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All articles tagged with #cms

2027 Medicare Advantage: Lower premiums mask rising out-of-pocket costs and benefit cuts

Despite a 16% drop in average monthly premiums for 2027, Medicare Advantage insurers are raising out-of-pocket costs and cutting supplemental benefits like dental care to boost margins. Major carriers including UnitedHealth Group and Humana are reducing plan availability and increasing cost-sharing, a shift driven by investor pressure for higher profits. While insurers publicly emphasize affordability and core coverage, federal data and independent analyses reveal significant reductions in benefits for millions of seniors. Open enrollment for 2027 plans begins October 15, requiring beneficiaries to carefully compare plans to avoid unexpected cost increases or loss of provider access.

via STAT|

#cms #health-insurance #healthcare

healthcare9 days ago•25 min saved

2027 Medicare Advantage: Flat premiums mask rising costs and shrinking plan choices

CMS data shows 2027 Medicare Advantage premiums will drop 16% to $12, but insurers are cutting plans and raising out-of-pocket costs to boost margins. Enrollment is projected to fall to 34 million, with major carriers like Centene and Humana exiting hundreds of counties.

via Healthcare Dive|

#cms #cost-sharing #healthcare

healthcare9 days ago

Medicare Advantage premiums drop 16% for 2027 as insurers cut plans to boost margins

The Centers for Medicare & Medicaid Services (CMS) projects that average monthly premiums for Medicare Advantage (MA) plans will fall by 16% to $12 in 2027, down from $14.37 in 2026. While headline costs drop, insurers are significantly reducing the number of available plans and increasing cost-sharing to improve margins. Stand-alone Part D prescription drug premiums are expected to rise slightly to $36. Open enrollment runs from October 15 to December 7, 2026.

via Fierce Healthcare|

#cms #healthcare #medicare-advantage

healthcare10 days ago•1 min saved

CMS Projects 2027 Medicare Advantage Premiums to Drop 16% Despite Enrollment Disputes

The Centers for Medicare & Medicaid Services (CMS) announced that average monthly premiums for Medicare Advantage plans will decrease by 16% to $12 in 2027, while stand-alone Part D prescription drug premiums will rise slightly to $36. Although insurers predict enrollment declines, CMS expects higher participation. Open enrollment runs from October 15 to December 7.

via USA Today|

#cms #health-insurance #healthcare

health-policy14 days ago•5 min saved

Vance-led task force cancels 760,000 ACA plans, citing fraud

The Trump administration has canceled 760,000 Affordable Care Act (ACA) plans, claiming fraud, and is investigating 420,000 more. Officials say the move saves $2.2 billion, but experts warn it may disenroll legitimate enrollees and worsen coverage gaps.

via The Guardian|

#affordable-care-act #cms #health-insurance

health-policy16 days ago•410 min saved

Vance and Oz Disenroll 750,000 ACA Users, Citing Fraud

The Trump administration has canceled coverage for approximately 750,000 Affordable Care Act enrollees, claiming they were fraudulently enrolled or did not exist. Vice President JD Vance and CMS Administrator Mehmet Oz stated the move will save taxpayers $2.2 billion. While the administration is investigating an additional 419,000 cases, health experts dispute the scale of the fraud, arguing that enrollment declines are largely due to the expiration of pandemic-era subsidies rather than widespread fraud.

via NBC News|

#affordable-care-act #cms #health-policy

health-policy16 days ago•12 min saved

Vance-led task force cancels 315,000 ACA enrollments, citing fraud

The Trump administration has canceled 315,000 Affordable Care Act marketplace enrollments, affecting approximately 760,000 people, citing widespread fraud and improper eligibility. Vice President JD Vance and CMS Administrator Mehmet Oz announced the action on September 22, 2026, estimating it will save the federal government $2.2 billion. The administration is also verifying the eligibility of another 419,000 enrollees and suspending insurance brokers accused of facilitating fraudulent sign-ups. While officials describe the move as a necessary crackdown on 'phantom' enrollees and ineligible recipients, critics argue the criteria are vague and may strip coverage from legitimate beneficiaries.

