Plain-English guidance on Medicare, retirement planning, and navigating coverage changes in Ohio.
CMS’s efforts to expand Medicare coverage of GLP-1s for obesity could provide substantial benefits to millions of Medicare beneficiaries, given the potential demand for these highly effective medicat…
The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescr…
Just over 35 million people are enrolled in Medicare Advantage in February 2026, an increase of 1.1 million since a year ago. The increase was largely driven by increased enrollment in special needs…
This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage mar…
On February 14, 2026, CMS released a dataset with provider-level spending data that the agency suggests could be used to identify unusual billing patterns for specific services, states, or providers.…
Medical or prescription denials can be frustrating, heart-breaking and downright wrong. Many denials are automated by AI and happen in a matter of seconds with no real review. You have rights and rem…
This brief describes the Managed Care Program Annual Report (MCPAR), a relatively new, comprehensive report on state Medicaid managed care programs that includes plan-level data. It is used with othe…
The PERM program measures improper payments in Medicaid through cyclical audits of state Medicaid programs. This brief explains the PERM program and its three component error rates as well as upcomin…
The Medicare drug price negotiation program could improve coverage of drugs selected for negotiation for Medicare beneficiaries because the law requires all Medicare Part D plans to cover each of the…
On January 1, 2026, the Center for Medicare & Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements…
