The Centers for Medicare & Medicaid Services (CMS) has released the Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. The finalized policies are expected to increase MA payments by 5.06%, totaling over $25 billion. Key updates include adjustments to growth rates, risk adjustment models, and Star Ratings measures.

The Effective Growth Rate for 2026 has risen to 9.04%, reflecting updated Medicare Fee-For-Service (FFS) data. CMS also finalized the full implementation of the 2024 CMS-HCC risk adjustment model for MA plans and introduced a blended risk score for PACE organizations to support their transition to encounter data submissions.

Part D updates align with the Inflation Reduction Act, including a $2,100 out-of-pocket threshold for catastrophic coverage, insulin cost caps, and no-cost adult vaccines. CMS also updated Part D risk adjustment models to reflect these changes and ensure accurate plan bids.

Star Ratings updates include disaster adjustments, measure refinements, and a focus on clinical care and patient outcomes. CMS continues to seek feedback on future enhancements to the Star Ratings program.

For more details, visit the CY 2026 Rate Announcement.