via The New York Times|

#affordable-care-act #cms #health-policy

health-policy16 days ago•78 min saved

Vance-led task force cuts 760,000 ACA enrollees over fraud claims

The Trump administration has disenrolled approximately 760,000 individuals from Affordable Care Act (ACA) marketplaces, citing fraudulent enrollment. Vice President JD Vance announced the move on Tuesday, stating it will save the government $2.2 billion. The administration is also conducting additional verification on 419,000 other enrollees and suspending insurance brokers involved in improper signups. This action is part of a broader anti-fraud initiative led by Vance, HHS, and CMS, which has shifted to a proactive 'stop and caught' model using AI analytics. Critics argue the process bypassed standard regulatory channels and may impact legitimate enrollees, while supporters contend it addresses significant waste following the expiration of pandemic-era subsidies.

via AP News|

#affordable-care-act #cms #health-policy

health-policy23 days ago•2 min saved

Medicare expands ACCESS to cover more chronic-condition tech-enabled care

Medicare's ACCESS model, which pays approved companies to use technology to help beneficiaries manage chronic conditions (initially diabetes, hypertension, chronic musculoskeletal pain, depression, and anxiety), will be expanded to include substance use disorder, heart failure, COPD, tobacco use, and longer-term musculoskeletal care. The new condition tracks start in spring 2027, and officials say about 75% of Medicare beneficiaries will be eligible for at least one track.

via STAT|

#access-model #chronic-disease-management #cms

health25 days ago•6 min saved

Rural Health Transformation Fund Falls Short on Cash, Shifts to Innovation

The Rural Health Transformation Fund, originally pitched as a $50 billion cash infusion to blunt Medicaid cuts, was redirected toward creating sustainable programs and technology-driven rural care reform rather than filling revenue gaps. States submitted proposals emphasizing workforce development, digital upgrades, and new care models, with pilots including drone-delivered medications, AI imaging, and expanded remote monitoring. Maine has already begun releasing funds for EHR upgrades, workforce support, and rural hospital stabilization, while hospital leaders remain skeptical about the fund’s ability to sustain transformative change after five years given ongoing financial pressures.

via statnews.com|

#cms #health #health-policy

health-care1 month ago•20 min saved

Abbott Pushes Back on Federal Hold, Defending Texas Medicaid Funding

Texas Gov. Greg Abbott publicly defends roughly $10 billion in Medicaid funding for Texas hospitals after the federal government withholds the money, saying Texas financing fully complies with federal law and the delay threatens hospital care, as CMS reviews how the funding is generated and calculated amid a long-running dispute.

via The Texas Tribune|

#cms #greg-abbott #health-care

health-care1 month ago•7 min saved

Hospitals Warn New Medicaid Rules Could Deeply Slash Funding

Hospitals say two CMS proposed rules restricting state taxes and payments that inflate Medicaid dollars could erase far more funding than Congress planned — about $340B in expected losses by 2034, rising to roughly $681B in additional losses through 2035 — while the rules would yield $756B in federal savings and $265B in state savings. Hospitals warn the impact could force reduced services, layoffs, or closures, though CMS says the reforms curb misused dollars and will be finalized after comments, with a phased rollout starting in 2028.

via Politico|

#cms #funding #health-care

health-care1 month ago•32 min saved

Texas Hospitals Brace for $27 Million Daily Medicaid Funding Hit

Texas hospitals are bracing for a $27 million-a-day shortfall in CHIRP Medicaid funding after the federal government withheld about $9.8 billion for next year, threatening to cut services and create a backlog while Texas and federal officials dispute how local hospital taxes are calculated and how funds are allocated.

via The Texas Tribune|

#abbott #chirp #cms

health1 month ago•3 min saved

HHS flags suspected gender-affirming care billing across major providers

The Department of Health and Human Services announced referrals to federal investigators of hundreds of providers over potentially anomalous billing of gender-affirming care for minors, including about $50 million in claims from 2015–2025 and major hospitals among those named. The CMS-commissioned report cited patterns it says could financially benefit providers, while the administration continues to push policies to curb or end funding for such care, drawing criticism from major medical groups and ongoing regulatory actions.

via Fierce Healthcare|

#billing-practices #cms #gender-affirming-care

health-policy2 months ago•5 min saved

Judge lets Medicaid work-rule for chronically ill patients move forward, with future challenges possible

A federal judge declined to block the rule requiring chronically ill Medicaid beneficiaries to prove they can’t work to keep coverage, keeping the policy in place ahead of a Jan. 1 implementation as the broader legal challenge continues; injunction denied without prejudice, allowing renewed challenges if new harms surface, while doctors warn of administrative burdens and potential impacts on patient care.

via Politico|

#cms #health-policy #judge-richard-j-stearns