CMS’ Medicare Benefit Policy Manual
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…
While health plans generally welcome the payment increase, some organizations representing medical providers have expressed concerns about potential disparities in payment distribution.
Today, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Advance Notice for the Medicare Advantage (MA) and the Medicare Part D Prescription Drug Programs that would update payment policies for these programs. This release complements the Contract Year 2026 MA and Part D proposed rule that CMS released in November 2024.
Each year, CMS is required to update MA payment rates and regularly conducts technical updates to make improvements needed to keep MA payments up-to-date and accurate. CMS makes technical updates and improvements through the proposed Advance Notice and final Rate Announcement process for this purpose. Per statute, the Rate Announcement must be released by the first Monday in April, which is April 7, 2025. If finalized, the proposed policies in the CY 2026 Advance Notice are projected to result in a net increase of 4.33%, or over $21 billion, in MA payments to plans on average year-over-year in CY 2026.
CMS releases proposed 2026 payment Policy updates for Medicare Advantage and Part D programs | CMS. (2025, January 17). https://www.cms.gov/newsroom/press-releases/cms-releases-proposed-2026-payment-policy-updates-medicare-advantage-and-part-d-programs
2026 Medicare Advantage and Part D Advance Notice Fact Sheet | CMS. (2025, January 17). https://www.cms.gov/newsroom/fact-sheets/2026-medicare-advantage-and-part-d-advance-notice-fact-sheet
Rowan, K. (2025, January 23). Medicare Advantage Increase for Payers, not Providers. The Rowan Report. https://www.therowanreport.com/2025/01/23/medicare-advantage-increase/
Siddiqi, Z. (2025, January 13). As CMS proposes 4.33% Medicare advantage pay increase, experts see better negotiation outlook for nursing homes. Skilled Nursing News. https://skillednursingnews.com/2025/01/as-cms-proposes-4-33-medicare-advantage-pay-increase-experts-see-better-negotiation-outlook-for-nursing-homes/
Hammel, N. (2025, February 10). CMS releases proposed 2026 MA payment policy updates. https://www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Releases-Proposed-2026-MA-Payment-Policy-Updates.aspx
Gain clarity on the Medicare Advantage payer rates and contract terms bogging down your team and affecting reimbursements.
