MPI Blog | Medicare Policy Initiative

MPI Blog

As we age, most of us will rely on Medicare to cover doctor visits, hospital stays, medical equipment, emergency care, prescription drugs, and more. But it’s a complex and costly program that can and should deliver better value to its beneficiaries and to the taxpayers who foot the bill. Read more on our blog.

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CMS Suspends New Medicare Advantage Prior Authorization Transparency Rules Amid Public Concerns About Care Denials

by Ciannah Correa

CMS’ decision to suspend enforcement of key prior authorization and utilization management rules in Medicare Advantage will halt a source of information and transparency. In this MPI blog, Research Fellow Ciannah Correa breaks down the rules that CMS has suspended, what PA transparency rules still take effect in 2026, and how these changes may affect enrollee choice and oversight in MA.

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SHIPs Provide a Critical Service for Medicare Beneficiaries

by CHIR Medicare Policy Initiative

By Jack Hoadley, Beth Fuchs, and Rachel Schmidt The authors have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers can call for unbiased assistance choosing among …

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The Trump Administration’s First Regulatory Action on Medicare Advantage Omits Some Prior Authorization Guardrails

by CHIR Medicare Policy Initiative

By Neil Patil and Carrie Graham On April 4, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized the Contract Year (CY) 2026 Medicare Advantage (MA) and Part D Final Rule. While CMS’s decision not to require Medicare and Medicaid to cover GLP-1 medications for treating obesity is likely to make headlines, another important issue has …

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Policy options to cover anti-obesity drugs: Highlighting the Georgetown policy compendium as a resource

by CHIR Medicare Policy Initiative

By Jack Hoadley The Trump Administration announced on April 4, 2025, that it would not broaden coverage of anti-obesity drugs in Medicare. They did not rule out reconsidering this possibility in the future, however, and others have offered policy proposals for expanding coverage of these drugs. These proposals are included in the compendium of policy …

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Privatizing Medicare: Challenges and Unanswered Questions about Default Enrollment into Medicare Advantage

by CHIR Medicare Policy Initiative

By Carrie Graham and Madeline McBride A number of conservative policymakers and think tanks have pushed to make “privatizing Medicare” part of the current Trump administration’s healthcare agenda. One path toward more privatization is to “default” Medicare beneficiaries into private managed care plans called Medicare Advantage (MA). This would mean that instead of being in traditional …

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Did Changes From the Inflation Reduction Act Affect Medicare Beneficiaries’ Plan Decisions During Open Enrollment? Reflections From Two SHIP Counselors

by CHIR Medicare Policy Initiative

Two research professors from Georgetown University’s Medicare Policy Initiative, Rachel Schmidt and Jack Hoadley, have spent the majority of their careers conducting research and advising federal policymakers on improvements to the Medicare program. They also volunteer directly with Medicare beneficiaries through their counties’ State Health Insurance Assistance Program (SHIP) – a free service where consumers …