Below is a summary of recent events to help you stay current on the healthcare and Medicare news that impacts you. This page is updated frequently, so check back regularly to keep up with changes in the healthcare industry.
New Medicare program offers weight-loss drugs for $50 a month
Eligible Medicare beneficiaries may now be able to receive certain GLP-1 medications for weight management for $50 a month through a new demonstration program from the Centers for Medicare & Medicaid Services.
The initiative, known as the Medicare GLP-1 Bridge, is designed to expand access to certain GLP-1 medications. As part of the program, CMS will study how increased access affects health outcomes and Medicare spending. The program is currently set to end December 31, 2027.
Who may qualify?
The Medicare GLP-1 Bridge is available only to certain beneficiaries enrolled in a Medicare Part D prescription drug plan. Not everyone with Medicare is eligible.
Medicare beneficiaries are not eligible if they already:
Beneficiaries interested in the Medicare GLP-1 Bridge should talk with their physician to determine whether they qualify.
How the program works
Eligible participants will pay a flat $50 monthly copayment for covered medications. However, the copayment won’t count toward a Part D deductible or annual out-of-pocket spending limits.
CMS will administer the program through a centralized system that handles prior authorization, claims processing and pharmacy payments.
Demand for GLP-1 medications has surged in recent years. According to healthcare analytics company IQVIA, Medicare prescriptions climbed from about 400,000 in early 2020 to roughly 2 million by mid-2025.
"For too long, many Americans have been unable to access these treatments because of cost," said CMS Administrator Dr. Mehmet Oz. "The Medicare GLP-1 Bridge creates a new pathway for eligible beneficiaries to afford GLP-1 medications."
DOJ shuts down $174 million Medicare telemarketing scam
A Missouri man was recently sentenced to 10 years in federal prison for orchestrating a large-scale scheme that billed Medicare for over $174 million in genetic testing, according to the U.S. Attorney’s Office for the Eastern District of Louisiana.
Jamie P. McNamara, 50, operated several laboratories for 18 months in Louisiana and Texas. During that time, he used the laboratories to submit hundreds of millions of dollars in Medicare claims for cancer and cardiovascular genetic tests.
Medicare paid over $55 million before the scheme was uncovered.
How the scheme worked
Prosecutors said McNamara relied on call centers and telemarketers who encouraged Medicare beneficiaries to accept genetic tests.
Orders were signed by telemedicine providers who:
McNamara also paid illegal kickbacks, disguised bribes through sham contracts, hid his ownership by using family members’ names on documents, and shifted billing between labs to evade scrutiny.
Additional violations
While on pretrial release, McNamara fled during an unrelated arrest and cut off an ankle monitor, leading to his detention until sentencing.
A 10-year sentence for Medicare fraud
In November, a federal judge imposed the maximum penalty for McNamara, which includes:
“Medicare fraud targets vulnerable populations, and our office will continue seeking just punishment for business owners and professionals who abuse this crucial trust-based system to steal taxpayer dollars,” said Acting U.S. Attorney Michael M. Simpson.
CMS: Medicare enrollees to pay more for Part A & B in 2026
Medicare enrollees will pay more for Part A and Part B in 2026, as premiums, deductibles, and coinsurance amounts rise across both programs, according to the Centers for Medicare & Medicaid Services.
Here’s a look at the updated 2026 premiums, deductibles, and key cost-sharing amounts:
Part A cost changes for 2026
Here are the main Part A cost-sharing changes for 2026:
● Inpatient hospital deductible: $1,736 (up from $1,676 in 2025)
● Daily hospital coinsurance for days 61–90: $434 (up from $419)
● Daily coinsurance for lifetime reserve days: $868 (up from $838)
● Skilled nursing facility coinsurance (days 21–100): $217 per day (up from $209.50)
Part A buy-in premium
Some individuals age 65 and older and people with disabilities must pay a premium to enroll in Part A:
● Reduced monthly premium: $311 in 2026 (up $26)
● Full monthly premium: $565 in 2026 (up $47)
Medicare Part B costs for 2026
Medicare Part B covers physician services, outpatient hospital care, durable medical equipment, certain home health services, and other outpatient care.
Part B premium & deductible
● Standard monthly premium: $202.90 in 2026 (up from $185.00)
● Annual deductible: $283 in 2026 (up from $257)
CMS said the increases reflect projected price changes and expected utilization consistent with historical trends.
