A new research letter in JAMA analyzes the impact of Medicare Advantage plan exits, finding that millions of enrollees are forced to select new coverage when insurers withdraw. The study notes that such disruptions can complicate care coordination, especially for seniors with complex medical needs, fueling debate over marketplace stability.
Federal regulators have ordered a temporary halt on new enrollments in certain Elevance Health Medicare Advantage plans after identifying compliance issues. The action reflects growing federal scrutiny of private insurers to ensure they meet program requirements and protect beneficiaries.
A proposed update to Medicare Advantage payment rules has generated a record number of public comments from insurers, providers, and advocacy groups. The proposal aims to refine insurer reimbursements and address concerns about the risk-score calculations used to determine payments.
Washington Post Health Brief – Today
CMS has proposed a near-flat increase of just 0.09% in Medicare Advantage reimbursement rates for 2027 — far below insurer expectations. Insurers and policy groups warn this could lead to reduced supplemental benefits and higher premiums for beneficiaries. The comment period remains open until Feb 25 ahead of an April 6 final rule.
What Medicare Is and Who It Serves Medicare is the federal health insurance program for people aged 65 and older, as well as certain younger individuals with disabilities or specific conditions like End-Stage Renal Disease. In 2026, it continues to serve as the primary health coverage for over 60 million Americans. The program is divided into distinct “parts,” each covering different services.
Medicare Part A: Your Hospital Insurance covers inpatient care in hospitals, skilled nursing facility care following a hospital stay, hospice care, and some home health services. For most beneficiaries, there is no monthly premium for Part A if they or their spouse have at least 40 quarters of Medicare-covered employment. However, cost-sharing does apply when you use services. The 2026 Part A inpatient hospital deductible is $1,736 per benefit period Source: CMS.
Medicare Part B: Your Medical Insurance covers outpatient care, doctor visits, preventive services, durable medical equipment, and ambulance services. Unlike Part A, Part B requires a monthly premium. The standard monthly premium for 2026 is $202.90. You must also meet the annual Part B deductible of $283 before coverage begins for most services Source: CMS.
Medicare Part C: The Medicare Advantage Alternative, also known as Medicare Advantage, allows private insurance companies approved by Medicare to provide your Part A and Part B benefits. These plans often include additional benefits like prescription drug coverage (Part D), along with dental, vision, or hearing services.
Medicare Part D: Your Prescription Drug Coverage is optional insurance to help pay for outpatient prescription medications. You can get Part D by joining a stand-alone Prescription Drug Plan (PDP) to add to Original Medicare, or by selecting a Medicare Advantage plan that includes drug coverage (MA-PD).
Where to Find Official Plan Information The definitive source for comparing all Medicare Advantage and Part D plans available in your area is the federal government’s Medicare Plan Finder tool at Medicare.gov/plan-compare. This tool allows you to input your medications and preferred pharmacies to see exact costs.
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NEW YORK (AP) — Drugs that treat Type 2 diabetes, HIV and arthritis are among 15 new medications chosen for a Medicare drug price negotiation program that allows the federal government to haggle directly with drug manufacturers, the Trump administration said Tuesday.
The Size of Medicare (Nationally) in the U.S.
For the whole US, Medicare enrolls 64 million people. Of those, 9.1 million are on Medicare due to a disability, 16% of the Medicare population. Another 500,000 are on Medicare due to End-Stage Renal Disease (ESRD). Medicare accounts for 4% of the US Gross Domestic Product (GDP), or around $780 billion dollars, making it the second most expensive Federal program. (Social Security, at about one trillion ($1,000,000,000,000) per year.
The average total cost per Medicare beneficiary is $12,187 per year. Of that, beneficiaries pay an average of $170.10 per month, or $2041,20, for Part B in 2022 and pay an additional average of ca. $6,000 out of pocket, for a total of around $8100. A very good private insurance plan, in contrast, would cost around $26,000 per year.
Medicare accounted for 20 percent of total national health spending, 30 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services in 2017.