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The Centers for Medicare & Medicaid Services (CMS) is expected to finalize payment rates and policies for the 2026 Medicare Advantage (MA) and Part D programs in early April 2025. The January 2025 advance notice proposed a 2.23% average payment increase for MA plans, expected to rise to 4.33% with coding adjustments. Key determining factors of the final rate notice include the final growth rate, the ongoing phase-in of a new risk model, the normalization factor, and more. This +Insight delves into the details of these factors and their implications for the 2026 payment year.
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Read on as we explore the different pathways for NTAP eligibility, the associated criteria for each pathway, and the timeline and key dates to consider before applying.
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Congress is simultaneously pursuing two major initiatives involving government spending: funding/appropriations and budget reconciliation.
Download our cheat sheet that describes both initiatives and includes a comparison table to help you understand and follow these bills as Congress continues its work.
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In this +Insight, we review and categorize recent Medicare site-neutral policy proposals and suggest considerations to guide analysis of these policies’ potential impact.
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Policy changes under the Trump administration could reshape value-based care models, payment structures, and participation requirements. Our latest +Insight explores the current landscape and potential changes, highlighting opportunities and challenges.
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This +Insight provides an overview of Medicaid restructuring options, what those policies could entail, and their potential impact on state budgets and continued health coverage for millions of Americans enrolled in Medicaid today.
