Medicare

Reform priorities aim to reshape PBM oversight, delink compensation from drug prices, boost transparency, and protect pharmacy access.

Medicare Advantage beneficiaries face forced disenrollment in 2026 as plan exits drive coverage termination, pushing millions toward traditional Medicare and Part D’s $2100 cap.

Penetration of Medicare Shared Savings Program accountable care organizations and Medicare Advantage was not associated with substantive changes in health care use among commercial enrollees.

The editor in chief of Evidence-Based Oncology lauds Congress' authorization of a path for Medicare coverage for multicancer early detection.

Medicare Advantage enrollment has increased in the US and Puerto Rico, with a dramatic growth among Puerto Rico beneficiaries with end-stage renal disease.

The postpandemic reinstatement of Medicare’s 3-day rule lengthened hospital stays without affecting SNF use, spending, or short-term outcomes, raising questions about its value.

The authors call for policy reforms that could strengthen patient-provider relationships, support care innovation, and improve quality for Medicare beneficiaries.

Beneficiaries in ACOs receive significantly higher rates of primary and preventive services, signaling value-based care’s impact on quality and chronic disease management.

Increasing Medicare Advantage payments for full Medicaid enrollees was not associated with meaningful changes in inpatient or nursing home use.

The upcoming price negotiations are the third cycle since the Inflation Reduction Act was passed in 2022.

The decline in primary care providers threatens Medicare FFS patients' access to new visits, highlighting urgent needs for policy reform and workforce solutions.

The ACCESS Model signals a shift toward outcome-aligned payments and a necessary reframing of what “value” actually means.

The most-viewed content focused on the “One Big Beautiful Bill,” the Most Favored Nation drug policy, and other changes under the Trump administration.

Industry leaders discuss how policy, pricing, and innovation will shape the future of oncology care and patient access.

Oncology leaders warn that declining reimbursements and policy gaps threaten patient access and drive inequities in cancer care.

Recent political shifts impacting health policy and access to care for millions dominated the news in 2025.

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

With ACA subsidies and key CMS payment models ending in 2025, premiums are set to rise, shifting costs to consumers and employers.

Rachel A. Prusynski, DPT, PhD, discusses her study on how payment models affect home health care delivery and patient outcomes.

Chronic Conditions Data Warehouse comorbidity data vary by insurance status. Analyses using these data that fail to account for insurance status are subject to information bias.

In this investigation, the authors evaluated the impact of a voluntary transition to risk-based contracts under Medicare Advantage on health care use.

Performance on Medicare Star Ratings medication adherence measures is significantly tied to performance on the intermediate outcome and statin process measures.

Explore how the WISeR Model addresses prior authorization reform, Medicare costs, and AI's role in tackling the health care affordability crisis.

The White House announced significant drug pricing cuts for GLP-1s for diabetes and obesity for Medicare and Medicaid beneficiaries and on TrumpRx.

A JAMA study found 30-day outpatient follow-up decreases hospital readmissions, especially for patients with heart failure and heart attack.