{
  "data_version": "1",
  "schema": "https://whatledto.com/data",
  "id": "centers-for-medicare-medicaid-services",
  "name": "Centers for Medicare & Medicaid Services",
  "kind": "regulator",
  "url": "https://whatledto.com/who/centers-for-medicare-medicaid-services",
  "description": "",
  "same_as": [],
  "timelines": [
    {
      "slug": "social-security-2027-cola",
      "title": "Social Security's Next Raise: From the 2.5% COLA to the 2027 Announcement",
      "url": "https://whatledto.com/events/social-security-2027-cola",
      "json": "https://whatledto.com/events/social-security-2027-cola.json",
      "role": "Sets Medicare Part B premiums, which are generally deducted from Social Security payments.",
      "entries": 1,
      "updated_at": "2026-10-14T14:48:41.575777+00:00"
    },
    {
      "slug": "medicare-advantage-2027",
      "title": "Medicare Advantage's Retreat: From the 2026 Rate Hike to the 2027 Plan Exits and Open Enrollment",
      "url": "https://whatledto.com/events/medicare-advantage-2027",
      "json": "https://whatledto.com/events/medicare-advantage-2027.json",
      "role": "Sets Medicare Advantage and Part D payment, plan, star-rating, marketing, and RADV audit policies.",
      "entries": 26,
      "updated_at": "2026-10-14T02:01:40.262749+00:00"
    }
  ],
  "entries": [
    {
      "timeline": "medicare-advantage-2027",
      "id": 1370,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n1370",
      "date": "2026-09-18",
      "date_precision": "day",
      "title": "CMS opens PY2024 RADV medical-record submission window",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Medicare Advantage",
        "RADV audits",
        "Centralized Data Abstraction Tool"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "medicare-advantage",
        "radv-audits",
        "centralized-data-abstraction-tool"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/files/document/radv-py2024-audit-methods-guidance.pdf",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2026-08-28",
          "quote": "MR submission window opens: September 18, 2026."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 1014,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n1014",
      "date": "2026-09-11",
      "date_precision": "day",
      "title": "CMS makes PY2024 RADV audit enrollee lists available",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Medicare Advantage",
        "RADV audits",
        "CDAT"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "medicare-advantage",
        "radv-audits",
        "cdat"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/files/document/radv-py2024-audit-methods-guidance.pdf",
          "outlet": "CMS",
          "published": "2026-08-28",
          "quote": "“EDL available in CDAT for viewing and downloading: September 11, 2026.”"
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 1011,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n1011",
      "date": "2026-09-09",
      "date_precision": "day",
      "title": "CMS opens second preview for preliminary 2027 star ratings",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Medicare Advantage",
        "Medicare Part D",
        "Star Ratings"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "medicare-advantage",
        "medicare-part-d",
        "star-ratings"
      ],
      "sources": [
        {
          "url": "https://www.documentcloud.org/documents/28613734-hpms-memo-for-second-plan-preview/",
          "outlet": "CMS memorandum via DocumentCloud",
          "published": "2026-09-08",
          "quote": "“The second plan preview will be available starting September 9, 2026 and will end on September 15, 2026 at 11:59 p.m. Pacific time.”"
        },
        {
          "url": "https://www.healthcaredive.com/news/medicare-advantage-stars-cutpoints-2027-cms/829963/",
          "outlet": "Healthcare Dive",
          "published": "2026-09-10",
          "quote": "“Earlier this week, the CMS released draft cutpoints, the thresholds the agency uses to convert MA plans’ quality and performance scores into a 1 to 5 star rating, as part of the preview process before regulators announce official results in early October.”"
