The Affordable Care Act created the most significant changes to Medicare since its inception to create new incentives for health care providers to deliver higher quality care at a lower cost. Under the direction of the Centers for Medicare and Medicaid Services (CMS) Innovation Center, these policies — including Accountable Care Organization program, bundled payment, and primary care reforms — continue to evolve. Understanding whether these models are successful in reducing spending growth, and how they can be modified to achieve this goal, is central to the future of Traditional Medicare.
Center for Advancing Health Policy through Research
Traditional Medicare
Traditional Medicare is public health insurance that provides coverage to about half of the 62 million adults aged 65 and older who are covered by the federally-funded Medicare insurance program.
Recent News
Traditional Medicare plan holders have typically not had to wait for prior authorization before receiving medical treatment. CMS recently announced a new program to test prior authorization requirements for certain services in six states to root out fraud, waste and abuse. Jeffrey Marr highlights what’s needed to set up a well-functioning prior authorization system.
Modern Healthcare
Rural aid loophole: Urban hospital dual status sparks concerns
Another news article speaks on a study published in Health Affairs that reveals a sharp rise in urban hospitals reclassifying themselves as "rural" under Medicare rules, allowing them to access financial benefits intended for rural health providers. Researchers warn that this loophole could redirect billions in federal funds away from genuinely rural hospitals and urge policymakers to take corrective action.
Hundreds of large, urban hospitals have taken advantage of a 2016 policy change to classify themselves as both urban and rural, allowing them to access financial benefits meant for rural hospitals. Researchers warn that this loophole could divert billions in taxpayer funds away from actual rural communities and into already well-funded urban hospitals unless policymakers intervene.
This piece, authored by Hayden Rooke-Ley, argues that while the Trump administration’s One Big Beautiful Bill Act threatens to gut Medicaid funding by nearly $1 trillion over a decade, states still have powerful tools to protect coverage and even strengthen their healthcare systems. By capping inflated prices in the private insurance market and redirecting those savings to Medicaid—where every dollar is federally matched—states can blunt the impact of federal cuts, support vulnerable providers, and reduce systemic inequities.
Harvard Medical School
Hospital-SNF Integration and APM Participation
This article highlights a study published in JAMA Network Open that explores the impact of hospital-SNF (skilled nursing facility) integration on participation in alternative payment models (APMs), particularly focusing on the Bundled Payments for Care Improvement Advanced (BPCI-A) program. The findings reveal that while integration influences APM participation, the effects are complex, pointing to broader implications for healthcare systems.
Health Affairs Forefront
Are Changes To The Medicare Physician Fee Schedule Driving Value In US Health Care?
The Medicare Physician Fee Schedule is a cornerstone of U.S. healthcare policy, directly influencing how services are priced and covered. This Health Affairs blog delves into a brief analysis of the CY25 Physician Fee Schedule Proposed Changes and what impact it could have moving forward.