enrollment.
August 8, 2026Costs & IRMAA
Bipartisan Senate Bill Would Cap Year-to-Year Medicare Physician Payment Swings
Six senators from both parties introduced legislation to limit how much the Medicare physician conversion factor can change in a single year, aiming to reduce the uncertainty that has pushed some doctors away from accepting Medicare.
August 7, 2026Policy & oversight
Federal Audit Found at Least 4.7 Million Dollars in Medicare Overpayments at an Arkansas Hospital
An OIG audit of Jefferson Regional Medical Center found a high rate of billing errors on claims flagged as elevated risk, producing an estimated 4.7 million dollars in improper Medicare payments. The hospital disputed most of the findings.
August 7, 2026Carriers & the market
Federal Auditors Find Most Sampled Medicare Advantage Diagnosis Codes From Gateway Health Plan Lacked Medical Record Support
An OIG compliance audit found that 232 of 286 sampled enrollee records from a Pennsylvania Medicare Advantage plan did not support the diagnosis codes submitted to CMS for federal payment calculations.
August 7, 2026Medicare Advantage
2027 Medicare Advantage Bid Data Points to Stable Low Premiums but Fewer Supplemental Extras
Plan bids released by CMS on July 28 show insurers are preserving low monthly premiums going into 2027, while a continuing decline in over-the-counter cards, meal benefits, and other extras signals another year of supplemental benefit cutbacks.
August 7, 2026Policy & oversight
CMS Publishes Plan to Speed Medicare Coverage for Breakthrough Medical Devices
A new pathway would give FDA-cleared breakthrough devices a national Medicare coverage decision within weeks of regulatory approval, rather than waiting years under the standard process.
August 7, 2026Drug prices & Part D
Bipartisan Senate Bill Would Preserve Drug Discounts for Safety-Net Hospitals and Shut Down a Rebate Pilot
Six senators from both parties introduced the SUSTAIN 340B Act on August 5, proposing to protect point-of-purchase drug discounts for safety-net providers while adding new transparency and audit requirements.
August 6, 2026Enrollment & timing
Drug Plans Have Until August 11 to Waive a Small Premium Gap That Could Keep Low-Income Members Enrolled
With today marking the close of the 2027 Part D rebate reallocation window, a five-day period opens Friday for sponsors to declare they will absorb a premium difference of up to 2 dollars rather than trigger automatic reassignment for their Extra Help members.
August 6, 2026Policy & oversight
Federal Audit Found 97 Cybersecurity Gaps in Medicare Billing Contractors for Fiscal Year 2024, Though the Most Serious Deficiencies Declined
An OIG annual report to Congress found information security deficiencies across all seven Medicare administrative contractors in fiscal year 2024, while noting that high-risk and moderate-risk gaps fell compared with the prior year.
August 6, 2026Policy & oversight
CMS Published Second-Quarter 2026 Drug Coding Decisions That Shape How Medicare Identifies and Pays for New Medicines
The quarterly HCPCS drug coding update, posted July 29 and highlighted in the August 6 MLN Connects newsletter, determines which new medications and biologicals get a dedicated Medicare billing code.
August 6, 2026Enrollment & timing
Part D Plans Face Back-to-Back Deadlines This Week to Finalize 2027 Premiums and Market Participation
Medicare prescription drug plans must complete rebate reallocation by August 6 and notify CMS of de minimis intent by August 11, two steps that lock in whether plans remain in the 2027 market and at what premium.
August 5, 2026Policy & oversight
CMS Sets a Sunset Date for the NTAP Alternative Track for Breakthrough Devices and Advances the RAPID Pathway
The fiscal year 2027 hospital payment final rule phases out the alternative NTAP track that breakthrough-designated devices used to qualify for Medicare reimbursement, while a new CMS-FDA program called RAPID is positioned to take its place.
August 5, 2026Policy & oversight
Medicare Rights Center Says New Medicaid Work Requirements Rule Threatens Low-Income Medicare Enrollees
A CMS final rule implementing Medicaid work and reporting requirements drew sharp criticism from the Medicare Rights Center, which warns that dual-eligible beneficiaries could lose the Medicaid coverage that helps them afford Medicare premiums and cost-sharing.
August 5, 2026Drug prices & Part D
CMS Counted a 2020 Reclassification Date for Creon, Delaying Medicare Price Talks by Years, Report Says
Public Citizen says CMS allowed AbbVie to use the date Creon was reclassified as a biologic rather than its original FDA approval date, pushing the drug's eligibility for Medicare price negotiation years into the future.
August 5, 2026Policy & oversight
AHA Urges CMS to Channel Rural Health Transformation Funds Toward Hospitals and Providers
The American Hospital Association filed formal comments on August 5 pressing CMS to direct more of the new 50-billion-dollar Rural Health Transformation Program toward direct patient care, arguing current spending caps leave rural communities underserved.
August 5, 2026Drug prices & Part D
Medicare Part D Deductible Rises to 700 Dollars and Out-of-Pocket Drug Cap Reaches 2,400 Dollars for 2027
The Inflation Reduction Act tied the Medicare Part D annual deductible and catastrophic spending limit to drug cost growth, and both parameters rise again for 2027, continuing an upward pattern as specialty and GLP-1 drug spending climbs across the program.
August 4, 2026Costs & IRMAA
Medicare Advantage Plans Offer Dental and Hearing Benefits in Almost All Cases, but Coverage Limits Leave Many Seniors With High Bills
Nearly all Medicare Advantage plans list dental and hearing coverage among their features, but annual dollar caps and service restrictions mean enrollees can still face hundreds or thousands of dollars in out-of-pocket costs each year, KFF research finds.
August 4, 2026