Health and Tech Now weekly: Medicare cuts doctor pay 2.31% for 2027

This is this week’s Health and Tech Now weekly issue, sent Tuesday, Nov. 10, 2026. Get it in your inbox every Tuesday, free: subscribe on Substack.

Every source link below was reopened on Mon Nov 9, 2026 between 4:10 and 4:25 PM CT.

Opener

Medicare will pay most doctors 2.31% less per service in 2027. CMS set the main fee schedule conversion factor at $32.63, down from $33.40 (CMS fact sheet, Nov. 4, 2026). Home health and hospital outpatient departments get raises in the same round of final rules.

Roundup

Medicare pay. CMS cut the main 2027 physician fee schedule conversion factor 2.31%, to $32.63 from $33.40. Clinicians in qualifying advanced APMs get a 1.83% cut, to $32.95 (CMS fact sheet, Nov. 4, 2026). Starting April 1, 2027, approved ACOs can reduce or eliminate Part B cost sharing for assigned beneficiaries (HHS, Nov. 4, 2026). The home health final rule sets the national 30 day rate at $2,092.69, up from $2,038.22, and keeps a temporary 3% cut. CMS puts total home health spending up 2.4%, or $415 million (Federal Register, Nov. 9, 2026). Our stories: doctor pay and home health

Hospitals. The 2027 outpatient final rule raises rates 2.3%, which CMS says adds about $1.78 billion. It pays 340B hospitals for drugs at average sales price minus 28%. The 340B remedy offset cuts their other outpatient payments by 2.0 percentage points. CMS puts that at about $1.6 billion in 2027 (CMS final rule, filed Nov. 4, 2026). CMS also announced $10 billion in Year 2 Rural Health Transformation awards to all 50 states. Texas got the most, $282.0 million, and New Jersey the least, $142.3 million (CMS, Nov. 9, 2026). Our stories: 340B hospitals and rural awards

Drug pricing. A Nov. 5 final rule makes Medicare drug price negotiation permanent. CMS can pick up to 20 Part B and Part D drugs a year from 2029. The rule takes effect Dec. 5 (CMS fact sheet, Nov. 5, 2026). The 2029 list is due by Feb. 1, 2027 (CMS timeline, Nov. 2026). A drug given once, such as a gene therapy, counts as 12 thirty day supplies in the price math (final rule, filed Nov. 5, 2026). BIO, Biocom California and California Life Sciences sued on Nov. 6 to block GLOBE. The groups say the Part B model ties rebates to prices in 19 countries (BIO, Nov. 6, 2026). PhRMA sued on Oct. 7 (PhRMA, Oct. 7, 2026). GLOBE takes effect Nov. 30 (Federal Register, Oct. 2, 2026). Our stories: negotiation, gene therapy pricing and the GLOBE suit

Health insurers. CVS Health plans to split off about 9,000 pharmacies into a separate public company, CVS Pharmacy, in the first half of 2028. Aetna and Caremark stay with CVS Health (CVS Health, Nov. 4, 2026). Aetna’s medical benefit ratio fell to 91.3% from 92.8% in the third quarter (CVS Q3 results, Nov. 4, 2026). Humana raised its 2026 Adjusted EPS guidance to at least $9.50 from at least $9.00. Its Insurance segment benefit ratio was 93.7%, and individual Medicare Advantage members rose to 6.46 million from 5.24 million (Humana SEC filing, Nov. 6, 2026). Clover Health earned $6.4 million in the quarter, against a $24.4 million loss a year earlier. Its members rose 45% to 158,907 (Clover Health, Nov. 4, 2026). Our stories: CVS, Humana and Clover

Surprise billing. Insurers left nearly 30% of No Surprises Act arbitration awards unpaid since 2024. That comes from a New York Times analysis of 400,000 awards from billing firm HaloMD. Anthem’s unpaid share was 74%. The Labor Department is investigating Anthem’s unpaid awards, according to documents the Times obtained. The law lets regulators fine insurers $100 for each day an award goes unpaid. No fine has been issued (The New York Times, Nov. 3, 2026, syndicated Nov. 9). Our story

ACA agents. A federal judge in Maryland stayed CMS’s moratorium on new HealthCare.gov agent and broker registrations on Nov. 5. The order told CMS to open training by Nov. 6 (court order, D. Md., Nov. 5, 2026). The freeze had blocked about 19,000 licensed agents and brokers (NABIP, Nov. 5, 2026). CMS now lists plan year 2027 registration and training as live for new and returning agents (CMS, checked Nov. 9, 2026). Our story

Medicare Advantage. Nearly 400,000 Minnesotans, close to one in three people on Medicare in the state, will lose their Medicare Advantage plan for 2027. No Medicare Advantage plan will be sold in 15 counties, where Cost plans and Original Medicare remain. In Crow Wing, Lake of the Woods and Wadena counties, Original Medicare is the only option (Minnesota Attorney General, Nov. 2, 2026). Our story

