CMS proposes extensive 2027 changes to Medicare Advantage and Part D, including Star Ratings overhaul and $14B spending increase. Insurers should assess impacts on quality bonuses and compliance.

GAO report reveals systemic fraud in ACA marketplace subsidies, causing billions in improper payments and driving up healthcare costs. Policy reforms seek to improve program integrity and reduce premiums.

CMS proposes new measures to allow Medicare Advantage enrollees to switch plans mid-year following provider network changes, improving continuity of care for seniors.

Medicare delays $7.8B hospital drug cost clawback, appeals MA audit ruling, and adds cardiac ablations to ambulatory surgery coverage for 2026.

The Medicare Diabetes Prevention Program has enrolled less than 1% of eligible beneficiaries since 2018 due to administrative, referral, and awareness challenges despite proven effectiveness. CMS changes aim to improve access and provider reimbursement.

Medicare's outdated reimbursement system is jeopardizing rural office-based medical practices by underpaying for advanced outpatient procedures, leading to consolidation and increased healthcare costs. Proposed reforms aim to preserve independent care and improve access.

The Strengthening Medicare for Patients and Providers Act proposes indexing Medicare physician payments to the Medicare Economic Index to reflect economic realities and stabilize reimbursement.

Pharmaceutical companies agree to significant Medicare drug price cuts under Trump administration, projecting billions in savings with impacts on Medicare Part D and drug affordability.

CMS proposes to revamp Medicare Advantage Star Ratings, affecting insurer compliance and operations. Legal appeals and health system updates also impact the US market.

The expiration of enhanced ACA health insurance subsidies could double premiums, reduce coverage for millions, and strain state budgets, with significant economic and healthcare impacts nationwide.