Medicare coverage determinations can influence the appropriate use of medical technology and the creation of better evidence to support clinical and health policy decisions. In this paper, the Urban Institute's Robert Berenson and co-authors Sean Tunis, Steve Phurrough, and Penny Mohr argue that the process for making coverage decisions in the Medicare program falls short of its potential to contribute to improved health outcomes for beneficiaries. The paper, funded by the Robert Wood Johnson Foundation, offers several achievable steps in five topic areas to improve the coverage process.