Centers for Medicare & Medicaid Services

CMS scheduled the payment-year 2024 RADV medical-record submission window to open on September 18, 2026. Selected Medicare Advantage organizations must submit records and coversheets through the Centralized Data Abstraction Tool.

CMS made enrollee data lists available in CDAT for selected payment-year 2024 contract-specific RADV audits. The guidance set September 11, 2026, as the date for viewing and downloading the lists.

CMS made its second plan preview available from September 9 through September 15, 2026. The preview process includes draft cut points before official Medicare Advantage ratings are released.

With insurers having told investors which 2027 plans will end on December 31, members learn by letter in early October, leaving a window before open enrollment closes on December 7. Those whose plan is terminated get a guaranteed-issue right to buy Medigap if they return to Original Medicare, a protection lost if they simply pick another MA plan.

The Centers for Medicare & Medicaid Services issued payment-year 2024 RADV audit methods guidance. CMS said it had not decided whether it would collect extrapolated overpayments or only errors associated with sampled enrollees.

The U.S. District Court for the Southern District of Georgia denied Elevance Health's motion for a preliminary injunction over its Medicare Advantage star ratings. The court also denied the government's motion to dismiss the case.

CMS released the 2027 Part D national average bid and base beneficiary premium, $41.33, up from $38.99 in 2026, with the increase held to the Inflation Reduction Act's 6 percent-a-year premium stabilization limit. In the same release CMS said the Part D premium stabilization demonstration that had subsidised standalone drug plans in 2025 and 2026 would end, leaving plans to price the redesigned benefit on their own for 2027.

CMS filed a notice of appeal to the U.S. Court of Appeals for the Eleventh Circuit against the May ruling that it had exceeded its authority on ten star-ratings measures, according to Clover's 10-Q and a Becker's report citing a July 21 court filing; the appellate docket shows the case opened July 22. CMS had meanwhile recalculated Clover's rating to 4.5 stars and begun recalculating other 2027 quality-bonus ratings.

GAO found that CMS corrective-action plans were not sufficiently detailed and did not adequately monitor progress. The report addressed improper-payment and fraud risks in Medicare Advantage.

Elevance Health sued the Department of Health and Human Services and the Centers for Medicare & Medicaid Services over the recalculation of Medicare Advantage quality ratings. Elevance Health alleged that the recalculation did not align with the Clover Health ruling and affected $115 million in payments.

Representative Lloyd Doggett and 44 colleagues introduced the Saving MEDICARE Act. The bill addresses Medicare Advantage payments, coding, quality bonuses, and RADV audit oversight.

CMS issued guidance that it was voluntarily recalculating 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts. CMS said the recalculation resulted from the preceding court decision.

CMS informed Clover that it had recalculated Clover's 2026 Star Rating to 4.5 stars. CMS instructed Clover to submit alternate bids using the 4.5-star rating.

Elevance Health sent a $342.2 million wire payment to the Centers for Medicare & Medicaid Services in connection with a Medicare Advantage risk-adjustment enforcement matter. Court records reported that the wire transfer occurred on May 27.

A federal district court granted Clover Insurance partial summary judgment, holding that CMS exceeded its statutory authority in calculating ten star measures and skipped notice-and-comment on ten more, the second court in a year to upend the ratings. Humana cited the decision in its pending Fifth Circuit appeal a week later.

The final 2027 rate announcement raised the net payment update from 0.09 percent to 2.48 percent, about 4.98 percent once expected risk-score growth is counted, mainly by updating the effective growth rate with newer fee-for-service data. Plan stocks rallied, but the update still trailed the 5.06 percent of 2026 and medical-cost trends insurers said were running near 7 percent.

The contract-year 2027 rule dropped the planned health-equity reward in favour of the historical reward factor, removed a set of star measures including call-center tests and added a depression screening measure, codified the Inflation Reduction Act's Part D redesign, and eased marketing rules such as the 48-hour scope-of-appointment wait, effective October 1, 2026. CMS declined to finalise several beneficiary-protection proposals from the Biden era.

A Healthcare Dive analysis of CMS enrollment files showed 35.5 million people in Medicare Advantage in February 2026 versus 34.4 million a year earlier, growth of about 3 percent against a historical pace of up to 10 percent. UnitedHealthcare fell to just under 9.4 million from 10.3 million before open enrollment; Elevance, Centene and CVS lost 14, 4 and 3 percent of members; Humana was the big gainer.

CMS proposed a net average increase of just 0.09 percent, about $700 million, for 2027, its smallest in years, citing the star ratings, risk-adjustment trends and the continued phase-in of the 2024 risk model. Insurers and Wall Street read the notice as confirmation that 2027 benefits and footprints would shrink further.

Kaiser Permanente affiliates agreed to pay $556 million to resolve False Claims Act allegations that they submitted invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments, one of the largest risk-adjustment settlements to date. Kaiser said the agreement contains no admission of wrongdoing or liability.

CMS set the standard Part B premium at $202.90 a month for 2026, up $17.90 from $185, with the deductible rising to $283, citing projected price changes and higher use of services. For a retiree on the average benefit the premium increase took roughly a third of the $56 COLA, because Part B premiums are deducted from Social Security checks.

Judge Reed O'Connor ruled that CMS acted lawfully when it downgraded Humana's ratings on the strength of a few failed test calls to its customer service lines, dismissing the case with prejudice. The 2025 downgrade had pushed most of Humana's members out of four-star plans and cost it an estimated billion dollars or more in 2026 bonus revenue; Humana appealed to the Fifth Circuit in late November.

CMS posted the 2026 star ratings on the Plan Finder on October 9, 2025. About 207 MA-PD contracts, 40 percent, earned four or more stars, and the enrollment-weighted average rating edged up to 3.98 from 3.95. The ratings set the 2027 quality bonus payments that feed into the 2027 rate announcement.

Previewing the 2026 landscape, CMS said plans' own bids projected enrollment of 34 million, down from 34.9 million and from 50 percent of Medicare to about 48 percent, though the agency expected actual enrollment to hold up better. Average MA premiums were projected to fall from $16.40 to $14.00 a month, with 99 percent of beneficiaries still having access to a plan.

In Humana v. Becerra, the Northern District of Texas granted Humana summary judgment and threw out the 2023 final rule on procedural grounds, finding CMS had changed its justification for dropping the fee-for-service adjuster between proposal and final rule. The decision undercut the extrapolation behind the audit expansion announced in May; CMS appealed to the Fifth Circuit on November 21 and said audits would continue.

Administrator Mehmet Oz announced that Risk Adjustment Data Validation audits would cover all roughly 550 MA contracts annually instead of about 60, with coders expanded from 40 to about 2,000 and the backlog of payment years 2018 to 2024 to be completed by early 2026. CMS cited estimates of up to $17 billion a year in overpayments from unsupported diagnoses.

Two months into the Trump administration, CMS finalized the 2026 rate announcement with a net payment increase of 5.06 percent, more than double the 2.23 percent the Biden administration had proposed in January, largely by using more recent claims data. It followed the April 4 final rule that dropped Biden-era proposals such as covering anti-obesity drugs.