The Centers for Medicare & Medicaid Services (CMS) has announced the 2026 Medicare Advantage (MA) capitation rates and Part C and Part D payment policies. Following the release of the 2026 MA and Part D Advance Notice, CMS reviewed public comments before finalizing policies that project a 5.06% increase in MA payments to plans, equating to over $25 billion in 2026. Key updates include changes to growth rates, risk adjustment models, and Star Ratings. The Effective Growth Rate is set at 9.04%, reflecting updated Fee-for-Service (FFS) data. Additionally, CMS finalized the three-year phase-in of the 2024 CMS-HCC risk adjustment model for MA organizations and introduced a blended risk score for PACE organizations. Specific policies for Puerto Rico and updates from the Inflation Reduction Act of 2022 (IRA) are also included. For more details, refer to the official CMS announcement.
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