Medicare rules, CMS guidance, reimbursement, and benefit changes affecting patients and providers.
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.
Starting in 2026, new federal rules require many insurers to publicly report how often they deny, approve, or delay prior authorization requests. Here’s what that could mean for patients, doctors, and access to care.
COVID-19, flu, and RSV continue to pose serious risks in nursing homes and long-term care facilities. Here’s what current CDC and CMS guidance means for residents, families, and caregivers in 2026.
Medicare drug coverage has changed in recent years, including a $2,000 annual cap on out-of-pocket Part D costs. Here’s what people with Medicare should understand in 2026 about prescription costs, payment options, and coverage rules.
Medicare beneficiaries are seeing continued changes to prescription drug costs, Medicare Advantage rules, and payment policies in 2026. Here’s what the latest CMS updates mean for your coverage, out-of-pocket costs, and access to care.
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