CMS Confirms Major Changes to Medicare Advantage Policies for 2026

The recent announcements from the Centers for Medicare & Medicaid Services (CMS) under the direction of CMS Administrator Dr. Mehmet Oz, signal significant forthcoming changes to the Medicare Advantage (MA) landscape, reflecting an interesting shift under the Trump administration.

These updates, notably approved in the CY 2026 Final Rule, aim at stabilizing the MA program amidst ongoing healthcare challenges, offering potential room for cautious enhancement of benefits previously cut due to economic pressures. 

Key changes include refined standards for inpatient hospital claims, protection against previous ad-hoc adjustments to approved admissions and prescriptions, and an increased oversight in handling the provision of care. Especially impactful, the implementation of integrated health risk assessments for dual Medicare and Medicaid enrollees by 2027 spearheads efforts to reduce healthcare fragmentation—a notable step towards streamlined beneficiary management.

In addition, CMS has decided not to extend Part D coverage for anti-obesity medications, a decision bound to influence future coverage discussions. While these amendments foster program stability, industry leaders and stakeholders should anticipate these regulatory updates requiring robust operational changes, hinting at a significant period of adjustment as insurers align with new compliance and performance standards. Overall, these regulations not only impact market dynamics but also aim at enhancing the quality of care for enrollees, underscoring the administration's goals of improving healthcare access and affordability while maintaining rigorous oversight.