The Centers for Medicare & Medicaid Services (CMS) finalized an increase of the average benchmark payments to Medicare Advantage (MA) plans by 5.06%, or $25 billion, on Monday. It is nearly a three-percentage-point increase over the advance notice proposed in the waning days of the Biden administration and will be seen as favorable to payers. The CMS said this is due to the effective growth rate increase from 5.93% to 9.04% in the rate announcement.
Mehmet Oz, M.D., was confirmed on April 3 to become Administrator of the federal Centers for Medicare and Medicare Services (CMS). The Senate on Thursday confirmed Dr. Mehmet Oz, the celebrity TV doctor, 53-45 and along party lines to lead Medicare and Medicaid, which insure nearly half of all Americans. The future of both programs is the subject of fierce debate: Republicans are contemplating significant cuts to Medicaid, which provides health care to low-income Americans.
CMS has published its final rule for Medicare Advantage and Part D in 2026, outlining a series of regulatory updates aimed at strengthening consumer protections and improving care coordination across the Medicare Advantage and Part D programs. While the final rule solidifies several changes — including measures to streamline prior authorization, tighten oversight of supplemental benefits and codify provisions from the Inflation Reduction Act — CMS stopped short of addressing two of the most closely watched issues: expanding coverage for GLP-1s and regulating the use of AI in prior authorization. Those decisions have been deferred to future rulemaking.
Rural areas are quickly losing independent physicians and medical practices amid the corporatization of healthcare, a new report finds. The report was commissioned by the Physicians Advocacy Institute (PAI), a nonprofit advocacy organization focused on fair and transparent payment policies. The research, conducted by Avalere Health, used the IQVIA OneKey database, which contains physician and practice location information on health system ownership.
America’s Physician Groups (APG) has issued a report with detailed recommendations for reform suggestions for the Center for Medicare & Medicaid Services, including moving fully in the direction of accountable care in traditional Medicare and incentivizing two-sided risk payment arrangements between Medicare Advantage plans and physician groups. Its report, “Medicare Done Right: Prescriptions For Success,” observes, “healthcare costs continue to rise faster than the growth in the nation’s economy,” with affordability challenges for both beneficiaries and the nation.
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