The Trump administration’s final rule brought significant changes to Medicare Advantage (MA) plans for 2026, This rule increases capitation rates for MA plans by 5.1%, which is a substantial boost for health insurers and is expected to accelerate the growth of MA enrollment.
While the rule offers a win for skilled nursing facilities by restricting MA plans’ ability to modify previously approved inpatient hospital decisions, it notably removes proposed safeguards concerning the use of artificial intelligence (AI) in coverage decisions. This decision regarding AI is a departure from the Biden administration’s earlier proposals and leaves concerns about algorithmic biases unaddressed, despite widespread interest in the regulation of AI in healthcare. These changes are anticipated to benefit senior living operators by potentially increasing revenue opportunities through MA partnerships and advancing value-based care models.
Christman, A. (2025, May 6). How CMS’ recent capitation rate increase could accelerate Value-Based Care, MA in Senior living. Senior Housing News. https://seniorhousingnews.com/2025/05/05/how-cms-recent-capitation-rate-increase-could-accelerate-value-based-care-ma-in-senior-living/
Christman, A. (2025, April 10). New Medicare advantage Capitation rate increase could accelerate senior living’s Value-Based care movement. Senior Housing News. https://seniorhousingnews.com/2025/04/10/new-medicare-advantage-capitation-rate-increase-could-accelerate-senior-livings-value-based-care-movement/
Herman, B. (2025, April 8). Trump gives major lift to 2026 Medicare Advantage payments. STAT. https://www.statnews.com/2025/04/07/medicare-advantage-payment-rate-2026-cms-trump/
Siddiqi, Z., (2025, April 5). CMS rule fails to put restrictions on Medicare Advantage Plans’ AI use. Skilled Nursing News. https://skillednursingnews.com/2025/04/breaking-cms-rule-fails-to-put-restrictions-on-medicare-advantage-plans-ai-use/
Marselas, K. (2025, April 4). Final Medicare Advantage rule gives LTC providers win but removes key AI protections – McKnight’s Long-Term Care News %. McKnight’s Long-Term Care News. https://www.mcknights.com/news/breaking-final-medicare-advantage-rule-gives-ltc-providers-win-removes-key-ai-protections/
Easily track your competitors' payer rates, monitor Medicare Advantage payer trends and discover new markets.