Impact of skin substitute payment changes
CMS noted that without 2026 fee schedule changes affecting skin substitutes, the standard Part B premium would have been about $11 higher per month.
● Under the updated rule, these products will be treated as incident-to supplies beginning in 2026, reducing Medicare spending while maintaining patient access.
● The change comes after Medicare spending on skin substitutes exploded from $256 million in 2019 to more than $10 billion in 2024.
Immunosuppressive drug premium
Beneficiaries who maintain Part B coverage only for immunosuppressive drugs after a kidney transplant will pay a standard premium of $121.60 in 2026.
Medicare Part D income-related adjustments
CMS also released the 2026 income-related monthly adjustment amounts for Medicare Part D.
● These adjustments apply to about 8% of beneficiaries and are added to a plan’s monthly premium.
● Part D plan premiums vary by plan, and CMS does not set a standard premium amount.
Medicare reform to save $19 billion in wound-care payments
Changes to Medicare’s payment rules for wound-care products are expected to save about $19 billion next year, according to the Centers for Medicare & Medicaid Services.
The changes outlined in the 2026 Medicare Physician Fee Schedule final rule aim to:
“The new Medicare fee schedule delivers a major win for seniors, protects hometown doctors, and safeguards American taxpayers,” said U.S. Health and Human Services Secretary Robert F. Kennedy Jr. “It realigns doctor incentives and helps move our country from a sick-care system to a true health care system.”
From 2019 to 2024, Medicare spending for wound-care products (also called “skin substitutes”) rose from $256 million to more than $10 billion a year. Medicare attributes the 3,800% increase to abusive pricing practices and the use of products with limited clinical value.
Cutting waste in wound care
The final rule also includes updates to improve payment accuracy, expand preventive services, and strengthen chronic disease management for Medicare beneficiaries.
Audit: Medicare system error paid suppliers $22.7 million
Medicare mistakenly paid suppliers $22.7 million over seven years for durable medical equipment, according to a U.S. Department of Health and Human Services Office of Inspector General audit report.
Auditors found that payments were made for prosthetics, orthotics, and other supplies provided to enrollees during inpatient hospital stays. In addition, up to $5.9 million in deductibles and coinsurance may have been wrongly collected.
“Medicare overpaid suppliers because the system edits that should have prevented or detected the overpayments were not adequate,” said OIG Acting Deputy Inspector General for Audit Services Carla Lewis.
Medicare billing rules for in-patient care
Under Medicare rules, suppliers should not bill for DMEPOS items provided while a patient is admitted to a hospital or other inpatient facility. Those items must be supplied by the facility or through an arrangement with it.
“None of the $22.7 million in payments for DMEPOS items covered by this audit should have been paid,” according to the audit report.
“Because improper payments continue to be made, further review of the edits may be necessary to determine whether refinements are needed.”
Although the Centers for Medicare & Medicaid Services updated its payment system edits in January 2020 to reduce these errors, auditors found that improper payments continued.
Next steps
Based on the findings, CMS will seek to recover the $22.7 million, ensure refunds to beneficiaries, and fix billing system errors.
In 2024, auditors found that improper Medicare payments totaled $31.7 billion dollars caused by billing and documentation errors.
Arizona couple sentenced for $1.2 billion Medicare fraud scheme
A husband-and-wife team from Phoenix, Ariz., were recently sentenced to prison for orchestrating a $1.2 billion Medicare fraud scheme.
The couple submitted more than $1.2 billion in false and fraudulent claims from 2022 to 2024 to:
In addition to their prison sentences, King and Gehrke were ordered to pay over $1.2 billion in restitution and forfeit $410 million in assets, including luxury cars, annuities, jewelry, and bank accounts.
Behind the Medicare fraud scheme
Gehrke operated Apex Medical LLC and Viking Medical Consultants LLC, which recruited elderly and terminally ill patients for expensive, medically unnecessary wound grafts, according to the U.S. Department of Justice.
Investigators found that the couple:
Abnormal billing pattern tips off investigation
Investigators identified the fraud after detecting abnormal billing patterns for wound grafts through data analytics and coordinated audits conducted by the Health Care Fraud Strike Force.
Once the abnormal billing patterns were identified, agencies participating in the investigation included the:
Medicare prescription drug premiums to drop 10% in 2026
About 50 million people enrolled in Medicare Part D prescription drug plans will pay lower premiums in 2026, according to the Centers for Medicare & Medicaid Services.
