Medicare-related News

This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.

The Medicare program will spend at least $13 billion on the Medicare Advantage quality bonus program in 2026, as 68% of Medicare Advantage enrollees are in a plan that qualifies for higher payments under the program.

This interactive provides the facts on Medicare spending. Medicare, which serves 70 million people and accounts for 14 percent of the federal budget and 21 percent of national health spending, is at the heart of discussions about health expenditures and affordability. Explore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending.

This analysis finds that CMS’s proposed cut to Medicare reimbursement for 340B drugs, and accompanying increase for other outpatient services, would reduce revenues among safety-net hospitals while increasing revenues among for-profit hospitals.

Without these extra subsidies in place for 2027, some Part D stand-alone drug plan (PDP) enrollees could see a larger premium increase for drug coverage next year than they’ve faced in recent years, though plan-specific premium amounts are not yet known. While some policymakers questioned the rationale for and cost of the premium stabilization demonstration, which totaled $9.8 billion in 2025 and 2026, the extra subsidies worked as intended to stabilize year-over-year PDP premium increases and prevent substantial PDP enrollment changes.