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.
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Key Dates
Department and Agencies
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