“Millions of Medicare beneficiaries will continue to have access to a broad range of affordable coverage options in 2026,” says CMS Administrator Dr. Mehmet Oz. “We want every beneficiary to take advantage of Open Enrollment—compare your options and choose the plan that gives you the right care at the best price.”
Lower premiums for prescription drug coverage
CMS estimates the average total premium for stand-alone Medicare Part D prescription drug plans will decline from:
For Medicare Advantage plans that include prescription drug coverage, the average Part D premium is expected to drop from:
Controlling prescription drug plan premiums
Lower premiums for Medicare prescription drug plans are partly the result of the Part D Premium Stabilization Demonstration, introduced in 2025.
Nearly everyone enrolled in stand-alone Part D plans in 2025 are covered by private insurance companies participating in the program for 2026.
Open Enrollment begins October 15
Medicare Open Enrollment for the 2026 plan year runs from October 15 to December 7, 2025.
New eligibility rules expand access to catastrophic insurance
Catastrophic health insurance will be available to more consumers starting November 1, 2025, according to the U.S. Department of Health and Human Services.
Catastrophic health insurance is a low-premium, high-deductible plan designed to provide healthcare coverage for consumers in worst-case scenarios such as a serious illness or injury.
In 2025, only about 54,000 people purchased catastrophic health plans. That number could grow under the new HHS guidelines.
Here’s how access is changing:
“Catastrophic coverage offers affordable health insurance for younger Americans and those facing hardship to have security when they need it most,” says Secretary of Health and Human Services Robert F. Kennedy, Jr. “Expanding access to catastrophic coverage is another step in making health insurance more affordable.”
Beginning November 1, 2025, consumers can apply for the hardship exemption in two ways:
For carriers: Expanded eligibility may increase demand for catastrophic plans, particularly among consumers priced out of bronze or silver coverage.
Federal announcement may extend short-term health insurance options
Last year, the federal government cut the duration of short-term health insurance to a maximum of four months (three months with a one-month extension). But that may change, according to a new announcement from the Centers for Medicare & Medicaid Services.
Federal agencies reviewing the rules of short-term health insurance include the U.S. Departments of Labor, Health and Human Services, and the Treasury.
According to a joint statement published on August 7, 2025:
Short-term rules under review
The rules under review include limited short-term, limited-duration insurance that limits plans to an initial contract of three months and a maximum coverage period of four months.
Prior to the 2024 rules, short-term health insurance was available for 12 months in some states, and renewable two more times, for coverage up to three years.
What it may mean for consumers and carriers
Medicare inpatient psychiatric facilities to receive $70 million boost for fiscal year 2026
Payments for Medicare inpatient psychiatric facilities will rise by 2.5% in fiscal year 2026, adding about $70 million in funding, according to a final rule from the Centers for Medicare & Medicaid Services.
Medicare helps cover inpatient psychiatric care for thousands of older adults and people with disabilities each year, often in rural or teaching hospitals that rely heavily on federal funding. The new payment updates will take effect October 1, 2025.
What it means for Medicare providers
What it means for Medicare beneficiaries
“These policies will improve or maintain individual access to high-quality care by ensuring that payment rates reflect the best available data on the resources involved in inpatient psychiatric care and the costs of these resources,” according to the Centers for Medicare & Medicaid Services.
Medicare skilled nursing facility payments to increase by approximately $1.16 billion for fiscal year 2026
Medicare skilled nursing facility payments will rise by approximately $1.16 billion in 2026 under a final rule from the Centers for Medicare & Medicaid Services.
The change, effective October 1, 2025, increases payment rates by 3.2% and updates rules on patient classification, quality reporting, and the Value-Based Purchasing program for Medicare-approved skilled nursing providers.
Key changes for skilled nursing facilities include:
What this means for Medicare beneficiaries
For the 65 million Americans enrolled in Medicare, these updates could mean better care, more accurate facility evaluations, and less time wasted on paperwork. Here’s what’s changing:
DOJ: Florida man sentenced for $61 million Medicare fraud scheme
A 64-year-old Florida man was recently sentenced to 12 years in prison and three years supervised release for a $61 million Medicare fraud scheme involving durable medical equipment (DME), according to the U.S. Department of Justice.
Peter Roussonicolos pleaded guilty to conspiracy to commit health care fraud and wire fraud in November 2024. In addition to the prison sentence, he was ordered to pay $21 million in restitution and forfeit $2.5 million.