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 636,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n636",
      "date": "2026-09-05",
      "date_precision": "day",
      "title": "Plan non-renewal letters are due by October 2; open enrollment runs October 15 to December 7",
      "summary": "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.",
      "type": "report",
      "entities": [
        "Humana",
        "UnitedHealthcare",
        "Aetna",
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "humana",
        "unitedhealthcare",
        "aetna",
        "centers-for-medicare-medicaid-services"
      ],
      "sources": [
        {
          "url": "https://247wallst.com/personal-finance/2026/09/05/insurers-have-already-told-wall-street-which-advantage-plans-die-on-december-31-members-are-the-last-to-know-and-the-letter-isnt-due-until-october-2/",
          "outlet": "24/7 Wall St.",
          "published": "2026-09-05",
          "quote": "Insurers spent the summer telling Wall Street exactly which Medicare Advantage plans are disappearing on December 31. Enrolled members get a letter in October, a closing enrollment window in December, and a rare legal protection most will never realize they… This post may contain links from our sponsors and affiliates, and Flywheel Publishing may receive compensation for actions taken through them."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 656,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n656",
      "date": "2026-08-28",
      "date_precision": "day",
      "title": "CMS defers decision on collecting extrapolated RADV overpayments",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "RADV audits"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "radv-audits"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/files/document/radv-py2024-audit-methods-guidance.pdf",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2026-08-28",
          "quote": "CMS has not yet decided whether it will collect extrapolated overpayment amounts or only overpayments associated with the sampled enrollees for these audits."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 655,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n655",
      "date": "2026-08-27",
      "date_precision": "day",
      "title": "Federal judge denies Elevance star-ratings preliminary injunction",
      "summary": "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.",
      "type": "legal",
      "entities": [
        "Elevance Health",
        "Department of Health and Human Services",
        "Centers for Medicare & Medicaid Services",
        "U.S. District Court for the Southern District of Georgia"
      ],
      "parties": [
        "elevance-health",
        "department-of-health-and-human-services",
        "centers-for-medicare-medicaid-services",
        "us-district-court-for-the-southern-district-of-georgia"
      ],
      "sources": [
        {
          "url": "https://docs.justia.com/cases/federal/district-courts/georgia/gasdce/2%3A2026cv00061/128226/45",
          "outlet": "U.S. District Court for the Southern District of Georgia order, reproduced by Justia",
          "published": "2026-08-27",
          "quote": "ORDER denying #34 Motion to Dismiss; denying #7 Motion for Preliminary Injunction."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 634,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n634",
      "date": "2026-07-28",
      "date_precision": "day",
      "title": "2027 Part D base premium set at $41.33 under the IRA's 6 percent cap",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/fact-sheets/medicare-part-d-2027-national-average-monthly-bid-amount-information",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2026-07-28",
          "quote": "For 2027, the base beneficiary premium will be $41.33."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 640,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n640",
      "date": "2026-07-21",
      "date_precision": "day",
      "title": "CMS files notice appealing Clover star-ratings ruling",
      "summary": "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.",
      "type": "legal",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Department of Health and Human Services",
        "Clover Health",
        "U.S. Court of Appeals for the Eleventh Circuit"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "department-of-health-and-human-services",
        "clover-health",
        "us-court-of-appeals-for-the-eleventh-circuit"
      ],
      "sources": [
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1801170/000180117026000200/clov-20260630.htm",
          "outlet": "Clover Health Form 10-Q",
          "published": "2026-08-05",
          "quote": "On July 21, 2026, CMS filed its Notice of Appeal of the district court's decision in the Stars Litigation with the United States Court of Appeals for the Eleventh Circuit."
        },
        {
          "url": "https://www.beckershospitalreview.com/legal-regulatory-issues/cms-appeals-clovers-medicare-advantage-star-ratings-win/",
          "outlet": "Becker’s Hospital Review",
          "published": "2026-07-22",
          "quote": "The case will now move to the U.S. Court of Appeals for the Eleventh Circuit, according to a July 21 court filing."
