The Centers for Medicare and Medicaid Services (CMS) recently released two major Medicare Advantage (MA) regulations, both of which have implications for Medicare Advantage and Part D (MAPD) plan payments, quality performance, and broader plan operations. The regulations include:
- Contract Year (CY) 2027 Medicare Advantage (MA) and Part D Final Rule (CMS-4208-F3/CMS-4212-F), which outlines regulation changes for Medicare Parts C and D (MAPD) programs.
- CY 2027 MAPD Rate Announcement, which finalizes changes to the payment policies of the MAPD programs.
CY 2027 MA and Part D Final Rule
The
Contract Year (CY) 2027 MA and Part D Final Rule finalized the removal of 11 Star Ratings measures as proposed and implemented mandatory Inflation Reduction Act (IRA) Part D changes. CMS also deregulated certain MA areas—including marketing and agent broker requirements—and finalized some supplemental benefits policies proposed in the CY26 MAPD proposed rule. The final rule highlights CMS’ move toward deregulation, simpler quality programs, and alignment with statutory changes under the Inflation Reduction Act of 2022.
CY 2027 MA and Part D Rate Announcement
The
CY 2027 MA and Part D Rate Announcement is projected to increase MA payments by 2.48% (approximately $13 billion) from 2026 to 2027, up from the 0.09% increase estimated in the Advance Notice. CMS projects that coding pattern changes will raise MA risk scores, producing an additional 2.50% increase in payments. Taken together, CMS estimates a total payment increase of 4.98%.
CMS did not move forward with proposed changes that would have significantly updated the MA risk adjustment model and reduced payments in an effort to maintain market stability. However, it did finalize limits on which diagnosis sources can be used for risk adjustment to strengthen program integrity.
Please reach out to AHCA's Population Health Policy Analyst,
Rohini Achal or
Nisha Hammel, Vice President, Reimbursement Policy & Population Health with any questions.