In the news
In the news.
What is moving in Medicare, and what it means for you.
Medicare Advantage
Medicare Advantage Enrollment Tops 55 Percent in 2026, but the Two Largest Insurers Are Cutting Their County Presence
A KFF analysis finds 35.2 million Medicare beneficiaries are now in Medicare Advantage, up 1.1 million since early 2025, while UnitedHealthcare and Humana each exit roughly 200 counties.
September 8, 2026Policy & oversight
A Pending CMS Rule Would Set Hard Time Limits on Drug Prior Authorization Decisions in Medicare Advantage
CMS's proposed interoperability and drug prior authorization rule (CMS-0062-P) would require Medicare Advantage and other plans to resolve urgent drug requests within 24 hours and standard requests within 72 hours.
September 8, 2026Policy & oversight
Texas Receives 281.3 Million Dollars, the Program's Largest State Award, to Expand Rural AI Telehealth
Texas's first-year Rural Health Transformation grant leads all states and centers on artificial intelligence, telehealth infrastructure, and growing the rural provider workforce.
September 7, 2026Medicare Advantage
Special Needs Plans Now Enroll Nearly 1 in 4 Medicare Advantage Members, KFF Reports
A KFF analysis of 2026 Medicare Advantage enrollment finds that plans tailored to people with chronic illnesses or limited incomes have grown sharply and now represent nearly one quarter of all Medicare Advantage membership.
September 7, 2026Policy & oversight
CMS Opens the FY 2028 Window for Hospitals Seeking Add-On Medicare Pay for New Technologies
A Federal Register notice invites hospitals and manufacturers to apply for supplemental Medicare payments when brand-new devices or drugs enter hospital care, with a virtual public meeting set for December and comments due by mid-December.
September 7, 2026Policy & oversight
California Receives 233.6 Million Dollars in Federal Rural Health Grants for Telehealth and Workforce
California's first-year Rural Health Transformation Program award will fund expanded telehealth, rural workforce development, and new care models for communities far from hospitals.
September 7, 2026Policy & oversight
Virginia Receives 122 Million Dollars in Federal Rural Health Grants to Expand Telehealth, Paramedics, and Workforce Training
CMS distributed the first portion of Virginia's first-year Rural Health Transformation Program award on August 28, with funds directed toward remote monitoring, community paramedicine, maternal care, and allied health career pipelines.
September 6, 2026Policy & oversight
OIG: Conflicting Medicare Rules Allowed an Estimated 380 Million Dollars in Organ Payments Not Required by Federal Law
A federal audit completed September 1 found that CMS guidance permitted reimbursements to certified transplant centers for organs never implanted in Medicare patients, diverging from what federal statute requires.
September 6, 2026Costs & IRMAA
OIG: A Medicare Billing Contractor Improperly Paid an Estimated 19.5 Million Dollars for Doctor Visits and Therapy in Nursing Homes
An audit of Novitas Solutions found that more than half of sampled claims for evaluation and management visits, psychotherapy, and podiatry services provided to nursing home residents did not meet Medicare documentation requirements.
September 6, 2026Policy & oversight
MedPAC Opens Its New Study Cycle With Plans to Examine Part D Spending Growth, Medicare Advantage Trends, and Physician Payment Adequacy
The congressionally chartered Medicare advisory commission met September 3 and 4 to launch its 2026-2027 research agenda, which centers on prescription drug cost trends and the adequacy of what Medicare pays hospitals, doctors, and nursing homes.
September 6, 2026Policy & oversight
Rhode Island Channels 5.48 Million Dollars in Federal Rural Health Funds Into Student Healthcare Career Training
CMS announced that Rhode Island's first-round Rural Health Transformation Program award, among the smallest in the country, will go entirely into school-based career and technical education programs aimed at building the state's future healthcare workforce.
September 5, 2026Policy & oversight
Federal Watchdog Says CMS Needs Better Oversight of Contract Workers Who Inspect Nursing Homes
States have leaned more heavily on outside contractors to conduct nursing home inspections, but a new OIG audit finds CMS lacks adequate controls over how those contractors perform their work.
September 5, 2026Policy & oversight
New York Receives 76 Million Dollars in Federal Rural Health Grants Focused on Care Coordination and Technology
CMS announced the first-round Rural Health Transformation Program award for New York, targeting fragmented care in rural communities where Medicare patients often see multiple providers with little coordination between them.
September 5, 2026Policy & oversight
Michigan Gets 25 Million Dollars in Federal Rural Health Funds for Telehealth and Technology Upgrades
CMS announced first-round Rural Health Transformation Program funding for Michigan, with most of the money directed at connecting rural providers through upgraded digital systems and improved broadband access.
September 5, 2026Policy & oversight
Medicare Starts a New Risk-Based Nursing Home Inspection System This Week, With a Care Compare Label Coming September 30
Nursing homes that consistently earn five stars and have no harmful-care citations will face shorter, smaller inspections starting September 8. A new Care Compare icon will identify qualifying facilities for families comparing nursing home options.
September 4, 2026Policy & oversight
Medicare Now Covers a Stool RNA Test for Colorectal Cancer Screening, With No Deductible or Coinsurance
ColoSense, a mail-in multi-target stool RNA test for colorectal cancer, became a covered Medicare benefit effective June 8, 2026, at no cost to the beneficiary. It joins Cologuard and other non-invasive options already covered by Medicare without cost-sharing.
September 4, 2026Policy & oversight
Indiana to Receive 120 Million Dollars in Federal Rural Health Grants for Maternal Care, Primary Care, and Behavioral Health
The federal Rural Health Transformation Program is delivering 120 million dollars to Indiana, targeting eight regions of the state with expanded prenatal services, new mobile medical clinics, and strengthened crisis response.
September 4, 2026Policy & oversight
Georgia Receives 93.3 Million Dollars in Federal Rural Health Grants for Telehealth, Surgical Robotics, and Value-Based Hospital Care
The federal Rural Health Transformation Program is directing 93.3 million dollars to Georgia, where the state plans to help 87 rural hospitals prepare for value-based care, expand telehealth, and bring surgical robotics to underserved communities.
September 4, 2026Medicare Advantage
Federal Auditors Found Medicare May Have Overpaid Medicare Advantage Plans 462 Million Dollars for Stroke Diagnoses That Lacked Hospital Records
An OIG audit of 2021 claims found that acute stroke diagnosis codes appearing on physician records across a sample of Medicare Advantage enrollees had no corresponding hospital record, a pattern auditors say inflated risk scores and generated large overpayments.
September 3, 2026Drug prices & Part D
Comment Period Closes September 18 on How Drug Companies Must Apply Medicare-Negotiated Prices at Clinics and Doctor's Offices Starting in 2028
A CMS draft guidance describes the step-by-step process manufacturers must follow to make sure negotiated Medicare prices actually reach patients receiving infused or injected medicines at a doctor's office or outpatient clinic. Public comments are due September 18, 2026.
September 3, 2026