Health tech and wearables. Apple’s redesigned Health app is in the iOS 27.3 developer beta. It reaches users as a free update later this year (Apple, Nov. 3, 2026). Users can book a $119 lab panel of more than 50 biomarkers at about 2,000 Quest Diagnostics sites (Apple, Sept. 9, 2026). Oura Ring 5 goes on sale at Ulta.com on Nov. 10 and in 1,000 Ulta Beauty stores on Nov. 22 (Oura, Nov. 9, 2026). WHOOP follows at select Ulta stores in March 2027 and cites Ulta’s 47 million loyalty members (WHOOP, Nov. 3, 2026). Hims & Hers now sells Lilly’s Foundayo from $149 a month and Zepbound from $299 a month (Lilly and Hims & Hers, Nov. 6, 2026). Our stories: Apple, Oura and WHOOP and Hims & Hers

What it means

Our read, drawn from the Roundup above.

For company leaders. The 2027 Medicare pay rules split providers. Doctors lose 2.31% on the conversion factor. Home health gets 2.4% in total and hospital outpatient rates rise 2.3%. The 340B remedy offset still takes about $1.6 billion from 340B hospitals. Contracts priced off Medicare rates move with these numbers on Jan. 1.

Drug price negotiation is now regulation, with up to 20 drugs a year from 2029. Drugmakers with Part B products face GLOBE on Nov. 30 unless a court stops it.

CVS will run Aetna and Caremark apart from its stores by 2028. Aetna’s benefit ratio fell 1.5 points, and Humana and Clover both grew Medicare Advantage membership.

The Times found Cigna, UnitedHealthcare and Aetna also left large shares of awards unpaid. Providers that win arbitration now have public numbers to cite when an insurer doesn’t pay.

For sellers. Medicare Open Enrollment ends Dec. 7. The new plan must get the request by then for coverage on Jan. 1 (Medicare.gov, checked Nov. 9, 2026). In Minnesota, nearly 400,000 people lose their Medicare Advantage plan. In three counties, Original Medicare is the only option, so clients there need a stand alone Part D plan for drug coverage. Expect calls from those clients first.

On the ACA side, agents who missed 2026 registration can now register for 2027 through CMS. New agents take the full Individual Marketplace course before they can sell. The court case is still open, and the parties propose next steps by Nov. 12.

Some clients will ask about the ACO change. Starting April 1, 2027, some ACOs can cut Part B cost sharing for their assigned patients.

For members. If your Medicare Advantage plan ends Dec. 31, your plan’s notice names the date. Pick new coverage by Dec. 7 to have it on Jan. 1. If you choose Original Medicare, add a Part D plan for drug coverage.

If you live in Crow Wing, Lake of the Woods or Wadena county in Minnesota, Original Medicare is the only option in 2027. Add a Part D plan by Dec. 7.

If your doctor is part of an ACO, ask whether it will cut your Part B cost sharing starting April 1, 2027.

Check plans on Medicare.gov or call 1-800-MEDICARE.

The number

74%. The share of No Surprises Act arbitration awards Anthem left unpaid since 2024. Across insurers the share is nearly 30%, in a New York Times analysis of 400,000 awards (The New York Times, Nov. 3, 2026).

The tracker

Plan Exit Watch. Medicare Advantage members in plans that end Dec. 31 and don’t roll into a 2027 plan, by state. Counts only, no carriers. New this week: Ohio, Washington and Oregon.

Source: CMS 2027 Plan Crosswalk (Oct. 1, 2026) and CMS enrollment by contract, plan, state and county (October 2026). County pages: Minnesota, Florida, New York, Texas, Ohio, Washington, Oregon, Maine, Illinois and Oklahoma.

Since last week

Stories we updated after new filings or facts came in. Each link goes to the updated story.

Labor rule makes PBMs disclose rebates, sees $22B in savings What changed: the final rule ran in the Federal Register on Nov. 2. It takes effect Jan. 4, 2027, and applies to plan years starting on or after July 1, 2027. Federal Register, Nov. 2, 2026.

Next week

• Nov. 10: the CMS CARE proposed rule publishes. CMS estimates about $320 million a year in provider savings. Comments are due 60 days after publication (Federal Register public inspection, filed Nov. 5, 2026).
• Nov. 12: the parties in the ACA agent cases propose a schedule for next steps (court order, Nov. 5, 2026).
• Nov. 15 to 18: HLTH USA in Las Vegas (HLTH).
• Nov. 30: the GLOBE model takes effect (Federal Register, Oct. 2, 2026).
• Dec. 5: the drug price negotiation final rule takes effect (CMS fact sheet, Nov. 5, 2026).

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Health and Tech Now is an independent publication. Views are not those of any employer. Public sources only. Every story links its primary source. Nothing here is medical, legal, financial or plan enrollment advice.