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

• Out-Of-Pocket Health Care Costs For People Retiring In 2026 Estimated At $185,500, Up 7.5% From 2025
• Medicare Launches Post-Payment Review Of Home Health Stays Lasting 361 Days Or Longer
• Costco & SCAN Health Plan Launching Medicare Advantage Plans In 3 Markets
• July 2026 Data Book: Health Care Spending & The Medicare Program
• Cityblock Health Raises $116 Million, Acquires Rural Medicare Provider Organization Homeward Health In An All-Stock Transaction
• Health Plans Deny Between 12% & 18% Of Prior Authorization Requests
• 2026 PACE Rural Memo
• Programs Of All-Inclusive Care For The Elderly (PACE) Marketing Guidelines
• Program Of All-Inclusive Care For The Elderly
• Amazon Pharmacy Starts $50 GLP-1 Delivery For Medicare Beneficiaries
• State Medicaid & Children’s Health Insurance Program Applied Behavior Analysis Toolkit
• The $18.6 Billion Bump: Best Of The 2026 OPEN MINDS Service Excellence Institute
• Medicare Program; Contract Year 2027 & Certain Contract Year 2026 Policy & Technical Changes To The Medicare Advantage Program, Medicare Prescription Drug Benefit Program & Medicare Cost Plan Program
• Home Health Agencies That Specialize In Post-Acute Care Have Lower Hospitalization & SNF Utilization Rates
• Medicare Ends Part D Premium Subsidy Program

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Three Largest Medicare Advantage Organizations Had The Highest Denial Rates For Long-Term Acute Care Requests

Medicare Advantage organizations (MAOs) denied 65% of prior authorization requests for admission to long-term care hospitals (LTCH) and 54% of requests for admission to inpatient rehabilitation facilities (IRF), according to a federal analysis of data from 19 MAOs during June 2024. The three largest MAOs by enrollment (CVS Health, Humana, and UnitedHealth) had the highest volume of prior authorization requests for these two post-acute settings and issued denials at higher rates than other MAOs. The… Read

• Optum Health To Expand Home-Based Care Programs For Rural Members With Complex Chronic Conditions
• CMS Proposes Restricting Third-Party Provision Of Medicare Remote Monitoring Services
• CMS Is “All In” On Value
• Proposed Rule: Medicare & Medicaid Programs; CY 2027 Payment Policies Under The Physician Fee Schedule & Other Changes To Part B Payment & Coverage Policies
• MorseLife Announces Multi-County Expansion Of PACE & Behavioral Health Services In Florida

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