Executive Summary
As part of its mandate from the Congress, each June the Commission reports on potential improvements to Medicare payment systems and issues that affect the Medicare program, including changes to health care delivery and the market for health care services. The six chapters of our June 2026 report cover the following topics:
• Improving payment incentives in Medicare. We describe incentives in fee-for-service (FFS) Medicare, alternative payment models (APMs), and Medicare Advantage (MA) and challenges in improving them.
• The complexity of Medicare enrollment decisions for beneficiaries. We explore the complex coverage choices that beneficiaries must make during initial and subsequent Medicare enrollment periods as well as the various resources available to help make those decisions.
• Medicare payment operations and their role in identifying improper payments. We detail the processes for making payments to Medicare providers and the measures in place to identify and reduce improper payments and fraud.
• Estimated association between MA enrollment and hospitals’ and post-acute care providers’ finances. We examine how changes in MA enrollment are associated with the finances of various health care providers, including hospitals, skilled nursing facilities (SNFs), home health agencies (HHAs), and inpatient rehabilitation facilities (IRFs).
• Access to hospice and certain complex palliative services for beneficiaries with end-stage renal disease or cancer. We describe potential approaches to improve the accuracy of Medicare’s hospice payments and address potential concerns about access to certain complex palliative services for hospice beneficiaries.
• Mandated report: Assessment of the Medicare Ground Ambulance Data Collection System. We assess and analyze information recently collected by CMS from ground ambulance service providers and recommend the continued collection of such data, though with a more streamlined approach to focus on data essential to assessing the accuracy of Medicare payments and Medicare beneficiaries’ access to care.
Excel files of the data underlying the figures in the chapters of this publication are available for download. Excel files are provided when the data are not otherwise shown or labeled in the chapter.