Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

• The 2025 Federal Budget Reconciliation Bill (H.R.1 – One Big Beautiful Bill Act): Implications For The Health & Human Service Field
• Humana’s CenterWell Business Agrees To Acquire The Villages Health In Florida 
• BlueCross BlueShield Of Tennessee Winding Down Shared Health Subsidiary, With Dual Eligible Plans In Mississippi & Texas 
• CMS Rescinds EMTALA Guidance On Emergency Abortions 
• Medicare Advantage Capitation Payments To Increase By 7.2% For 2026 
• Medicare Beneficiaries With Psychological Distress Made Fewer Outpatient Mental Health Visits After Age 65, But Used More Acute Care Services 
• Indiana Dual Eligible System: An OPEN MINDS State Profile
• Illinois Dual Eligible System: An OPEN MINDS State Profile
• Home Health Agencies Offering Telehealth Decreased 19% Since COVID-19 Public Health Emergency Ended
• Medicare Advantage Prior Authorization Use Common For Higher Levels Of Behavioral Health Services
• Pennsylvania Dual Eligible System: An OPEN MINDS State Profile
• Michigan Dual Eligible System: An OPEN MINDS State Profile
• Prescribing Changes Reduce Potential Opioid Overuse Under Primary Care Plus Model
• The FQHC Question
• Mercy & Humana Partner To Open 65 Prime+ Clinics In Missouri 

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Telehealth Flexibilities Did Not Increase Outpatient Medicare FFS Visit Volume, But Did Result In Lower Post-Visit Costs

After Medicare eased telehealth restrictions during the COVID-19 public health emergency, telehealth visits among fee-for-service (FFS) beneficiaries rose during 2020, but then stabilized in 2021 and beyond. The increased volume of telehealth visits was not associated with an increase in the volume of outpatient evaluation and management (E&M) visits. Telehealth-initiated episodes of care were associated with lower use of lab tests and imaging compared to in-person visits. Telehealth visits were associated with lower 30-day Medicare… Read

• Humana & Longevity Health Extend Medicare I-SNP Partnership Through 2030
• The Medicaid Question
• Oregon Releases PACE RFP For Jackson & Josephine Counties
• Medicare ACOs Not More Effective Than Traditional Medicare At Helping Beneficiaries With Dementia Avoid Unwanted Care At The End Of Life
• Payer & Provider Organization Adoption Of Collaborative Care Model For Integrated Mental Health & Medical Care On The Rise Since 2018

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