Medicare-related News

As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. This brief summarizes these initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to highlight facts about recent experiences with and use of digital health tools among Medicare beneficiaries and older adults more generally.

The Administration’s proposed changes for certain imaging services would further advance site-neutral payment reform but, like prior changes, are modest relative to more expansive options raised by MedPAC and others.

Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at higher rates than requests overall. When these decisions are appealed, they are frequently overturned, particularly for skilled nursing facility stays. This may cause delays for Medicare beneficiaries who are particularly vulnerable or have high care needs.

Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS, the effects on beneficiaries, and other proposals to improve payment accuracy.

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.