        },
        {
          "url": "https://litigationtracker.law.georgetown.edu/litigation/clover-insurance-company-v-department-of-health-and-human-services-et-al-2/",
          "outlet": "Georgetown Law Health Care Litigation Tracker",
          "published": null,
          "quote": "Date Filed July 22, 2026"
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 639,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n639",
      "date": "2026-07-21",
      "date_precision": "day",
      "title": "GAO finds gaps in CMS plans for RADV audits",
      "summary": "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.",
      "type": "report",
      "entities": [
        "U.S. Government Accountability Office",
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "us-government-accountability-office",
        "centers-for-medicare-medicaid-services"
      ],
      "sources": [
        {
          "url": "https://files.gao.gov/reports/GAO-26-107946/index.html",
          "outlet": "U.S. Government Accountability Office",
          "published": "2026-07-21",
          "quote": "CMS’s corrective action plans are not sufficiently detailed and do not adequately monitor progress."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 651,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n651",
      "date": "2026-07-01",
      "date_precision": "day",
      "title": "Elevance Health sues HHS and CMS over star-ratings recalculation",
      "summary": "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.",
      "type": "legal",
      "entities": [
        "Elevance Health",
        "Department of Health and Human Services",
        "Centers for Medicare & Medicaid Services",
        "Clover Health"
      ],
      "parties": [
        "elevance-health",
        "department-of-health-and-human-services",
        "centers-for-medicare-medicaid-services",
        "clover-health"
      ],
      "sources": [
        {
          "url": "https://docs.justia.com/cases/federal/district-courts/georgia/gasdce/2%3A2026cv00061/128226/45",
          "outlet": "U.S. District Court for the Southern District of Georgia order, reproduced by Justia",
          "published": "2026-08-27",
          "quote": "Plaintiffs filed the instant action on July 1, 2026."
        },
        {
          "url": "https://www.statnews.com/2026/07/02/elevance-lawsuit-medicare-advantage-star-ratings-clover/",
          "outlet": "STAT",
          "published": "2026-07-02",
          "quote": "Elevance Health has sued the U.S. government, alleging that federal efforts to recalculate its Medicare Advantage quality ratings didn’t align with a recent court ruling, costing the health insurer $115 million."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 650,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n650",
      "date": "2026-07-01",
      "date_precision": "day",
      "title": "Lloyd Doggett and colleagues introduce the Saving MEDICARE Act",
      "summary": "Representative Lloyd Doggett and 44 colleagues introduced the Saving MEDICARE Act. The bill addresses Medicare Advantage payments, coding, quality bonuses, and RADV audit oversight.",
      "type": "regulatory",
      "entities": [
        "Lloyd Doggett",
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "lloyd-doggett",
        "centers-for-medicare-medicaid-services"
      ],
      "sources": [
        {
          "url": "https://doggett.house.gov/media/press-releases/democrats-introduce-saving-medicare-act-stop-insurers-profiteering-medicare",
          "outlet": "Office of Rep. Lloyd Doggett",
          "published": "2026-07-01",
          "quote": "Today, U.S. Representative Lloyd Doggett (D-TX), Ranking Member of the House Ways & Means Health Subcommittee, joined by 44 colleagues, introduced the Saving Medicare Enrollees from Deceptive Insurers and Creating Ample Resources for Everyone (Saving MEDICARE) Act."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 638,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n638",
      "date": "2026-06-17",
      "date_precision": "day",
      "title": "CMS begins recalculating certain 2027 quality bonus ratings",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Clover Health"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "clover-health"
      ],
      "sources": [
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1801170/000180117026000166/clov-20260617.htm",
          "outlet": "Clover Health Form 8-K",
          "published": "2026-06-18",
          "quote": "On June 17, 2026, CMS issued updated guidance informing all Medicare Advantage Organizations that it was voluntarily recalculating the 2027 Quality Bonus Payment ratings for certain Medicare Advantage contracts as a result of the preceding decision."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 637,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n637",
      "date": "2026-06-09",
      "date_precision": "day",
      "title": "CMS recalculates Clover rating to 4.5 stars",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Clover Health"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "clover-health"
