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

• Habitat Health With Kaiser Permanente Opens South Los Angeles PACE Center For Adults Age 55 & Over
• At-Risk Medicare Advantage Plans Showed Better Outcomes For Dual Eligibles Than Traditional Medicare
• Reinstatement Of Medicare’s Three-Day Rule Increased Hospital Length Of Stay
• Medicare Spending Projected To Double By 2036; Medicaid Spending To Rise By Half
• Medicare Advantage Forced Disenrollment Rate Increased From 1% To 10% By 2026
• Potentially Inappropriate CNS-Active Prescribing In Older Adults Declines From 19.9% To 16.2%
• HHS & CMS Announce Nationwide Medicare & Medicaid Fraud Prevention Strategies
• 18 States Urge CMS To Reinstate Targeted Nursing Home Staffing Mandate For Certain For-Profit Operators
• Community Care Cooperative Strengthens ACO Network With 10 New FQHCs To Improve Outcomes and Reduce Costs
• Medicare ACOs To Serve 4.4% More Beneficiaries In 2026
• Government Funding Bill Extends Medicare Telehealth Flexibilities & Hospital At-Home
• Maryland Expands Advanced Primary Care To Medicare & Medicaid Members
• Medicare Advantage Plans Denied 4.1 Million Prior Authorization Requests In 2024
• Wider Circle Partners With CalOptima Health To Support Dual-Eligible Members In California
• Real U.S. Health Care Spending Increased 4.6% From 2023 To 2024

See All

Medicare Advantage Beneficiaries With Mental Health Diagnoses Made More Mental Health Visits After Switching To Traditional Medicare

Among Medicare beneficiaries with mental health diagnoses, those who switched from Medicare Advantage to traditional Medicare in 2018 made more mental health visits after the switch, according to a recent study. Researchers conducted a longitudinal analysis of Medicare Advantage encounter data and traditional Medicare claims data from 2017 and 2018 for beneficiaries diagnosed with mental health disorders. The comparison focused on mental health utilization for the 12 months before and after beneficiaries switched from Medicare… Read

• 13.6 Million People Were Dual Eligibles For At Least One Month In 2022
• Federal Data Indicate The Average U.S. Nursing Home Is 25% Short-Staffed
• Older LTSS Recipient Use Of Telehealth Differs Depending On Residence Type
• Alzheimer’s Disease & Related Dementia Are The Third Most Common Hospice Diagnoses
• Data Book: Beneficiaries Dually Eligible For Medicare & Medicaid

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