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

• GoHealth Medicare & Health Insurance Broker Files Chapter 11 Bankruptcy
• New York Governor Hochul Announces Completion Of $54 Million Supportive Housing Development On Manhattan’s Lower East Side
• Percentage Of Florida Older Adults Hospitalized For Mental Disorders Increased By 16% Between 2022 & 2024
• Five-Star Hospitals Increased 32% While One-Star Hospitals Declined 12% In Medicare’s 2026 Quality Ratings
• Health Care Professionals At PeaceHealth To Participate In Medicare Value-Based Care Programs Supported By Honest Health
• PacificSource To Exit ACA Market & Pull Out Of Montana Entirely
• Federal Home Health Value-Based Purchasing Program Linked To Reduced Dementia Care Disparities
• Providence Health Plan In The Pacific Northwest To Wind Down Insurance Business
• CMS Accelerates Efforts To Support Health System-Wide Electronic Prior Authorization
• Payments For At Least 16% Of Medicare Virtual Check-Ins Potentially Improper; E-Visit Error Rate Was At Least 2.6%
• Humana Introduces New Value-Based Cardiology Care Partnerships For Medicare Advantage Members
• CMS To Exclude Unsupported Diagnoses From Medicare Advantage Risk Scores Starting In 2027
• Hospital-At-Home Associated With Similar Or Better Short-Term Clinical Outcomes Compared With Traditional Inpatient Care
• CMS Imposes Nationwide Six-Month Moratorium On New Hospice & Home Health Enrollment
• U.S. Health Insurance Enrollment Declined By 2.3 Million Between 2024 & 2025

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Higher Telemedicine Use By Medicare Mental Health Specialists Linked To Slight Increase In Rural Access

Medicare mental health specialists with high uptake of telemedicine mental health services between 2018 and 2023 had a 0.88 percentage point higher share of services provided to fee-for-service (FFS) beneficiaries in rural areas, compared to mental health specialists in the lowest telemedicine uptake quartile, according to a recent study. Much of the increase in rural service use was due to existing patients moving farther away from their specialists, rather than new rural beneficiaries seeking out… Read

• Primary Care Visit Rates Among Medicare Beneficiaries Declined 10% Between 2017 & 2023
• Medicare Advantage Organizations, Prescription Drug Plan Sponsors, & Other Interested Parties: Announcement Of Calendar Year (CY) 2027 Medicare Advantage (MA) Capitation Rates & Part C & Part D Payment Policies
• CMS Launches $50 GLP-1 Medication Demonstration Program For Medicare Beneficiaries
• Nevada Hospital Ends Inpatient Care, Converts To Rural Emergency Status
• Medicare Part D Subsidy Expansion Reduces Medication Non-Adherence By 5.5 Percentage Points

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