Medicare Policy Pulse

The Quality Rating System assigns ACA Marketplace plans 1-5 star ratings based on medical care, member experience, and plan administration to help consumers compare options on HealthCare.gov.

This year's Medicare open enrollment, starting October 15, 2026, brings unusual complexity for beneficiaries navigating Advantage plan changes.

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• Standard eligibility hits at 65 with Social Security or via disability, ESRD, or ALS after qualifying periods.
• TRICARE users turning 65...

President Trump announced one-time $90 payments from the Medicare Improvement Fund to offset October Part B premiums for eligible enrollees. Eligible...

Medicare's chronic underpayment of physicians is eroding care access and continuity for beneficiaries.

• Reimbursement has plunged 33% since 2001...

Older adults weighing Medicare options must balance provider flexibility against costs and networks.

• Traditional Medicare allows adding Medigap for...

Medicare covers items and services only when they satisfy three statutory requirements:

• Fall within a benefit category in Section 1861 of the Act
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Across multiple states, SHIP counselors are stepping up with free, unbiased assistance during the Oct. 15–Dec. 7 open enrollment period.

• Alabama...

Insurer withdrawals are accelerating across the Midwest and Florida, leaving hundreds of thousands of beneficiaries to find new coverage for 2027.

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Beneficiaries face several rising costs for 2027, primarily in prescription coverage.

• Part B premium projected to increase $6.60 to $209.50, with...

The 2027 Medicare Advantage star ratings reveal uneven impacts across payers, members, and quality metrics.

• Plan finances face volatility: quality...

Medicare’s dental benefit expansion raises practical hurdles for providers treating medically complex patients.

• Medicare Advantage trends show...

Key enrollment periods combine across sources for a clear map:

• Initial Enrollment Period: 7-month window around your 65th birthday for Parts A/B, C,...

CMS released updated Medicare Advantage and Part D enrollment and disenrollment guidance on August 25, 2026.

• Mandatory start: Plans must apply new...

Review your Annual Notice of Change now to catch 2027 shifts in premiums, networks, and drug lists.

Key checks before December 7:

• List your drugs,...

Use your Annual Notice of Change as the starting point for 2027 decisions. Review premium hikes, drug formulary shifts, provider networks,...

Bipartisan lawmakers introduced the Puerto Rico Medicare Advantage Fairness Act to correct a formula that understates care costs because it relies on...

• Medicare representatives never make unsolicited calls or emails for plans or cards.
• Refuse requests for Medicare IDs or Social Security numbers...

Medicare's updated TAVR policy removes hospital volume minimums, shifts to operator standards, and ends evidence development requirements for...

Higher out-of-pocket maximums and lower prices for 10 Medicare-negotiated drugs mark the 2026 Part D changes already in effect.