Cms Plans 4.3% Medicare Advantage Payment Increase For 2026

The U.S. Centers for Medicare & Medicaid Services (CMS) in 2026 plans to raise payments to Medicare Advantage plans by 4.3% in 2026.

CMS has issued an advance notice of policy changes for Medicare Advantage and Part D that would install technical updates, including to the ways the agency calculates payments to health plans.

“CMS has worked to ensure that people with Medicare Advantage and Medicare Part D have access to stable and affordable offerings,” said CMS Administrator Chiquita Brooks-LaSure, in a statement. “Today’s Advance Notice continues CMS’ efforts to provide access to affordable, high-quality care in Medicare Advantage while being a good steward of taxpayer dollars. We are also continuing implementation of the Inflation Reduction Act, ensuring people with Medicare Part D have more affordable coverage for their medications.”

Many providers depend on MA payments to at least partially support their home health and other programs, including supplemental benefits palliative care, among others.

The changes are intended to continue CMS’s three-year phase-in of updates to the MA risk adjustment model and growth-rate calculation related to medical education costs. However, it will be up to the incoming Trump administration to bring these changes to fruition — if they so choose.

CMS expects to spend $9.2 trillion on MA payments to plans during the next 10 years — $1.3 trillion of those dollars represent rebates used for MA supplemental benefits and premium buy-downs. Without the proposed updates, CMS would make an estimated $10.4 billion in additional payments in 2026 that the agency has called “not necessary to support stability in the program.”

“The Advance Notice continues a data-driven approach that ensures MA payment is accurate, drives competition, and supports accountable care, shifting the focus to managing care and improving outcomes,” said CMS Deputy Administrator and Director of the Center for Medicare Dr. Meena Seshamani, in a statement.

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