Medicare Advantage Plans Face 2026 Policy Overhaul and Tweaks
Published Date: 4/15/2025
Rule
Summary
Starting in 2026, Medicare Advantage, Part D drug plans, cost plans, and PACE programs will see updates to improve drug coverage, payment rules, and special plans for people with both Medicare and Medicaid. These changes also include new ways to rate plan quality and put some drug price negotiations into action. If you’re enrolled or work with these programs, expect smoother services and some new deadlines to keep an eye on.
Analyzed Economic Effects
6 provisions identified: 5 benefits, 0 costs, 1 mixed.
Changes to Prescription Drug Coverage
Starting in 2026, Medicare Part D prescription drug coverage rules are updated to improve how drugs are covered. If you have Medicare drug coverage, these rule changes could change what drugs are covered and how your plan handles them.
Updates for Dual-Eligible Special Needs Plans
Starting in 2026, rules for dual eligible special needs plans (D-SNPs) are updated. If you have both Medicare and Medicaid and are in a D-SNP, these updates affect those special plans that serve people with both coverages.
Medicare Drug Price Negotiation Moves Forward
Starting in 2026, this rule implements parts of the Medicare Drug Price Negotiation Program so some negotiated drug prices are put into action. If you get drugs through Medicare, negotiable prices may affect what you pay for certain medications.
Updates to Medicare Cost Plans and PACE
Starting in 2026, Medicare cost plans and Programs of All-Inclusive Care for the Elderly (PACE) are revised. If you are an older adult in a PACE program or enrolled in a Medicare cost plan, these changes affect those programs and how they operate.
Medicare Prescription Payment Plan Changes
Starting in 2026, the rule changes how the Medicare Prescription Payment Plan works and updates payment rules related to prescriptions. If you get medications through Medicare plans, these payment rule changes may affect how payments are arranged or passed through plans.
Changes to Part C and D Star Ratings
Starting in 2026, the rule revises how Medicare Advantage (Part C) and Part D plans are rated with updated Star Ratings. If you choose or compare Medicare plans, you may see different plan quality ratings under the new rules.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-10890 — Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
Starting July 1, 2026, Medicare is updating the Increasing Organ Transplant Access (IOTA) Model to help kidney transplant hospitals do even better at getting more people transplanted and improving care quality. These changes affect hospitals involved in kidney transplants and aim to make the process smoother and more effective, with new payment rules that reward success. This update is part of a 6-year plan running through 2031 to save more lives and boost patient experience.
2026-10292 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
This proposed rule changes how states can pay Medicaid managed care plans and certain doctors to make sure payments are fair, efficient, and encourage enough providers to offer quality care. It affects states, Medicaid managed care organizations, and targeted Medicaid practitioners, aiming to keep payments balanced and services available. Comments on these changes are open until July 21, 2026, so stakeholders have time to weigh in before it’s finalized.
2026-10050 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
Starting in 2027, health insurance plans on federal and state marketplaces will see new rules to make coverage fairer and easier to use. These changes affect insurance companies, agents, and people buying plans, including new fees, penalties, and better protections for those with hardships. Expect updates on plan quality, dental coverage limits, and longer-term catastrophic plans, all aiming to keep your health coverage solid and affordable.
2026-07205 — Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges
This new rule will help Medicare, Medicaid, CHIP, and health plan companies share patient info more easily and speed up drug approval requests. It affects Medicare Advantage, Medicaid, CHIP, and health plans on federal exchanges, aiming to make care smoother and faster. These changes will start soon and could save time and money by cutting red tape.
2026-04797 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
2026-04467 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This correction fixes some missing labels in important tables from the 2027 health insurance rules under the Affordable Care Act. It mainly affects insurance companies and people using marketplace plans by clarifying how risk and payments are calculated. These fixes take effect right away on March 6, 2026, ensuring everyone has clear info before the 2027 plan year starts.
Previous / Next Documents
Previous: 2025-06315 — List of Approved Spent Fuel Storage Casks: NAC Multi-Purpose Canister (NAC-MPC) System, Certificate of Compliance No. 1025, Amendment No. 9, and Revision to Amendment Nos. 6, 7, and 8
The NRC is making official some updates to the NAC Multi-Purpose Canister system used to safely store spent nuclear fuel. These changes, effective May 13, 2025, include a new amendment and tweaks to previous ones, helping keep storage safe and up to date. Nuclear facilities using this system should be ready for these updates, but no extra costs are expected.
Next: 2025-06320 — Modification to 2022 National Pollutant Discharge Elimination System (NPDES) Construction General Permit (CGP) for Stormwater Discharges From Construction Activities
The EPA just updated its 2022 Construction General Permit to cover construction projects on all federal lands where it’s in charge. This change clears up rules after a recent Supreme Court decision and makes sure projects in these special areas follow the right stormwater discharge guidelines. If you’re working on construction in federal lands, this update affects you now—no extra fees, just clearer rules!