In the news
In the news.
What is moving in Medicare, and what it means for you.
Costs & IRMAA
Three Compounding Forces Are Likely to Push Medicare Part D Premiums Higher for 2027
Rising drug spending, a new cap that shifted more cost from patients to insurers, and the end of a federal stabilization subsidy are all bearing down on Part D premiums heading into the 2027 enrollment season. Analysts say beneficiaries should compare plans rather than renew automatically.
September 23, 2026Drug prices & Part D
CMS Must Send Final Written Price Offers to 15 Drug Makers by September 30 in Third Negotiation Cycle
The final statutory step before drug manufacturers accept or reject Medicare prices arrives this week. CMS must issue written maximum fair price offers by September 30, and manufacturers have until October 31 to respond. Agreed prices would take effect in 2028.
September 23, 2026Agents & how we are paid
The 2027 Medicare Open Enrollment Season Is the First Under Relaxed Agent Marketing and Disclosure Rules
A final rule issued earlier this year shortened the period agents must retain call records, removed a requirement to mention free counseling services, and loosened language restrictions in marketing materials. Consumer advocates say beneficiaries should seek independent advice this enrollment season.
September 23, 2026Policy & oversight
CMS Barred a Puerto Rico Medicare Advantage Plan From Accepting New Members for 2027
The Centers for Medicare and Medicaid Services issued an enrollment suspension notice on September 3 prohibiting MMM Healthcare LLC from enrolling new Medicare Advantage beneficiaries under contract H7522 for contract year 2027. Existing members are not affected.
September 23, 2026Medicare Advantage
Federal Watchdog Found the Three Largest Medicare Advantage Plans Denied Long-Term Hospital and Rehab Admissions at the Highest Rates
An OIG data brief from June 2026 found those plans also used outside contractors to issue denials, and many of those contractor decisions were later reversed by the plan itself on appeal.
September 22, 2026Policy & oversight
Missouri Receives More Than 45 Million Dollars in Federal Rural Health Grants for Hospitals, Behavioral Care, and EMS Training
Today's announcement directs funds to facility upgrades at 20 rural hospitals, psychiatric consultation access for children and families, and training for hundreds of emergency medical workers.
September 22, 2026Costs & IRMAA
Medigap Plan G Premiums Are Rising Faster Than Usual, With Some Rates Up More Than 26 Percent in 2026
With open enrollment weeks away, rate filings show Plan G increases of 12 to 26 percent or more for major carriers, leaving beneficiaries weighing fewer low-cost switching options.
September 22, 2026Carriers & the market
CMS Closed Its Medicare Advantage Billing Enforcement Case Against Elevance After the Insurer Paid Approximately 342 Million Dollars
The case began in February with a threat to halt new enrollments over unsupported diagnosis codes. CMS declared the enforcement process finished in July after Elevance completed all required corrective steps.
September 22, 2026Costs & IRMAA
CMS Posts Preliminary 2027 Medicare Lab Payment Rates, Projects 1 Billion Dollars in Annual Savings
New draft rates would cut what Medicare pays for most laboratory tests by an average of about 16 percent starting in 2027, with a public comment window open through late October.
September 22, 2026Drug prices & Part D
About 140,000 Wellcare Part D Members Were Dropped Mid-Year After Small New Premiums Were Added to Their Previously Free Plans
KFF Health News found that Wellcare terminated tens of thousands of drug plan members in April 2026 when minimal monthly premiums went unpaid, leaving many without prescription coverage and at risk for permanent Medicare drug enrollment penalties.
September 21, 2026Policy & oversight
OIG Found About 2.3 Million Dollars in Medicare Telehealth Billing Violations That CMS Safeguards Did Not Catch
A federal audit found that Medicare paid for virtual check-ins and e-visits that violated billing timing rules because CMS and its contractors lacked automated detection tools.
September 21, 2026Policy & oversight
New Mexico Receives 74 Million Dollars in Federal Rural Health Funds to Expand Specialty Care Across Frontier and Tribal Communities
Six Regional Hub Organizations will use the five-year grant to bring telehealth, e-consults, chronic disease management, and workforce support closer to rural, frontier, and Tribal residents statewide.
September 21, 2026Policy & oversight
Traditional Medicare Required Prior Authorization for Certain Services in Six States for the First Time Starting January 2026, KFF Finds
A KFF examination of the WISeR Model, active in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, found it targets services whose spending grew about 400 percent between 2019 and 2024.
September 21, 2026Enrollment & timing
KFF: Nearly All of the 2.6 Million Medicare Advantage Members Who Lost Plans at Year-End 2025 Had at Least One Alternative in 2026
A KFF analysis found 98.9 percent of affected enrollees had a replacement plan available, though rural beneficiaries faced fewer choices and Vermont saw the sharpest disruption.
September 21, 2026Drug prices & Part D
MedPAC September Meeting Finds IRA Changes Improved Drug Affordability for Enrollees but May Be Accelerating Overall Medicare Part D Spending
Medicare's congressional advisory commission opened its new study cycle in September finding that Inflation Reduction Act drug benefit changes have helped individual beneficiaries while putting upward pressure on total program spending and future premiums.
September 20, 2026Costs & IRMAA
Medicare Advantage Drug Deductibles Tripled in Two Years, KFF Data Shows
The share of Medicare Advantage drug plan enrollees who face a prescription drug deductible climbed from 23 percent in 2024 to 82 percent in 2026, and the average deductible rose from 64 dollars to 371 dollars over the same period.
September 20, 2026Enrollment & timing
Employers Moved 1.2 Million Retirees Out of Medicare Advantage Drug Plans in 2026, First Decline Since 2010
Employer-sponsored Medicare Advantage drug plan enrollment fell by 1.2 million people in 2026, the first year-over-year drop since 2010, as employers shifted retirees into standalone drug plans at the fastest rate in more than a decade.
September 20, 2026Policy & oversight
CMS Releases Final Mandatory Participant List for New Medicare Specialist Payment Model Starting January 2027
Cardiologists and certain pain, orthopedic, and neurosurgery specialists treating Medicare patients for heart failure or low back pain in selected areas are now on notice that a mandatory payment model ties their Part B reimbursement to outcomes beginning January 1.
September 20, 2026Drug prices & Part D
Medicare's 2027 Part D Base Beneficiary Premium Will Be 41 Dollars and 33 Cents, Hitting the Inflation Reduction Act's Annual Cap
CMS set the 2027 Part D base beneficiary premium at 41 dollars and 33 cents in July, representing a 6 percent rise from the prior year and the maximum the IRA allows, a benchmark that shapes what drug plans charge as open enrollment approaches.
September 19, 2026Policy & oversight
Federal Audit Finds Medicare Billing Errors in 15 Percent of Claims Reviewed at South Carolina Hospital
An OIG compliance review of McLeod Regional Medical Center found 17 of 115 sampled claims contained errors, resulting in net overpayments of 38,676 dollars tied mainly to inpatient admission documentation and the two-midnight rule.
September 19, 2026