Behind the Medicare fraud scheme
Roussonicolos operated five DME companies as a silent partner, concealing his involvement due to prior felony convictions that made him ineligible to enroll as a Medicare supplier, U.S. Office of Inspector General.
Investigators from the U.S. Department of Health and Human Services and the Federal Bureau of Investigation also found that Roussonicolos:
“This defendant and his co-conspirators orchestrated an elaborate scheme to steal millions from Medicare through kickbacks and sham billing,” said Assistant Director Jose A. Perez of the FBI Criminal Investigative Division.
“Today’s sentencing demonstrates that those who exploit our healthcare system for personal gain will be held accountable.”
New Medicare program aims to reduce waste & improve prior authorization process
Medicare is launching a new program to reduce fraud, waste and abuse, after identifying an estimated $5.8 billion was wasted on low-value and unnecessary services in 2022. The program is also designed to improve care and the prior authorization process.
CMS will work with companies using artificial intelligence to help review selected services prone to overuse, including:
The WISeR Model: How it works
CMS will select companies to support the WISeR program based on geographic regions.
“Combining the speed of technology and experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures,” says Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz.
What it means for Original Medicare beneficiaries
The WISeR Model will not change Medicare’s coverage or payment criteria. Original Medicare beneficiaries will still be able to see the provider or supplier of their choice.
However, for selected services under the WISeR Model, providers will be required to either:
Providers with strong compliance records may qualify for exemptions in the future, reducing paperwork and focusing oversight on higher-risk areas.
CMS final rule reshapes enrollment, premiums and broker oversight
The Centers for Medicare and Medicaid Services recently finalized new changes to Affordable Care Act Marketplace rules. The updates affect enrollment periods, eligibility checks, plan renewals, premium payments and other Marketplace processes. Changes will be phased in between 2025 and 2028.
“This final rule also enacts permanent reforms to help the markets reset to the changing subsidy environment to improve affordability and stability over the long-term,” according to the U.S. Department of Health and Human Services.
Here’s a look at what’s changing and when the updates take effect:
Automatic re-enrollment is still the default, but premium subsidies are not.
End of the monthly Special Enrollment Period…
Stricter verification of income and eligibility before tax credits are applied.
Insurers may now deny coverage due to unpaid premiums if you are re-enrolling with the same insurer.
Deferred Action for Childhood Arrivals will no longer be eligible for Marketplace coverage.
Open Enrollment Period will shift to November 1 to December 31
States will be allowed to update Essential Health Benefits benchmark plans beginning in Plan Year 2028.
Stronger oversight of agents and brokers to prevent misconduct.
The final rule takes effect 60 days after its publication, with different provisions becoming active in plan years 2026, 2027, or 2028.
CMS announces 2026 rate changes for Medicare Advantage and Part D
The Centers for Medicare & Medicaid Services recently announced key updates to Medicare Advantage and Part D plan rates for 2026 that could affect millions of enrollees.
An estimated 68 million Americans enrolled in Medicare could be impacted by the 2026 changes, which include:
Medicare Advantage plan payments
According to the recent announcement by the Centers for Medicare & Medicaid Services:
This payment increase helps Medicare Advantage insurers cover the cost of medical care for the estimated 35.7 million enrolled in Medicare Advantage plans.
Medicare Part D prescription drug coverage cap
As part of ongoing reforms under the Inflation Reduction Act, the Centers for Medicare & Medicaid Services will implement a $2,100 annual cap on out-of-pocket Medicare Part D drug costs beginning in 2026.
In 2025, Part D out-of-pocket costs were capped at $2,000.
While the new cap is slightly higher than in 2025, it continues to limit out-of-pocket expenses, especially for individuals who take high-cost medications.
New record: 23.6 million enroll in Marketplace plans before Jan. 15 deadline
An estimated 23.6 million people have selected plans for coverage in 2025 through the Health Insurance Marketplace before the Jan. 15 deadline, according to the Centers for Medicare and Medicaid Services.
“We can’t lose sight of what’s behind our tremendous, record-setting progress: Millions of individuals and families who now have a critical connection to the lifeline of health care coverage,” says Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure.
By the numbers: Marketplace enrollment for 2025
Coverage for $10 or less per month with tax credits
“To the millions more who may still need coverage: Don’t delay,” says Brooks-LaSure. “Help is still available, including tax credits that have made coverage more accessible by reducing the barrier posed by high costs.”
Open Enrollment deadlines
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