Endeavor Health, the Chicago-area hospital system formed from the merger of NorthShore and Edward-Elmhurst, says it will step outside Aetna’s Medicare Advantage network starting Jan. 1, 2027. The change reaches patients who use an Aetna Medicare Advantage plan at Endeavor’s hospitals and clinics, though two groups keep their in-network access. Illinois state retirees enrolled in…

Three national groups representing home-health agencies and hospices are asking Medicare to let its nationwide freeze on new provider enrollments expire on Nov. 13, six months after it began. LeadingAge, the National Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation each sent letters to CMS Administrator Dr. Mehmet Oz…

The most a person with Medicare drug coverage will pay out of pocket for covered prescriptions rises to $2,400 in 2027, up from $2,100 this year, as plans mail their annual change notices this month ahead of open enrollment on Oct. 15. The standard deductible climbs to $700 from $615, while federal limits on tier…

Beginning April 1, 2027, people with Original Medicare who have heart failure, chronic obstructive pulmonary disease, a substance use disorder or nicotine dependence will be able to sign up for technology-supported care at home through Medicare’s ACCESS Model. The Centers for Medicare & Medicaid Services announced the expansion on September 15, 2026. Participating organizations may…

Medicare plans to cut what it pays laboratories for most blood tests, urinalysis and other diagnostic tests starting in 2027, a change the Centers for Medicare & Medicaid Services projects will save taxpayers about $1 billion a year. CMS released preliminary 2027 rates on September 21, 2026, and said its data show Medicare has been…

Medicare paid transplant hospitals an estimated $380 million from 2017 through 2022 to acquire organs that were never transplanted into Medicare patients, because long-standing CMS guidance conflicts with a federal law barring the program from subsidizing care for people it does not cover, the HHS Office of Inspector General found. The audit, issued September 1,…

Medicare Part D drug plans paid pharmacies $587.7 million from 2021 through 2023 for five drugs that should no longer have been covered, because their brand-name versions had already become available over the counter, federal auditors found. The HHS Office of Inspector General, in an audit issued August 31, 2026, traced nearly all of the…

Humana has rejected all four recommendations in a new federal audit of its HumanaChoice Medicare Advantage contract, including a call to review 212 additional enrollee-years of diagnosis codes that auditors flagged as possible data-entry errors. The HHS Office of Inspector General, which issued the audit of contract H5216 on September 10, 2026, found that medical…

Federal auditors found that medical records did not support the diagnosis codes UnitedHealthcare of Wisconsin submitted to Medicare in 183 of 250 sampled enrollee-years, and estimated the insurer was overpaid at least $46.9 million for 2020 and 2021. The HHS Office of Inspector General issued the audit of Medicare Advantage contract H5253 on September 10,…

The Centers for Medicare & Medicaid Services has barred eternalHealth from enrolling new Medicare beneficiaries into its two Medicare Advantage-Prescription Drug contracts, H1280 and H2694, after Massachusetts regulators placed the Boston insurer under administrative supervision. The enrollment suspension took effect at 11:59 p.m. Eastern time on August 27, 2026. It arrives weeks before Medicare’s annual…