      ],
      "sources": [
        {
          "url": "https://www.sec.gov/Archives/edgar/data/1801170/000180117026000137/clov-20260609.htm",
          "outlet": "Clover Health Form 8-K",
          "published": "2026-06-10",
          "quote": "On June 9, 2026, CMS informed Clover that, consistent with the Court’s order, it has recalculated Clover's 2026 Star Rating as 4.5 Stars, and has instructed Clover to submit alternate bids at 4.5 Stars."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 646,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n646",
      "date": "2026-05-27",
      "date_precision": "day",
      "title": "Elevance Health wires $342.2 million to CMS",
      "summary": "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.",
      "type": "financial",
      "entities": [
        "Elevance Health",
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "elevance-health",
        "centers-for-medicare-medicaid-services"
      ],
      "sources": [
        {
          "url": "https://www.fiercehealthcare.com/payers/elevance-health-pays-342m-government-midst-billing-probe",
          "outlet": "Fierce Healthcare / KFF Health News",
          "published": "2026-06-26",
          "quote": "Elevance Health, which covers about 2 million people on Medicare, sent the money to the Centers for Medicare & Medicaid Services via wire transfer on May 27, court records show."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 631,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n631",
      "date": "2026-05-27",
      "date_precision": "day",
      "title": "Clover wins a ruling that CMS exceeded its authority on ten star-ratings measures",
      "summary": "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.",
      "type": "legal",
      "entities": [
        "Clover Health",
        "Centers for Medicare & Medicaid Services",
        "Humana"
      ],
      "parties": [
        "clover-health",
        "centers-for-medicare-medicaid-services",
        "humana"
      ],
      "sources": [
        {
          "url": "https://www.groom.com/resources/oh-my-stars-a-federal-court-again-upends-cmss-medicare-advantage-ratings/",
          "outlet": "Groom Law Group",
          "published": "2026-05-28",
          "quote": "On May 27, 2026, a federal district court granted partial summary judgment for Clover Insurance Company (“Clover”), holding that CMS exceeded its statutory authority in calculating ten Star Ratings measures and separately failed to satisfy notice-and-comment rulemaking requirements for ten other measures."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 630,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n630",
      "date": "2026-04-06",
      "date_precision": "day",
      "title": "CMS finalizes 2027 rates at 2.48 percent, over $13 billion, up from the near-zero proposal",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Mehmet Oz",
        "UnitedHealth Group",
        "Humana"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "mehmet-oz",
        "unitedhealth-group",
        "humana"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-rate-announcement",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2026-04-06",
          "quote": "The final policies in the CY 2027 Rate Announcement are projected to result in an increase of 2.48% or over $13 billion in payments to MA plans in CY 2027. When accounting for estimated risk score trend in MA due to factors such as population changes and coding practices, this amounts to a 4.98% increase."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 629,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n629",
      "date": "2026-04-02",
      "date_precision": "day",
      "title": "2027 final rule reshapes star ratings and rolls back 2023 marketing safeguards",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Mehmet Oz"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "mehmet-oz"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/fact-sheets/contract-year-2027-medicare-advantage-part-d-final-rule",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2026-04-02",
          "quote": "First, for the 2027 Star Ratings, CMS is not implementing the Excellent Health Outcomes for All reward (previously called the Health Equity Index reward) that was developed to incentivize improved performance for a subset of enrollees and will continue the historical reward factor that encourages consistently high performance for all enrollees across all quality measures."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 628,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n628",
      "date": "2026-02-24",
      "date_precision": "day",
      "title": "Enrollment data: MA grows only 3 percent to 35.5 million; UnitedHealthcare down 9 percent since October",
      "summary": "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.",
      "type": "report",
      "entities": [
        "UnitedHealthcare",
        "Humana",
        "Elevance Health",
