Medicare rules, CMS guidance, reimbursement, and benefit changes affecting patients and providers.
CMS has finalized its 2026 payment rule for hospital outpatient departments and ambulatory surgery centers. Here’s what the changes mean for Medicare patients, hospital finances, and where you receive care.
OTC hearing aids are now widely available for adults with mild to moderate hearing loss. Here’s what the FDA requires, how they differ from prescription devices, what traditional Medicare does and does not cover, and when a medical exam is still essential.
Hospitals and insurers now publish more pricing data than ever, including negotiated rates and cash prices. Here’s what those files actually show, how CMS is enforcing compliance in 2026, and what they mean for your out-of-pocket costs.
New federal rules are rolling out in 2026–2027 to shorten prior authorization timelines, require clearer denial explanations, and move more requests online for certain Medicare Advantage, Medicaid, CHIP, and Marketplace plans. Here’s what’s changing — and what it means for patients.
CMS has finalized its 2026 Medicare Advantage payment update, outlining how plan payments, risk adjustment, and quality bonuses will change next year. Here’s what that could mean for premiums, extra benefits, and provider networks.
New CMS rules are changing how prior authorization works for many Medicare Advantage, Medicaid managed care, CHIP, and ACA Marketplace plans. Here’s what’s different in 2026, what hasn’t changed, and what to do if your care is delayed or denied.
In 2026, the first negotiated drug prices under Medicare’s new program take effect. Here’s what that means for seniors, how the Maximum Fair Price works, and how the $2,000 Part D cap fits in.
Federal price transparency rules require hospitals and insurers to post negotiated rates and consumer tools—but the data can be hard to use. Here’s what patients should know in 2026.
Adults 65 and older remain at highest risk for severe COVID-19. Here’s what the CDC and FDA say about the 2025–2026 vaccine update, how well it protects against hospitalization, and how Medicare covers the cost.
Anti-amyloid antibody treatments such as lecanemab are now part of Alzheimer’s care in the United States—but only for certain patients. Here’s who qualifies, what Medicare covers, how MRI safety monitoring works, and what families should realistically expect.
A major Cochrane review finds that spinal manipulation offers modest relief for chronic low back pain—about similar to exercise and other recommended non-drug treatments. Here’s what that means for patients, safety, Medicare coverage, and when to seek urgent care.
FDA-approved anti-amyloid drugs like lecanemab can modestly slow early Alzheimer’s disease—but they are not cures. Here’s who qualifies, what the clinical trials showed, the real risks, and how Medicare coverage works in 2026.
Medicare Advantage plans and other insurers increasingly use algorithms to review prior authorization and claims. Federal watchdog findings and new CMS rules clarify what’s allowed, what isn’t, and what rights patients have when care is denied.
A surge of FDA-approved biosimilars for adalimumab and a redesigned Medicare Part D benefit with a $2,000 annual out-of-pocket cap are reshaping how Americans with arthritis pay for biologic drugs in 2026. Here’s what that means for your costs, coverage, and care decisions.
Federal minimum staffing standards for nursing homes are now phasing in nationwide. Here’s what the rule requires, when changes take effect, and what families should realistically expect in 2026.
Federal regulators have finalized the first nationwide minimum staffing standards for Medicare- and Medicaid-certified nursing homes. Here’s what 24/7 RN coverage and new hourly minimums mean for residents and families in 2026.
The finalized 2026 ACA Marketplace rules shape how premium tax credits are calculated, who qualifies for financial help, and what households should review before enrolling. Here’s what to check now to avoid surprise costs and coverage gaps.
CDC and ACIP have updated guidance for COVID-19, flu, and RSV vaccines for the 2025–2026 respiratory season. Here’s who should get vaccinated, whether shots can be given together, and how Medicare, Medicaid, and private insurance coverage works.
Medicare’s 2026 physician payment rule changes how doctors are paid for office visits, preventive services, telehealth, and chronic care. Here’s what that could mean for appointment access, screenings, and small or rural practices.
Starting in 2026, many Medicare Advantage, Medicaid, CHIP, and Marketplace plans must publicly report how often they approve or deny prior authorization requests and how long decisions take. Here’s what that new transparency could mean for patients and clinicians.
For the 2025–2026 RSV season, CDC now routinely recommends a one-time RSV vaccine for adults 75 and older, and for adults 60–74 with certain risk factors. Here’s what changed, what the evidence shows, and what it means for Medicare coverage and access.
The 2026 Medicare physician fee schedule affects how doctors are paid, which services are prioritized, and how easy it may be for patients to find care. Here’s what the latest CMS updates could mean for access, preventive services, and community health.
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