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The Latest Breaking News from CMS

One in Three U.S. Communities Has No Preferred Medicare Pharmacy, and That Gap Changes What Seniors Pay

One in three U.S. ZIP code areas lacks a preferred Medicare pharmacy, a new study finds. Here is how that gap changes what seniors pay.

Medical Daily

'Even Cancer Is Not Enough': Judge Allows Controversial Medicaid Rules To Stand

A federal judge has allowed a Trump administration Medicaid policy requiring terminally ill patients to prove inability to work for exemptions, sparking legal challenges from Democratic states.

International Business Times UK

Trump Administration Targets 100 ACA Agents Over Fake Enrollments as CMS Warns 35% of Marketplace Signups Could Be Illegitimate

The Trump administration is sending notices of intent to 100 agents affiliated with the Affordable Care Act marketplace who allegedly violated the exchange’s standards of conduct by submitting insurance applications without recipients’ Social Security numbers or other identifying information, according to a report published Thursday by Fox Business.

Benzinga

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Medicare Is Dropping Two Alcohol and Tobacco Measures from Its Quality Program for Psychiatric Hospitals

CMS finalized removal of two substance use measures from inpatient psychiatric quality reporting, changing what these facilities are measured on.

Medical Daily

Medicare Will Stop Requiring Nursing Homes to Report Staff COVID Vaccination Rates

CMS finalized a rule removing two COVID vaccination measures from nursing home quality reporting, changing what families can look up before choosing care.

Medical Daily

A Medicare Prior Authorization Pilot Has Run in Six States Since January Without Most Patients Knowing

A CMS pilot has applied prior authorization to some Original Medicare procedures in six states since January. How to tell if it affected you.

Medical Daily

Older Americans set to see Medicare cost rise after Trump kills subsidy for drug program

Decision to eliminate concession could mean higher monthly insurance premiums for millions of people

The Independent UK

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CMS Projects Its Own Medicaid Tax Rule Will Cut Federal Spending by $246 Billion

CMS actuaries estimate its proposed rule limiting Medicaid provider taxes would cut federal spending by $246 billion over ten years.

Medical Daily

Medicare Just Fined 14 Insurers as the Electronic Prior Authorization Deadline Approaches

CMS fined 14 Medicare plans $1.54 million and flagged prior authorization failures ahead of the January 2027 electronic exchange deadline.

Medical Daily

Medicare to End Premium Stabilization Program for Standalone Drug Plans

CMS is ending the Part D Premium Stabilization Demonstration after 2026. Here is what it did and what seniors will learn in September.

Medical Daily

CMS Flags 50 Medicaid Providers in Data Sweep, Including Billing for Tests Patients Did Not Need

CMS says its Medicaid Fraud War Room flagged 50 providers and blocked $203 million. Here is what it means if your provider is on the list.

Medical Daily

Four States Now Activate Medicaid Before Jail Release as New Federal Law Pressures the Rest

Four states now enroll people in Medicaid before release from jail. H.R. 1 has forced three others to pause, and outcome data is not in yet.

Medical Daily

Approved but Not Covered: Why Medicare Patients Wait a Year for Devices Their Doctors Can Already Prescribe

FDA approval does not mean Medicare pays. Here is why the gap exists, what the proposed RAPID pathway would change, and what patients can do now.

Medical Daily

What You Can Already Demand from a Hospital About Its Prices While Congress Argues About the Rest

Congress advanced two price transparency bills. Here are the pricing rights hospitals already owe you today, and how to actually use them.

Medical Daily

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Kiplinger

GLP-1 Medicare Coverage: How to Get It for $50 (And the Catch)

A new CMS program finally brings Wegovy and Zepbound within reach for seniors. But a hidden rule about your deductible could cost you thousands.

Benzinga

Trump Administration Pulls the Plug on a Medicare Subsidy That Cut Drug Premiums— Oz Says the 'Bailout' Is Over as Seniors Brace for 2027 Hikes

The Centers for Medicare & Medicaid Services (CMS) announced Tuesday it will end the Medicare Part D Premium Stabilization Demonstration after the 2026 plan year, ending a federal subsidy program that has helped keep prescription drug premiums lower and could result in higher costs for some seniors beginning in 2027.

International Business Times UK

Here's What Ending the Medicare Drug Subsidy Really Means for Your Parents' Premiums in 2027

Washington is ending a subsidy that held down Medicare drug premiums. Officials say costs will barely move, but most of the 25 million enrollees face higher 2027 bills.

The Economic Times

Trump administration to end Medicare Part D subsidy after 2026

The Trump administration will end a Medicare Part D subsidy program after 2026. Insurers have gained enough experience to price plans accurately without this support. CMS Administrator Dr. Mehmet Oz stated premiums will increase by less than ten dollars. Many Medicare recipients may even see their premiums decrease next year.…

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Kiplinger

Medicare 2027 Projections: Here's How Much Your Monthly Premiums Are Estimated to Rise

In 2027, Medicare participants will pay more for their health care. Fortunately, Part B costs are expected to rise less than 5%.

Medical Daily

Nebraska Has Been Running Medicaid Work Checks Since May. Every Other Expansion State Has Five Months.

Nebraska started Medicaid work checks in May. Forty other states and D.C. have until January, at roughly $15 million each. Who is ready?

Medical Daily

Federal Medicaid Work Rule Takes Legal Effect Friday as a Judge Weighs Whether to Pause It

The Medicaid work rule takes effect July 31, and CMS projects 2.3 million fewer enrollees in FY2027. What enrollees should check before August 31.

Medical Daily

Denied Coverage For Wegovy Or Zepbound? Here Is What The Latest Value Assessment Says About Price And Access

Denied for Wegovy or Zepbound? A new value analysis explains why plans refuse coverage and what exceptions and appeals actually involve.

Medical Daily

CMS Data Show 3 Million Fewer People Actually Covered by Marketplace Plans, and Those Who Stayed Face Record Deductibles

CMS data show marketplace enrollment fell to 19.2 million. Those who stayed shifted to bronze plans with record $3,786 average deductibles.

Medical Daily

ICER Finds Weight-Loss Drugs Cost-Effective, But Analysts Warn the Projected Savings Depend on Patients Staying On Them

ICER finds GLP-1s cost-effective for obesity, but analysts warn projected savings assume patients stay on treatment. What it means for coverage.

Medical Daily

CMS Projects Millions Fewer Medicaid Enrollees as Work Requirement Rule Takes Effect

CMS's Medicaid work requirement rule takes effect July 31. The agency projects 2.3 million fewer enrolled in 2027. What beneficiaries should do now.

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