        "Centene",
        "Aetna",
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "unitedhealthcare",
        "humana",
        "elevance-health",
        "centene",
        "aetna",
        "centers-for-medicare-medicaid-services"
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      "sources": [
        {
          "url": "https://www.healthcaredive.com/news/medicare-advantage-enrollment-2026-unitedhealth-humana-cms/812856/",
          "outlet": "Healthcare Dive",
          "published": "2026-02-24",
          "quote": "Almost 35.5 million people were enrolled in the privatized Medicare programs as of February, compared with about 34.4 million people in the same month last year, according to new government data."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 625,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n625",
      "date": "2026-01-26",
      "date_precision": "day",
      "title": "2027 advance notice proposes an almost flat 0.09 percent payment update",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
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        "Mehmet Oz"
      ],
      "parties": [
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        "mehmet-oz"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/press-releases/cms-proposes-2027-medicare-advantage-part-d-payment-policies-improve-payment-accuracy-sustainability",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2026-01-26",
          "quote": "If finalized, the proposed policies are projected to result in a net average year-over-year payment increase of 0.09%, or over $700 million in MA payments to plans in CY 2027."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 645,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n645",
      "date": "2026-01-14",
      "date_precision": "day",
      "title": "Kaiser Permanente affiliates agree to pay $556 million in FCA settlement",
      "summary": "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.",
      "type": "legal",
      "entities": [
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        "U.S. Department of Justice",
        "Centers for Medicare & Medicaid Services"
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      "parties": [
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        "us-department-of-justice",
        "centers-for-medicare-medicaid-services"
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      "sources": [
        {
          "url": "https://www.justice.gov/usao-ndca/pr/kaiser-permanente-affiliates-pay-556m-resolve-false-claims-act-allegations",
          "outlet": "U.S. Department of Justice",
          "published": "2026-01-14",
          "quote": "Affiliates of Kaiser Permanente, an integrated healthcare consortium headquartered in Oakland, California, have agreed to pay $556 million to resolve allegations that they violated the False Claims Act by submitting invalid diagnosis codes for their Medicare Advantage Plan enrollees in order to receive higher payments from the government."
        },
        {
          "url": "https://about.kaiserpermanente.org/news/allegations-related-to-medicare-risk-adjustment-resolved",
          "outlet": "Kaiser Permanente",
          "published": "2026-01-14",
          "quote": "The agreement resolves a False Claims Act lawsuit and has no admission of wrongdoing or liability."
        }
      ]
    },
    {
      "timeline": "social-security-2027-cola",
      "id": 378,
      "url": "https://whatledto.com/events/social-security-2027-cola#n378",
      "date": "2025-11-14",
      "date_precision": "day",
      "title": "Medicare Part B premium for 2026 jumps almost 10% to $202.90, eating into the COLA",
      "summary": "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.",
      "type": "announcement",
      "entities": [
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
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      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2025-11-14",
          "quote": "On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Medicare Part D income-related monthly adjustment amounts."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 624,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n624",
      "date": "2025-10-14",
      "date_precision": "day",
      "title": "Humana loses its second lawsuit over the 2025 star ratings, a day before open enrollment",
      "summary": "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.",
      "type": "legal",
      "entities": [
        "Humana",
        "Reed O'Connor",
        "Centers for Medicare & Medicaid Services"
      ],
      "parties": [
        "humana",
        "reed-oconnor",
        "centers-for-medicare-medicaid-services"
      ],
      "sources": [
        {
          "url": "https://www.healthcaredive.com/news/humana-medicare-advantage-star-ratings-lawsuit-dismissed-again/802739/",
          "outlet": "Healthcare Dive",
          "published": "2025-10-14",
          "quote": "A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment."
