2026 Final Rule for Medicare Advantage Programs Released

MEDICARE ADVANTAGE RATES

Medicare Advantage programs are set to receive a 2.83% increase in the rates paid to them by the federal government, helping to support the healthcare needs of their beneficiaries.
 

REMOVALS/ADDITIONS FROM MEDICARE ADVANTAGE PLANS

They have also begun a three-year phase-in to remove medical education costs from Medicare Advantage plans. At the same time, they are completing a separate three-year phase-in of enhancements to the Medicare Advantage Risk Adjustment Model, which was finalized in 2024.
 

MEDICARE ADVANTAGE PART D

Alongside these changes, a new regulation has been introduced to redesign the Medicare Part D program. As part of the Medicare Advantage Rule and updates to the Risk Adjustment data we previously discussed, cost-sharing measures have been implemented for insulin and vaccines. Additionally, Medicare prescription payment plans have been introduced, allowing beneficiaries to spread out-of-pocket costs more evenly throughout the year, rather than facing large drug expenses in just one or two months. The regulation also addresses timely filing requirements for prescription drug event records.

Some of these changes may not seem directly relevant from a home health or hospice perspective, since they primarily focus on how Medicare Advantage plans deliver services and coverage to their members. However, it’s important to keep in mind that Medicare Advantage plans play a significant role in home health—now more than ever—and they’re here to stay. In fact, around 75% of Americans turning 65 today are choosing Medicare Advantage over traditional Medicare. There’s also a growing push toward the privatization of Medicare, which continues to expand the reach and influence of these plans.
 

MEDICARE ADVANTAGE OPEN ENROLLMENT

As you know, the Medicare Advantage Open Enrollment Period runs from October through December 7. However, that’s not the only opportunity beneficiaries have to change their coverage. At any point during the year, they can switch to a five-star rated Medicare Advantage plan—and in some cases, even move from one five-star plan to another.

It’s a situation many may prefer to overlook, but it simply can’t be ignored. Medicare Advantage plans must be addressed in most states—while not universal, the majority of states and counties have significant participation. In many areas, these plans make up over 30% of the market, with some counties seeing rates as high as 75%.

Therefore, if we intend to succeed in home health, this is a reality we must actively address. Healthcare Provider Solutions is here to support you—with experienced staff who can help you navigate the process of negotiating being in-network with Medicare Advantage plans, as well as assist in renegotiating your existing Medicare Advantage contracts. For assistance, please feel free to reach out to us.

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