Insurance News
Regulatory updates in plain English
Stay current with the latest from CMS, state departments of insurance, NAIC, the Federal Register, and Congress — rewritten so you can actually understand what it means for your practice.
CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D
The Centers for Medicare & Medicaid Services (CMS) has proposed new rules to improve Medicare Advantage and Part D. These changes will make provider directories more accurate, require Pharmacy Benefit Managers (PBMs) to be transparent about their compensation, and protect low-income Medicare benefic...
Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026 (CMS-4214-P)
The Centers for Medicare & Medicaid Services (CMS) has proposed new rules that will affect Medicare Advantage and Medicare Part D programs starting in 2028. Key changes include eliminating the $1 copayment for generic drugs for low-income individuals who are fully eligible for both Medicare and Medi...
Commissioner Causey urges Medicare recipients to check their 2027 options
Insurance Commissioner Mike Causey is reminding Medicare recipients to review their plans during the Open Enrollment Period, which starts on October 15 and ends on December 7. Many plans may increase their costs, so it's important not to just stick with your current plan without checking for better ...
Medicare Open Enrollment starts Oct. 15 for 2027 plans
Starting tomorrow, October 15, you can change your Medicare coverage during the Open Enrollment period, which lasts until December 7. This affects anyone enrolled in Medicare, including those with prescription drug plans and Medicare Advantage plans. The Office of the Insurance Commissioner offers a...
2027 Medicare Advantage and Part D Star Ratings
The Centers for Medicare & Medicaid Services (CMS) has updated the Medicare Advantage (MA) and Part D Star Ratings for 2027, which will help seniors and people with disabilities find high-quality and affordable health coverage. These ratings, published on October 8, 2026, will be available during th...
CMS Finalizes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Original Medicare Part B
The Centers for Medicare & Medicaid Services (CMS) has announced a new program called the GLOBE Model, which aims to lower drug prices for Medicare Part B beneficiaries. This program will test a new way to calculate rebates for certain drugs, using prices from other countries as a benchmark. The goa...
CMS Prevents $1.6 Billion in Fraudulent Medicare Laboratory Payments
The Centers for Medicare & Medicaid Services (CMS) has successfully stopped over $1.6 billion in fraudulent payments to Medicare laboratories. This includes the removal of 157 fraudulent lab providers from the Medicare program, which saved $732 million. CMS is using advanced technology, like artific...
CMS Announces New Preliminary Medicare Payment Rates for Laboratory Services, Saving Taxpayers an Estimated $1 Billion Annually
The Centers for Medicare & Medicaid Services (CMS) has announced plans to change the payment rates for laboratory services under Medicare. Starting in 2027, these rates will be more closely aligned with what private insurers pay, which is expected to save taxpayers about $1 billion each year. Curren...
Preliminary Calendar Year (CY) 2027 Medicare Clinical Laboratory Fee Schedule Payment Rates
The Centers for Medicare & Medicaid Services (CMS) has released preliminary payment rates for clinical laboratory tests for the year 2027. This affects laboratories that provide diagnostic tests covered by Medicare. The new rates are based on what private insurers pay for these tests, following chan...
CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions
Starting in Spring 2027, Medicare will offer new options to help people with chronic conditions like heart failure, COPD, substance use disorders, and nicotine dependence. This initiative, called the ACCESS Model, will allow Medicare beneficiaries to receive ongoing care from home, using technology ...
Strengthening Original Medicare
The Center for Medicare is making changes to strengthen Original Medicare, which includes Parts A and B, affecting around 70 million Americans. They aim to improve access and affordability for beneficiaries while ensuring that Original Medicare remains a strong option alongside Medicare Advantage. K...
Manufacturer Effectuation of MFP Draft Guidance for 2028 Medicare Drug Price Negotiation
The Centers for Medicare & Medicaid Services (CMS) has released draft guidance for drug manufacturers regarding the implementation of the Maximum Fair Price (MFP) for certain drugs in 2028. This guidance outlines the processes manufacturers must follow to ensure that the agreed-upon prices are acces...
Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) has proposed new rules for Medicare payments starting January 1, 2027, which will affect how physicians and other healthcare providers are paid under the Physician Fee Schedule (PFS). The proposed changes aim to improve the quality and efficiency of...
Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule (CMS-1848-P) — Medicare Shared Savings Program Proposals
The Centers for Medicare & Medicaid Services (CMS) has proposed changes to the Medicare Shared Savings Program for 2027. These changes aim to improve financial incentives for Accountable Care Organizations (ACOs) and encourage participation, especially from those serving higher-risk populations. Key...
CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment, and Shift from Sick Care to Healthcare
The Centers for Medicare & Medicaid Services (CMS) is making major changes to Medicare that will affect healthcare providers and patients. These reforms aim to make it easier for doctors and hospitals to work together in groups called accountable care organizations (ACOs), which focus on preventing ...
Fiscal Year 2027 Medicare Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1847-F)
The Centers for Medicare & Medicaid Services (CMS) has updated the payment rules for Inpatient Psychiatric Facilities (IPFs) for the fiscal year 2027. Payments will increase by 2.3%, which translates to an additional $60 million for IPFs compared to the previous year. Starting in fiscal year 2028, t...
CMS Acts to Strengthen Care Quality, Cut Drug Costs, and Slash Out-of-Pocket Expenses for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) has announced changes to how Medicare pays for outpatient care, which will start in 2027. These changes aim to lower drug costs and out-of-pocket expenses for Medicare beneficiaries. CMS plans to adjust payment rates for drugs purchased under the 34...
Medicare Part D 2027 National Average Monthly Bid Amount Information
The Centers for Medicare & Medicaid Services (CMS) has released preliminary information about Medicare Part D bids for 2027, which will help plan sponsors prepare for the upcoming Medicare Open Enrollment. The average monthly bid amount for 2027 is set at $296.05, and the base beneficiary premium wi...