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Rates surge to relief of Medicare Advantage (MA) plans On April 7, the Centers for Medicare and Medicaid Services (CMS) issued the 2026 Final Announcement for Medicare Advantage (MA) and Part D plans. This annual announcement outlines the rates and other technical rate-setting details for the coming year as well as the final Star measures and details for Star Year 2026. In addition, the notice outlines potential changes to Star and display measures moving forward. This blog covers the non-Star issues in the Final Announcement – largely rates for 2026. On Monday, I will publish a blog in conjunction with Lilac Software on the final announcement from the standpoint of Stars changes. This will detail all the final Star measure changes, updates, and information discussed in the 2026 final MA and Part D Rule (released April 4) and the April 7 Final Announcement. 2026 MA rate proposal When the outgoing

Trump administration does not adopt much of Biden’s proposed 2026 rule As expected, the Trump administration has finalized some but not all of the former Biden administration’s massive proposed 2026 Medicare Advantage (MA) and Part D rule it issued in late November shortly before Biden’s term ended. In many ways, the proposed rule from Biden was a shot across the bow to Trump, laying out Biden’s views on key policy issues within MA and Part D. As is customary, succeeding administrations tend to scrutinize rules proposed or finalized late in the previous administration’s term and usually rescind, change, or modify proposals. This is because of philosophical differences as well as the sheer volume of rules that a new administration needs to go through in the first few months of settling in to govern. It is clear in the final rule for 2026 MA and Part D that the new Trump

The GOP’s annoyance regarding benefit and coverage rich states could drive some budget reconciliation cuts President Donald Trump and GOP leaders in Congress have seemingly ruled out or at least backed away from major changes to Medicaid that would impact coverage. And sentiment seems to be turning away from deep Medicaid cuts. The House’s large GOP budget reconciliation healthcare spending reduction bogey is being challenged by the Senate, which has drafted a reconciliation framework with reductions that would be much smaller. But many GOP leaders and conservative think tanks still want to rein in the program. Conservatives don’t love Medicaid. Their philosophy is that it is a handout. In their minds, healthcare is a commodity — something you budget for and earn over time as your income climbs. If they were to cover someone’s illness, it is done behind the scenes (through Medicaid slush funds to powerful hospitals in big

There is no question the size of government and workforce needs to be pared, but the outright attacks on and ongoing insinuation about the role of federal workers is troubling. Many of you wrote in to thank me for my dispassionate take on President Trump and his assertion of executive power on his return to office. As always, I appreciate the comments and reactions. Many of you felt I put what was occurring in context with what other presidents have done on both sides of aisle. As well, you appreciated the balanced assessment of what was happening. In that blog, I concluded that, while some of what Trump was asserting is not unreasonable, the speed and scattershot nature of the endeavors were issues and that major fallout could occur on many fronts, including on services to Americans. You can see that full blog here:  https://www.healthcarelabyrinth.com/trump-tests-limits-of-power-by-stretching-article-2-of-the-constitution/ . If you prefer podcasts,

Are the doubters or supporters right about Medicare Advantage? The Cigna Group officially closed its $3.3 billion sale of its Medicare lines of business to Health Care Service Corporation (HCSC) on March 19. The deal includes Medicare Advantage (MA) lives, Medicare Part D lives, its Medicare supplement business, and its CareAllies physician entity. HCSC jumps to 950,000 members from about 240,000 members as of March 1, 2025. It is a phenomenal development for HCSC, a mutual non-profit Big Blue in the Midwest. It is now the seventh largest MA plan by membership. If you look at the old Cigna enrollment and the old HCSC enrollment, they largely do not overlap and HCSC now has a nice national MA footprint. What does this tell us about MA? But what does this big MA life sale tell us about the industry and its perceived value to insurers? The sale certainly shows a

SNPs are seeing huge growth despite the financial crisis hitting MA The Medicare Advantage (MA) industry is going through very tough financial times. A variety of factors, including rate cuts, an increase in utilization, and a new risk scoring model, forced plans to reduce benefits and exit many geographies in 2024 and 2025. Even a proposed slight increase in rates in 2026 (unless changed by the new Trump administration) will likely lead to more benefit reductions and contraction in 2026. What MA plans did was shed unprofitable geographies and products, including more rural and suburban areas of the country and certain more-expensive preferred provider organization (PPO) products. But along the way, MA plans have doubled down on Special Needs Plan (SNP) investments. The investment in SNPs is driven by a few factors: So, SNPs offer MA plans the ability to improve health outcomes while also registering a healthy margin. But

February to March enrollment grows after dismal enrollment season In a February 27 blog, I detailed the growth in Medicare Advantage (MA) from January 2024 to February 2025 after a long delay from the Centers for Medicare and Medicaid Services (CMS) in posting the annual data. As I noted, the January enrollment statistics were up for a short time only to be taken down due to errors and presumably the transition in the White House. As I explained in the blog, the final January data still did not seem quite right, so I compared January 2024 to February 2025 instead. To summarize, the statistics show some of the financial struggles the industry continues to have. Growth is way down compared with prior years in the 2020s due to major geographic contractions as well as plan benefit reductions by major MA players. As the chart below shows, January 2024 to February

Dr. Mehmet Oz’s confirmation hearing shows where the Trump administration is going on Medicare drug prices and Medicare Advantage (MA). The confirmation hearing last week of Dr. Mehmet Oz, who is slated to be administrator of the Centers for Medicare and Medicaid Services (CMS) is a lesson in changing political dynamics. It also tells us that sometimes the people most supportive of a given program may be most apt to reform it. Let’s break down what occurred at Oz’s confirmation hearing in front of the Senate Finance Committee. What is interesting is that many of the lawmakers on Finance are also members of the other healthcare committee of cognizance, the Health, Education, Labor, and Pensions (HELP) committee. We cannot touch all of the ground covered at the hearing in this blog, but let’s hit the top issues and why in most cases Oz’s responses run contrary to what we may

The Health Equity Index (HEI) replaces the Reward Factor for Star Year 2027. Will the complex initiative last under Donald Treump’s anti-DEI campaign? Note: Published in collabortion with Lilac Software. If you are in need of Medicare Advantage (MA) Stars technology and expertise, visit https://lilacsoftware.com . The Health Equity Index (HEI) is officially here. Why? Well, it replaces the Reward Factor in the Medicare Advantage (MA) Star bonus prorgam for Star Year (SY) 2027, but we are smack in the middle of the measurement years that help MA plans to qualify for the new reward. Why is that? Because as opposed to measure performance, the HEI is a blend of two years of data and lags the usual measurement period a bit more. In the case of SY 2027, the HEI measurement period is a blend of measurement years (MY) 2024 and 2025. The Centers for Medicare and Medicaid Services

Reining in provider taxes is not an unreasonable way to achieve some Medicaid savings As the House Energy and Commerce Committee begins its debate over Medicaid cuts to hit an $880 billion spending cut bogey, the issue of provider taxes is sure to be raised and galvanize a great deal of controversy. GOP leaders in each chamber and President Trump have given commitments publicly that Medicaid coverage will not be cut. That seems to take off the spending cut table a massive restructuring of Medicaid (maybe, as some rightists still want this) as well as overt reductions in percentage reimbursement to states (maybe, again some rightists still want this). But the GOP is arguing that it will take a bite out of the size of Medicaid by eliminating fraud, waste, and abuse (FWA). Whether you use estimates by government authorities or external think tanks, the FWA and imporer payments numbers