        },
        {
          "url": "https://www.healthcaredive.com/news/humana-appeals-medicare-advantage-star-ratings-case/806628/",
          "outlet": "Healthcare Dive",
          "published": "2025-12-01",
          "quote": "The insurer continues to try to prove that regulators acted arbitrarily in downgrading its quality scores for 2025, despite numerous setbacks in the courts to date."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 623,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n623",
      "date": "2025-10-09",
      "date_precision": "day",
      "title": "2026 star ratings: 40 percent of MA-PD contracts at four stars or better, covering 64 percent of enrollees",
      "summary": "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.",
      "type": "report",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Humana",
        "UnitedHealthcare",
        "Elevance Health"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "humana",
        "unitedhealthcare",
        "elevance-health"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/files/document/2026-star-ratings-fact-sheet.pdf",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2025-11-18",
          "quote": "Approximately 40% of MA-PDs (207 contracts) that will be offered in 2026 earned four stars or higher for their 2026 overall rating."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 621,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n621",
      "date": "2025-09-26",
      "date_precision": "day",
      "title": "CMS projects the first fall in Medicare Advantage enrollment, to 34 million, as 2026 plans are filed",
      "summary": "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.",
      "type": "report",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Mehmet Oz"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "mehmet-oz"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/press-releases/medicare-advantage-medicare-prescription-drug-programs-expected-remain-stable-2026",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2025-09-26",
          "quote": "Based on plans’ projections, enrollment in MA is projected to be 34 million in 2026, a decrease from 34.9 million in 2025, with MA enrollment representing approximately 48% of all people enrolled in Medicare, compared to 50% in 2025."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 620,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n620",
      "date": "2025-09-25",
      "date_precision": "day",
      "title": "Judge O'Connor vacates the 2023 RADV audit rule that let CMS extrapolate overpayments",
      "summary": "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.",
      "type": "legal",
      "entities": [
        "Humana",
        "Reed O'Connor",
        "Centers for Medicare & Medicaid Services",
        "U.S. District Court for the Northern District of Texas"
      ],
      "parties": [
        "humana",
        "reed-oconnor",
        "centers-for-medicare-medicaid-services",
        "us-district-court-for-the-northern-district-of-texas"
      ],
      "sources": [
        {
          "url": "https://www.statnews.com/2025/09/25/federal-judge-vacates-medicare-advantage-audit-rule/",
          "outlet": "STAT",
          "published": "2025-09-25",
          "quote": "A federal judge on Thursday vacated a Biden-era rule that would have allowed the government to intensify its audits of private Medicare plans and recoup billions of dollars in overpayments over the next decade. Judge Reed O’Connor of the Northern District of Texas granted health insurer Humana’s motion for summary judgment in its lawsuit challenging a Centers for Medicare and Medicaid Services’ final rule from 2023 that would have increased so-called “risk adjustment data verification,” or RADV, audits of Medicare Advantage plans, which verify that the diagnoses Medicare Advantage plans record for their members are supported in those members’ medical records."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 615,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n615",
      "date": "2025-05-21",
      "date_precision": "day",
      "title": "CMS says it will audit every Medicare Advantage contract every year and clear the 2018 to 2024 backlog",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Mehmet Oz"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "mehmet-oz"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/press-releases/cms-rolls-out-aggressive-strategy-enhance-accelerate-medicare-advantage-audits",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2025-05-21",
          "quote": "Today, the Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024."
        }
      ]
    },
    {
      "timeline": "medicare-advantage-2027",
      "id": 614,
      "url": "https://whatledto.com/events/medicare-advantage-2027#n614",
      "date": "2025-04-07",
      "date_precision": "day",
      "title": "CMS finalizes 2026 Medicare Advantage rates: a 5.06 percent increase, about $25 billion more for plans",
      "summary": "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.",
      "type": "regulatory",
      "entities": [
        "Centers for Medicare & Medicaid Services",
        "Mehmet Oz"
      ],
      "parties": [
        "centers-for-medicare-medicaid-services",
        "mehmet-oz"
      ],
      "sources": [
        {
          "url": "https://www.cms.gov/newsroom/press-releases/cms-finalizes-2026-payment-policy-updates-medicare-advantage-and-part-d-programs",
          "outlet": "Centers for Medicare & Medicaid Services",
          "published": "2025-04-07",
          "quote": "Today, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs that finalizes the payment policies for these programs."
        }
      ]
    }
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