Summary
The Centers for Medicare & Medicaid Services (CMS) has proposed updates to Medicare Advantage and Part D policies for 2027. The changes include adjustments to how payments are calculated, updates to risk adjustment systems, and modifications to the star ratings system used to evaluate plans.
Key Facts
- CMS proposed a 0.09% average increase in Medicare Advantage payments for 2027, totaling over $700 million, considering changes in how patients are coded.
- The current risk-adjustment system will use newer health and cost data to better align payments with actual health risks.
- Diagnoses from paperwork not tied to real doctor visits will no longer be counted for payment calculations starting in 2027.
- Updates to the star ratings system include clarifying rules and specifying which performance measures count towards scores.
- The proposal aims to ensure affordable and reliable benefits for beneficiaries while reducing reliance on non-clinical coding practices.
- Stakeholders can submit comments on the proposed changes until February 25, 2026, with final announcements set for April 6, 2026.
