Medicare Policy Tracker

Payment Policy Proposals

• 🔥 340B Payment Cuts: CMS proposes slashing 340B drug payments to ASP minus 33.4% while increasing non-drug OPPS...

CMS's proposed CY 2027 OPPS rule targets costs through 340B reforms and site-neutral imaging payments, sparking debate over access and savings.

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The Part B late enrollment penalty adds a permanent 10% surcharge for each full year delayed, applied monthly for life on top of standard premiums.

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CMS's 2027 Star Ratings overhaul will channel billions in extra Quality Bonus Payments to insurers through a recalibrated Categorical Adjustment...

Three million Medicare beneficiaries could qualify for Extra Help but remain unenrolled. Agents should check eligibility via SSA.gov and Medicare.gov tools to connect clients with this prescription cost assistance.

CMS proposes new grounds for revoking Medicare provider enrollment, including operating in areas deemed to have an "excessive" number of providers at...

CMS is steering providers toward the existing Medicare home health benefit for earlier palliative care in serious illness, explicitly separating it...

The Trump administration's Medicare proposal to encourage hospitals documenting patients' end-of-life care preferences closely resembles ACA advance...

• $50 monthly copay covers a 28- or 30-day supply but does not count toward Part D deductibles or limits.
• Included products: Foundayo tablet,...

Regulatory Proposals

• 🔥 CMS Disenrollment Rules: CMS proposed new rules making it easier to remove skilled nursing providers from Medicare and...

• Medicare now covers select GLP-1 medications at a $50 copay under the new bridge program.
• Coverage remains temporary, with the program set to...

• CMS proposed allowing Medicare enrollment revocation based solely on location in "high risk" geographic areas, plus longer clawback periods for any...

Aetna is discontinuing roughly 90 Medicare Advantage plans across 34 states for 2027 through targeted service-area reductions.

• Scope and trigger:...

The 2026 Trustees Report projects the standard Part B monthly premium at $209.50 for 2027, a downward revision from the 2025 report's higher...

Policy Changes

• Medicare Advantage Star Ratings Lawsuit: A court ruling in favor of a Medicare Advantage insurer could affect how CMS calculates...

A court ruling favoring Clover Health may relax CMS star rating calculations for 2027, giving insurers more flexibility on bonus payments and benefit...

GLP-1 coverage under Medicare depends on the drug, diagnosis, and plan. Diabetes or cardiovascular use is covered more readily than weight loss...

Medicare's 2020 methadone coverage expansion for opioid use disorder produced clear gains in access.

• OTP Medicare acceptance rose 45.4 percentage...

Enrollment Guidance

• ⚡ Part B Special Enrollment Window: Workers who stay on employer coverage past 65 get an 8-month window to enroll in...

UnitedHealthcare is withdrawing Medicare Advantage plans affecting 600,000 members for 2027 after CMS ratebook updates lowered county benchmarks below...